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      Foveal structure and vasculature in eyes with idiopathic epiretinal membrane

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          Abstract

          Purpose

          To examine the foveal structure and vasculature in eyes with an idiopathic epiretinal membrane (ERM).

          Methods

          Forty-nine eyes of 48 patients with an idiopathic ERM were studied. The superficial foveal avascular zone (FAZ) was measured by optical coherence tomography angiography (OCTA; RTVue XR Avanti, Optovue Inc., Fremont, CA), and the central foveal thickness (CFT) was measured by swept source OCT (DRI-OCT, Topcon, Japan). Twenty eyes underwent vitrectomy with internal limiting membrane (ILM) peeling, and the FAZ and CFT were evaluated pre- and postoperatively. Forty-nine eyes of 49 age-matched healthy subjects were also examined as control.

          Results

          The FAZ in eyes with an ERM was significantly smaller than that of the control eyes (0.188±0.16 mm 2 vs 0.328±0.14 mm 2, P<0.01). The CFT in eyes with an ERM was significantly thicker than that of control eyes (315±0.14 μm vs 193±0.14 μm, P<0.01). The size of the FAZ was strongly correlated with the CFT (ERM, R = -0.753; control, R = -0.61, both P<0.01). The postoperative size of the FAZ was not significantly different from the preoperative size (0.115 mm 2 vs 0.128 mm 2, P = 0.17) but the CFT was significantly thinner (370 μm vs 288 μm, P<0.01) after the vitrectomy with ILM peeling in 20 eyes.

          Conclusions

          The results indicate that an ERM might affect the morphology and vasculature of not only the inner but also the outer retina before and after vitrectomy with ILM peeling. The FAZ area might have been affected by the ILM peeling.

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          Most cited references12

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          CORRELATION OF FOVEAL AVASCULAR ZONE SIZE WITH FOVEAL MORPHOLOGY IN NORMAL EYES USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

          To analyze the foveal avascular zone (FAZ) in normal eyes using optical coherence tomography angiography.
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            Inner segment/outer segment junction assessed by spectral-domain optical coherence tomography in patients with idiopathic epiretinal membrane.

            To evaluate the anatomic features of the photoreceptor inner/outer segment (IS/OS) junction before and after surgery by spectral-domain optical coherence tomography in patients undergoing idiopathic epiretinal membrane (ERM) surgery and to correlate these features with the functional outcomes. Prospective, cohort study. We prospectively studied 45 eyes of 45 patients with idiopathic epiretinal membrane who had a preoperative visual acuity of 20/32 or less and were scheduled to undergo transconjunctival 25-gauge vitrectomy. The patients were divided into 2 groups based on the preoperative structural integrity of the IS/OS junction: the intact IS/OS junction group and the disrupted IS/OS junction group. Changes in the IS/OS junction and best-corrected visual acuity were compared between 2 groups before and at 3, 6, and 12 months after surgery. A total of 45 patients were recruited for this study. There were 34 eyes with an intact IS/OS junction (group 1) and 11 eyes with a disrupted or irregular IS/OS junction (group 2), as determined before surgery. Significantly better postoperative best-corrected visual acuity was seen in group 1 as compared with that in group 2 at 3, 6, and 12 months after the surgery (P < .001). Significant improvement of visual acuity was also seen in group 1 when compared to group 2 (P < .05). Of the 34 eyes in group 1, 17 (50%) showed disruption of the IS/OS junction at 3 months after surgery, although this disruption was only transient and resolved completely by 12 months after the surgery. However, none of the eyes from group 2 showed a normal appearance of the IS/OS junction at any time point during the study period of 1 year. The IS/OS junction can recover in eyes with preoperative intact IS/OS junction as assessed over a follow-up period of 1 year after surgery. Preoperative integrity of the IS/OS junction may be an important prognostic factor for better visual recovery and better improvement of the postoperative best-corrected visual acuity after epiretinal membrane surgery. Copyright © 2010 Elsevier Inc. All rights reserved.
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              High-resolution imaging of the photoreceptor layer in epiretinal membrane using adaptive optics scanning laser ophthalmoscopy.

