Longitudinal Change in Retinal Nerve Fiber Layer Thickness and Its Association With Central Retinal Sensitivity After Epiretinal Membrane Surgery.

PURPOSE: To investigate the longitudinal changes in the peripapillary retinal nerve fiber layer (pRNFL) thickness after epiretinal membrane (ERM) vitrectomy with internal limiting membrane (ILM) peeling, examine associations between pRNFL thickness and central retinal sensitivity, and identify predictors of postoperative pRNFL thickness. DESIGN: Prospective, observational, cohort study. METHODS: This study enrolled 82 eyes of 82 Japanese patients that underwent surgery for unilateral idiopathic ERM, with their fellow eyes as controls. pRNFL thickness was measured in 4 (superior, temporal, inferior, and nasal) quadrants preoperatively and at 1, 3, 6, and 12 months postoperatively. Microperimetry was performed at 12 months postoperatively to evaluate central retinal sensitivity. Regression tree analysis was performed to predict pRNFL thickness at 12 months postoperatively. RESULTS: The temporal quadrant showed continuous pRNFL thinning after surgery, reaching statistical significance at 3, 6, and 12 months postoperatively (all P < 0.001). The pRNFL thicknesses in the fellow eyes significantly increased at all postoperative time points (all P < 0.001). At 12 months postoperatively, the average central retinal sensitivity was significantly correlated with the temporal pRNFL thickness in the eyes with ERM (r = 0.372, P < 0.001); no significant correlation was found in the fellow eyes. Regression tree analysis showed that the preoperative pRNFL thickness in the temporal quadrant and patient age were the main determinants of the temporal pRNFL thickness at 12 months postoperatively. CONCLUSIONS: The risk of deterioration of central retinal sensitivity after ERM vitrectomy with internal limiting membrane peeling should be considered for patients with thin temporal pRNFLs and older adults.

Prediction of Visual Prognosis after Epiretinal Membrane Surgery Using Regression Tree Analysis.

Background and Objective: Confounding factors should be considered when predicting visual prognosis after epiretinal membrane (ERM) surgery. We aimed to predict visual acuity after ERM surgery using regression tree analysis.Patients and Methods: We retrospectively reviewed 343 eyes of 343 patients who underwent vitrectomy for idiopathic ERM. Regression tree analysis was performed to predict best-corrected visual acuity (BCVA) at 6 months postoperatively.Results: Patients were first divided into two groups based on preoperative BCVA. Age, central macular thickness, and axial length were associated with visual prognosis in patients with specific preoperative BCVAs. When patients were subdivided into groups 1-8, BCVA was significantly better in group 1 than in groups 4-8 (p≤0.001), and in groups 2-5 and 7 than in groups 6 and 8 (p≤0.002).Conclusion: Surgical prognosis in eyes with ERM should be evaluated based on a comprehensive assessment of preoperative characteristics.

Impact of asteroid hyalosis on internal higher-order aberrations in eyes with cataract accompanied by acoustic shadows on swept-source optical coherence tomography examination.

Increased internal higher-order aberrations (HOAs) have been reported in eyes with asteroid hyalosis, which is usually asymptomatic. This report describes 2 patients with cataract and concurrent asteroid hyalosis. In the first case, internal HOAs were within the normal range, and swept-source optical coherence tomography (SS-OCT) did not show acoustic shadows. After cataract surgery, visual acuity improved and internal HOAs remained within normal limits. However, in the second case, SS-OCT revealed multiple acoustic shadows, presumably due to asteroid hyalosis, and internal HOAs increased in both eyes. After combined vitrectomy and cataract surgery, visual acuity and the internal HOA values improved in both eyes, and acoustic shadows disappeared on SS-OCT. Phacovitrectomy should be considered if the cause of visual impairment is cataract and asteroid hyalosis. Objective assessment of internal HOAs by a wavefront sensor and checking for acoustic shadows on SS-OCT might be useful in detecting this combination of ophthalmic conditions.

Anatomical and functional changes in paravascular abnormalities after epiretinal membrane removal.

PURPOSE: To investigate the anatomical and functional changes in areas containing paravascular abnormalities (PVA) in eyes with epiretinal membrane (ERM) after surgery. METHODS: Twenty-eight eyes with concurrent idiopathic ERM and PVA were enrolled in this prospective study. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and areas of PVA in the superficial and deep capillary levels detected on en face optical coherence tomography were measured preoperatively and 1, 3, and 6 months postoperatively. Retinal sensitivity in selected PVA lesions was evaluated by microperimetry preoperatively and 1 and 6 months postoperatively. RESULTS: The areas of PVA at the superficial capillary level before and 1, 3, and 6 months after surgery measured 1.65 ± 1.27, 0.44 ± 0.62, 0.40 ± 0.64, and 0.38 ± 0.62 mm2, respectively, while those at the deep capillary level measured 0.27 ± 0.57, 0.10 ± 0.26, 0.09 ± 0.29, and 0.05 ± 0.15 mm2, respectively. The areas of PVA in the superficial and deep capillary levels were significantly smaller postoperatively (all p < 0.001 at the superficial capillary level and p = 0.010 at the deep capillary level). Average retinal sensitivity values in the PVA lesions before and 1 and 6 months after surgery were 11.2 ± 3.5, 12.9 ± 3.2, and 13.2 ± 2.7 dB, respectively; the values at postoperative months 1 and 6 were significantly improved (p = 0.045 and p < 0.001, respectively). BCVA and CMT were significantly improved postoperatively. CONCLUSION: PVA not only improves anatomically but also functionally after ERM surgery. Vitrectomy can improve not only central vision but also retinal sensitivity in areas of PVA.