Inner Nuclear Layer Microcyst Configuration, Distribution, and Visual Prognosis in Patients With Epiretinal Membrane After Vitrectomy and Membrane Peeling

Abstract

Inner nuclear layer(INL) microcysts at central macula are a common finding in patients with epiretinal membrane (ERM) after vitrectomy and membrane peeling. Using en face mode of optical coherence tomography (OCT) angiography, patients with ERM after surgery were retrospectively reviewed to understand the configuration and distribution of microcysts as well as their impact on visual acuity. Forty-six eligible patients were enrolled and their baseline best-corrected visual acuities improved from 20/67 to 20/29 (P < 0.01) after surgery. Twenty-eight (60.9%) patients had microcysts that appeared at a median of 5 months after the surgery and persisted for mean 16 months follow-up. The microcyst appeared as spheroidal shape with length ranged from 20 to 80 μm and widths of 80 μm in average. They tend to group in cluster with a density of 245 microcysts per mm 2 . The frequency of microcyst distribution was 86%, 54%, 32%, 25% and 18% at the nasal, superior, inferior, temporal quadrants and central 1 mm, respectively. Linear regression analysis showed that INL microcysts at central and temporal quadrants were associated with poorer visual acuity (P = 0.02 and P = 0.01, respectively). The presence of INL microcysts in center subfield and involved wider area is a poor prognostic factor for visual outcomes.

Effect of Periocular Triamcinolone Acetonide on Prevention of Postsurgical Intraretinal Cystoid Changes after Vitrectomy with Membrane Peeling

“…5 ). New postoperative intraretinal cystoid changes were already described in earlier reports to have a delayed onset 12 , 13 , 14 , and usually do not occur within the first postsurgical month. The authors hypothesized the delayed onset of new postoperative intraretinal cystoid changes to be a typical sign of this finding, but it has also to be kept in mind that it is a common postsurgical procedure to prescribe anti-inflammatory eye drops for the first postsurgical weeks, probably preventing development of new postoperative intraretinal cystoid changes during the time period of application.…”

“…5 ). Neue postoperative intraretinale zystoide Veränderungen wurden auch schon in früheren Arbeiten mit verzögertem Auftreten nach der Operation beschrieben 12 , 14 und zeigen sich typischerweise nicht im 1. postoperativen Monat. Das verspätete Auftreten wurde von den Autoren als typisches Zeichen dieser neuen postoperativen intraretinalen zystoiden Veränderungen beschrieben, trotzdem sollte auch beachtet werden, dass in den ersten postoperativen Wochen normalerweise lokale antiinflammatorische Therapie verabreicht wird, mit möglicherweise präventiver Wirkung.…”

“…Newly developed intraretinal cystoid changes after surgery have been described in 1 to 61% of patients that underwent vitrectomy with membrane peeling due to idiopathic ERMs (iERMs) 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 . Effects of this finding on postsurgical results have been controversially discussed, as several authors reported newly developed postoperative intraretinal cystoid changes not affecting postoperative visual acuity 11 , 14 , whereas others found a risk for reduced visual acuity among patients with new postoperative intraretinal cystoid changes 6 , 8 , 10 , 13 .…”

“…Newly developed intraretinal cystoid changes after surgery have been described in 1 to 61% of patients that underwent vitrectomy with membrane peeling due to idiopathic ERMs (iERMs) 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 . Effects of this finding on postsurgical results have been controversially discussed, as several authors reported newly developed postoperative intraretinal cystoid changes not affecting postoperative visual acuity 11 , 14 , whereas others found a risk for reduced visual acuity among patients with new postoperative intraretinal cystoid changes 6 , 8 , 10 , 13 . The presence of new postoperative intraretinal cystoid changes in a minority of patients undergoing vitrectomy with membrane peeling could be hypothesized to indicate inflammatory processes being present during the postsurgical healing period.…”

“…Neue intraretinale zystoide Veränderungen nach Vitrektomie mit Membrane Peeling wurden bei 1 – 61% der Patienten mit idiopathischen ERM beschrieben 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 . Deren Auswirkungen auf die postoperativen Resultate werden kontroversiell diskutiert, da einige Autoren keine negativen Einflüsse auf den postoperativen Visus beschrieben haben 11 , 14 , im Gegensatz zu anderen Autoren, die ein Risiko für einen schlechteren postoperativen Visus, im Vergleich zu Patienten ohne neue postoperative intraretinale zystoide Veränderungen, berichtet haben 6 , 8 , 10 , 13 . Die Tatsache, dass bei einigen Patienten neue postoperative intraretinale zystoide Veränderungen entstehen, könnte ein Hinweis auf inflammatorische Prozesse im postoperativen Heilungsverlauf sein.…”