              To compare, in eyes with an idiopathic epiretinal membrane (ERM), photoreceptor cell structural abnormalities identified on high-resolution images obtained by adaptive optics scanning laser ophthalmoscopy (AO-SLO) with the severity of metamorphopsia and anatomic findings on spectral-domain optical coherence tomography (SD-OCT). Observational case series. Twenty-five eyes of 24 patients with idiopathic ERM and 20 normal eyes of 20 volunteer subjects. All participants underwent a full ophthalmologic examination, SD-OCT, and imaging with an original prototype AO-SLO system that incorporated liquid crystal-on-silicon technology. In eyes with ERM, M-CHARTS results were used to quantify metamorphopsia. Cone mosaic patterns on AO-SLO images and metamorphopsia severity. In normal eyes, AO-SLO images showed a regular photoreceptor mosaic pattern. In 24 (96%) of 25 eyes with ERM, "microfolds" (multiple thin, straight, hyporeflective lines in the photoreceptor layer) were identified on AO-SLO images; microfolds were not seen in normal eyes. Individual microfolds were approximately 5 to 20 μm wide, which is narrower than retinal folds seen in fundus photographs (>50 μm). Amsler charts revealed metamorphopsia around the fixation point in 12 of 13 eyes with microfolds in the fovea on AO-SLO but in none of 5 eyes without microfolds in the fovea (P < 0.001). Compared with eyes without foveal microfolds, eyes with foveal microfolds had more severe metamorphopsia (M-CHARTS distortion) in both horizontal and vertical lines (P < 0.001 for both) and greater average foveal thickness detected by SD-OCT (P=0.010). Voronoi analysis revealed that smaller numbers of cones in eyes with ERM had 6 neighbors, compared with normal eyes (P < 0.001). In eyes with ERM, average foveal thickness measured by SD-OCT correlated with visual acuity (P=0.001) and metamorphopsia scores, both horizontal (P=0.002) and vertical (P < 0.001), but visual acuity, metamorphopsia scores, and average foveal thickness were not related to SD-OCT findings of disruption in the photoreceptor inner and outer segment junction. Adaptive optics scanning laser ophthalmoscopy images in eyes with ERM showed abnormal cone mosaic patterns, described as microfolds in the foveal photoreceptor layer. The presence of microfolds was associated with metamorphopsia, suggesting that microfolds may be involved in the formation of metamorphopsia. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                2 April 2019
                2019
                : 14
                : 4
                : e0214881
                Affiliations
                [001]Department of Ophthalmology, Tokyo Women’s Medical University, Shinjuku, Tokyo, Japan
                Sankara Nethralya, Medical Research Foundation, INDIA
                Author notes

                Competing Interests: The authors have no proprietary interest in any aspect of this paper. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

                Author information
                http://orcid.org/0000-0001-5647-6372
                Article
                PONE-D-18-36776
                10.1371/journal.pone.0214881
                6445520
                30939161
                3accc07c-fff2-4cf3-afa5-7fd83d2e4c83
                © 2019 Okawa et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 25 December 2018
                : 21 March 2019
                Page count
                Figures: 3, Tables: 0, Pages: 8
                Funding
                Dr. Okawa has nothing to disclose. Dr. Maruko reports grants from JSPS KAKENHI (Grant Number JP16K11274), grants and personal fees from Novartis Pharma K.K., personal fees from Bayer Yakuhin, Ltd., personal fees from Santen Pharmaceutical Inc., personal fees from Alcon Japan, Ltd., personal fees from Topcon Co., Ltd., personal fees from Senju Pharmaceutical Co., Ltd., personal fees from NIDEK Co., Ltd., outside the submitted work. Dr. Kawai has nothing to disclose. Dr. Hasegawa has nothing to disclose. Dr. Arakawa has nothing to disclose. Dr. Iida reports grants and personal fees from Novartis Pharma K.K. (Japan), personal fees from Bayer Yakuhin, Ltd. (Japan), grants and personal fees from Santen Pharmaceutical Co., Ltd. (Japan), grants from Nidek, research support from Chuosangyo (Japan), outside the submitted work. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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