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Surgery for Idiopathic Epimacular Membrane: Morpho-Functional Outcomes Based on the Preoperative Macular Integrity of the Photoreceptoral Junction. A Prospective Pilot Study

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Abstract

Introduction

This study aimed to evaluate whether the preoperative integrity of the inner segment (IS) and outer segment (OS) photoreceptoral junction may influence the postoperative visual acuity, the macular morphology [assessed by spectral domain optical coherence tomography (SD-OCT)], and macular function (evaluated by multifocal electroretinogram, mfERG) in patients with idiopathic epimacular membrane (EMM) followed up for 6 months.

Methods

In this observational prospective study, 18 patients with EMM (mean age 72.5 ± 6.87 years) were enrolled. They were divided into two groups according to the preoperative integrity of the SD-OCT IS/OS junction: the EMM-I group with an intact IS/OS junction (11 patients, mean age 72.75 ± 3.49 years, providing 11 eyes) and the EMM-D group with a disrupted IS/OS junction (7 patients, mean age 70.86 ± 10.79 years, providing 7 eyes). For each enrolled patient, visual acuity (VA), mfERG, and SD-OCT were assessed at baseline (preoperative) and after 1, 3, and 6 months of follow-up after surgical treatment for EMM (pars plana vitrectomy with EMM removal and internal limiting membrane peeling).

Results

During the whole follow-up, VA was significantly increased in EMM-I eyes and unmodified in EMM-D eyes. In both groups, mfERG responses were not significantly different and not related to VA differences. In EMM-I eyes a significant reduction of central retinal thickness (CRT) was observed; however, it was not correlated with VA changes. In EMM-D eyes CTR was not significantly reduced, whereas macular volume was significantly reduced. These changes were significantly related to the corresponding differences in VA.

Conclusions

Our results suggest that the preoperative evaluation of the integrity of the IS/OS junction is relevant for postoperative outcomes. The recovery in VA was higher in EMM-I eyes than in EMM-D eyes. Postoperative recovery was not associated with morphology of the outer retina (photoreceptor and outer nuclear layer) and the function of preganglionic elements.

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Acknowledgements

We thank the participants of the study.

Funding

No funding or sponsorship was received for this study or publication of this article. The contribution of the Bietti Foundation for this study was supported the Italian Ministry of Health and Fondazione Roma.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

All authors (Giulio Ruberto, Vincenzo Parisi, Giulio Vandelli, Alessandro Falcione, Federica Manzoni, Ivano Riva, and Luciano Quaranta) declare that they have nothing to disclose.

Compliance with Ethics Guidelines

The research followed the tenets of the Declaration of Helsinki and the study was approved by the local institutional review board (IRB) (Scientific Committee of the Section of Ophthalmology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy). Each patient signed an informed consent.

Data Availability

All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis. The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy

    Giulio Ruberto, Giulio Vandelli, Alessandro Falcione & Luciano Quaranta

  2. IRCCS Fondazione Bietti, Rome, Italy

    Vincenzo Parisi & Ivano Riva

  3. Scientific Direction, Clinical Epidemiology and Biometry Unit, San Matteo Hospital Foundation, Pavia, Italy

    Federica Manzoni

Authors
  1. Giulio Ruberto
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  2. Vincenzo Parisi
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  3. Giulio Vandelli
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  4. Alessandro Falcione
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  5. Federica Manzoni
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  6. Ivano Riva
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  7. Luciano Quaranta
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Corresponding author

Correspondence to Vincenzo Parisi.

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Ruberto, G., Parisi, V., Vandelli, G. et al. Surgery for Idiopathic Epimacular Membrane: Morpho-Functional Outcomes Based on the Preoperative Macular Integrity of the Photoreceptoral Junction. A Prospective Pilot Study. Adv Ther 37, 566–577 (2020). https://doi.org/10.1007/s12325-019-01165-4

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  • DOI: https://doi.org/10.1007/s12325-019-01165-4

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