Peripheral Retinal Degenerations and Idiopathic Epiretinal Membrane: Analysis with Ultra-Wide-Field Scanning Laser Ophthalmoscopy

Abstract

Background: The present study examined the relationships among retinal structure, peripheral retinal abnormalities, and epiretinal membrane (ERM) and explored the utility of ultra-wide-field laser scanning ophthalmoscopy in idiopathic ERM assessment. Methods: The study sample comprised 276 eyes of 276 patients. Ultra-wide field fundus imaging was performed without mydriasis using Optos California. Each patient underwent a Goldmann three-mirror contact lens fundus examination. Results: Ultra-wide field laser scanning ophthalmoscopy revealed peripheral retinal degeneration in 84 (54.54%) eyes in the ERM and in 28 (22.95%) eyes in the control group. Goldmann three-mirror contact lens examination revealed peripheral retinal degeneration in 96 (62.33%) eyes in the ERM group and 42 (34.42%) eyes in the control group. Ultra-wide field ophthalmoscopy enabled the detection of nearly 87% of all peripheral retinal lesions in patients with ERM, but it cannot replace fundus examination with a Goldmann triple mirror or ophthalmoscopy with scleral indentation. Conclusions: In most patients, idiopathic ERM coexisted with changes in the peripheral retina. Some of these changes promote retinal detachment. Thus, surgeons should consider the risk of retinal tear during vitrectomy, which increases the scope of surgery and may adversely affect prognosis. Although ultra-wide field imaging is a valuable diagnostic method, it is not a substitute for Goldmann three-mirror contact lens fundus examination or ophthalmoscopy with scleral indentation.

Ultra-wide-field fundus photography compared to ophthalmoscopy in diagnosing and classifying major retinal diseases

“…For major retinal diseases these evaluation systems have similar sensitivity and specificity (almost 100%) and no statistically significant difference was found in fundus assessment between the two procedures (k = 0.997, 95%CI = 0.996-0.999). These findings differ from some previous reports 7,9,21 , but it must be underlined that the other study populations were small and mostly limited to peripheral retinal degenerations 7,9,21 . Moreover, these last reports used Optos® system 7,21 , whose limitations, mainly concerning true color, have already been reported 4 .…”

“…Although indirect ophthalmoscopy, particularly associated to scleral depression, and posterior biomicroscopy still remain the gold standard for fundus examination 19 , over the last ten years the use of fundus photography system has extensively increased 11,12,20 , as an adjunct to clinical evaluation 7,21,22 or as a screening tool for many retinal diseases, in particular diabetic retinopathy [4][5][6]10 , peripheral retinal lesions 8,9 and other retinal disorders 16,23,24 , also by means of deep learning technologies 3,6,25,26 . This is due to the progressive improvement of retinal fundus cameras, involving both the extent of retinal field evaluated and the quality of images: from the earliest cameras www.nature.com/scientificreports/ encompassing a retinal field of 20-30° in a single image 12 , we have now systems capable of acquiring real color fundus images covering up to 200° of retinal field with a pixel definition of 6604 × 4274 (Clarus™), or providing a two-tone fundus image of 200° of field with a 3900 × 3072 pixel definition (Optos®) 4,12,14 .…”

“…Some reports have shown that UWF fundus imaging is an effective useful tool for the assessment of diabetic retinopathy 4,5,12 , focusing on the higher accuracy of Clarus™ in detecting microaneurysm and retinal hemorrhages: by providing real color images and reducing lids and lashes artifacts, it allows a slightly more precise staging of diabetic retinopathy and maculopathy than Optos® camera 4 . Conversely, studies assessing the effectiveness of UWF imaging in detecting peripheral retinal lesions, such as retinal degenerations, retinal breaks, rhegmatogenous retinal detachment, have been conducted primarily with Optos®: despite considering UWF imaging a useful adjunct to medical evaluation, some authors do not agree it may represent substitute of clinical ophthalmoscopy due to the possible missing of some peripheral retinal lesions 7,21 . Other authors observed consistent findings between clinical and UWF imaging examination, and consider the two methods interchangeable 8,19 .…”

“…Although the clinician should be aware of the possibility that a minority of the most peripheral lesions may be not entirely visualized, it might be considered a first line diagnostic modality, in the context of a full ophthalmological examination.The recent coronavirus disease 2019 (COVID-19) pandemic has forced the medical community to revise and reorganize the methods of clinical evaluation, particularly in ophthalmology: despite being the current gold standard for the examination of retinal periphery, indirect ophthalmoscopy, as well as central fundus biomicroscopy for macular disorders, require a close contact with the patient and need adequate time of evaluation 1-3 . The broad use of ultra-wide-field (UWF) fundus cameras has helped to partly overcome these obstacles, allowing: the clinician to analyze fundus images even at distance, namely in a different location than the clinic, to reduce the time of evaluation for the patient and the clinician; to perform screening for retinal disorders, such as diabetic retinopathy 4-6 and peripheral retinal lesions [7][8][9] . Fundus imaging can be considered UWF when covering a field of retina equal to 100° or more 4,7,[10][11][12] , showing, in a single shot, retinal features anterior to vortex vein ampullae in all four quadrants 13 .…”

“…The broad use of ultra-wide-field (UWF) fundus cameras has helped to partly overcome these obstacles, allowing: the clinician to analyze fundus images even at distance, namely in a different location than the clinic, to reduce the time of evaluation for the patient and the clinician; to perform screening for retinal disorders, such as diabetic retinopathy 4-6 and peripheral retinal lesions [7][8][9] . Fundus imaging can be considered UWF when covering a field of retina equal to 100° or more 4,7,[10][11][12] , showing, in a single shot, retinal features anterior to vortex vein ampullae in all four quadrants 13 . Conversely, the term "wide field" should be used for images showing retinal features beyond the posterior pole but posterior to vortex vein ampulla, in all four quadrants 13 .The most widespread UWF fundus imaging systems currently in use are: Clarus™ (CLARUS 500™, Carl Zeiss Meditec AG, Jena, Germany) and Optos® (Optos California®, Optos PLC, Dunfermline, United Kingdom).…”