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Prognostic factors of idiopathic epiretinal membrane surgery and evolution of alterations of the central cone bouquet

  • Retinal Disorders
  • Published:
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Abstract

Purpose

To describe the structural changes observed postoperatively in epiretinal membranes (ERM), in particular the alterations in the central cone bouquet (CB), and to identify prognostic factors that might predict postoperative outcome.

Methods

We included 125 eyes of 117 patients who underwent idiopathic ERM removal with at least a 6-month follow-up. For each patient, spectral-domain optical coherence tomography (SD-OCT) was performed and best-corrected visual acuity (BCVA) was measured, before and after surgery.

Results

Before surgery, 44 eyes (35.2%) presented CB alterations: 65.9% a cotton ball sign, 15.9% a foveolar detachment and 18.2% a pseudovitelliform lesion. Median BCVA increased from 20/63 to 20/32 post-operatively (p = .001) with a mean follow-up of 17 months. The disappearance of CB alterations after surgery was observed in 97.7% of eyes. In stage 3 and 4 ERM, ectopic inner foveal layers persisted in 76.7% of eyes after surgery. Postoperative BCVA was correlated with change in central macular thickness and initial BCVA and was not correlated with the presence of preoperative CB alteration, the initial stage of ERM, the presence of postoperative dissociated optical nerve fiber layer, and the disappearance of ectopic inner fiber layers. The combination of cataract surgery and capsulotomy did not seem to change visual outcome and seemed to accelerate visual recovery. Incidentally, general anesthesia was correlated with final BCVA.

Conclusion

ERM surgery allowed a significant gain in BCVA and the disappearance of CB alterations in the great majority of cases. CB alteration did not show to be associated with poor visual prognosis.

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Abbreviations

BCVA:

best corrected visual acuity

CB:

central cone bouquet

CRT:

central retinal thickness

DONFL:

dissociated optic nerve fiber layer appearance

EIFL:

ectopic inner foveal layer

ERM:

epiretinal membrane

ILM:

internal limiting membrane

logMAR:

logarithm of the minimal angle of resolution

OCT:

optical coherence tomography

PPV:

pars plana vitrectomy

PVD:

posterior vitreous detachment

TLH:

tractional lamellar hole

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Acknowledgments

The authors would like to thank the following colleagues for their contributions: Drs Auzemery, Beladina, Destouches, Diedler, Jacquelin, Rivoal, Lim, Marcel, Mattar, Misgault, Nedey, Sabouret, Villiermet, and Voigt. They provided and cared for study patients.

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Authors and Affiliations

  1. Department of Ophthalmology, Intercommunal Hospital Center and Henri Mondor Hospital, Paris-Est Créteil University (UPEC, Paris XII University), 40 avenue de Verdun, 94000, Creteil, France

    Manon Ortoli, Rocio Blanco-Garavito, Benjamin Blautain, Nikitas Mastorakos, Eric H. Souied & Agnès Glacet-Bernard

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  1. Manon Ortoli
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  2. Rocio Blanco-Garavito
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  3. Benjamin Blautain
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  4. Nikitas Mastorakos
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  6. Agnès Glacet-Bernard
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Contributions

All the person named as an author in this study contribute in conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; drafting the work or revising it critically for important intellectual content and final approval of the version to be published.

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Correspondence to Manon Ortoli.

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Conflict of interest

None of the authors has any conflicts of interest to disclose.

Ethical approval

The design of this retrospective, observational series was approved by the Institutional Review Board of Creteil University. All patients provided written informed consent for participation in the study. The described research methods and analysis adhered to the tenets of the 1964 declaration of Helsinki.

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Supplementary Information

Fig4

Supplemental figure: Dissociated optic nerve fiber layer (DONFL) aspect in “En-face” blue reflectance. Four years after ERM surgery, the “En-face” blue reflectance picture shows several hyporeflective dots corresponding to the rearrangement of the retinal nerve fibers layer. Postoperative BCVA was 20/20. (PNG 1540 kb)

High Resolution Image (TIFF 1951 kb)

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Ortoli, M., Blanco-Garavito, R., Blautain, B. et al. Prognostic factors of idiopathic epiretinal membrane surgery and evolution of alterations of the central cone bouquet. Graefes Arch Clin Exp Ophthalmol 259, 2139–2147 (2021). https://doi.org/10.1007/s00417-021-05110-6

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  • DOI: https://doi.org/10.1007/s00417-021-05110-6

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