Diagnostic Reliability of Optical Coherence Tomography Biomarkers for Postsurgical Success in Visual Acuity in Patients with Idiopathic Epiretinal Membranes. / Diagnostische Reliabilität von optischen Kohärenztomografie-Biomarkern für postoperativen Erfolg bei idiopathischen epiretinalen Membranen.

INTRODUCTION: Several optical coherence tomography (OCT) biomarkers for postsurgical success in patients with idiopathic epiretinal membranes (iERMs) have been described in single predictor analyses. The aim of this study was to assess the reliability of diagnosis of OCT biomarkers and to calculate their impact on postsurgical visual acuity by applying multiple regression analysis. METHODS: This retrospective study included patients scheduled for pars plana vitrectomy with membrane peeling for iERMs. Presurgical OCT scans were analyzed for the presence of OCT biomarkers by two reviewers. Intra- and interobserver reliability was calculated with the Kuder-Richardson 20 test. RESULTS: Among the 136 patients included, intra-/interobserver reliability of the OCT biomarkers was 0.89/0.70 for ectopic inner foveal layer (EIFL), 0.82/0.53 for disorganization of retinal inner layer (DRIL), 0.93/0.89 for intraretinal cystoid changes, 0.84/0.78 for alterations of the ellipsoid zone, 0.84/0.72 for cotton ball sign, 0.68/0.58 for hyperreflective foci, 0.55/0.47 for epimacular membrane rips (EMM-rips), and 0.87/0.60 for retinal contraction. Only DRIL and central subfield macular thickness (CMT) were significant predictors for BCVA 3 months after surgery in a multiple regression analysis. CONCLUSION: Intraobserver reliability of OCT biomarkers was higher than interobserver reliability, reflecting both clinical and grading experience with respect to OCT biomarker evaluation. DRIL and CMT were shown to be significant predictors in a multiple regression analysis, with potential for negative influence on final BCVA after vitrectomy with membrane peeling for iERMs.

Henle Fibre Layer Haemorrhage after a Valsalva Manoeuvre.

A male patient, 59 years of age, presented with sudden deterioration of visual acuity (VA) caused by a Henle fibre layer haemorrhage (HFLH) in our outpatient department. He reported being under treatment with acetylsalicylic acid and experienced a Valsalva manoeuvre before he observed reduced vision. Due to the impairment caused by the haemorrhage, disturbing the patient's daily activities, intravitreal injection of recombinant tissue plasminogen activator combined with SF6 and bevacizumab was offered. After this procedure, the HFLH disappeared, VA improved from 20/40 to 20/20 (Snellen) 3 months after treatment and a typical hyperreflective vertical line was seen in optical coherence tomography.