Microcystoid Macular Changes in Association With Idiopathic Epiretinal Membranes in Eyes With and Without Glaucoma: Clinical Insights

• Published in: American journal of ophthalmology 2017-09, Vol.181, p.156-165
• Main Authors: Govetto, Andrea, Su, Daniel, Farajzadeh, Matthew, Megerdichian, Alin, Platner, Eva, Ducournau, Yvette, Virgili, Gianni, Hubschman, Jean Pierre
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cysts; Diabetic retinopathy; Edema; Epiretinal Membrane - diagnosis; Epiretinal Membrane - physiopathology; Female; Glaucoma; Glaucoma, Open-Angle - diagnosis; Glaucoma, Open-Angle - physiopathology; Humans; Intraocular Pressure; Macular Edema - diagnosis; Macular Edema - physiopathology; Male; Medical imaging; Membranes; Middle Aged; Multiple sclerosis; Ophthalmology; Optic Nerve Diseases - diagnosis; Optic Nerve Diseases - physiopathology; Optics; Retinal Neurons - pathology; Retrospective Studies; Statistical analysis; Surgery; Tomography, Optical Coherence; Visual Acuity - physiology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2017.06.023

To describe the clinical and surgical significance of microcystoid macular changes in the inner nuclear layer in patients with idiopathic epiretinal membranes, with and without glaucomatous optic neuropathy. Retrospective case series. Clinical charts and spectral-domain optical coherence tomography images of 264 eyes of 234 consecutive patients diagnosed with idiopathic epiretinal membranes were reviewed and analyzed. Surgical data were analyzed in a subgroup of eyes with microcystoid macular changes treated with pars plana vitrectomy and epiretinal and internal limiting membrane peel. In surgical cases, postoperative functional and anatomic results at 1 and 6 months were compared between glaucomatous and nonglaucomatous eyes. Associations of microcystoid macular changes with visual acuity and other morphometric parameters were assessed by means of linear or multiple logistic regressions. Microcystoid macular changes in the inner nuclear layer were diagnosed in 52 out of 264 eyes with epiretinal membranes (19.7%), of which 28 (55.0%) had concomitant glaucoma. The likelihood to develop microcystoid macular changes increased at advanced glaucoma and epiretinal membrane stages. The morphology of microcystoid macular changes was similar between glaucomatous and nonglaucomatous eyes. Forty-four out of 52 eyes (84.6%) with microcystoid macular changes, of which 20 were with glaucoma and 24 without glaucoma, underwent surgery with pars plana vitrectomy and epiretinal and internal limiting membrane peel. At 1 and 6 months after surgery the mean number of microcysts decreased significantly from baseline in nonglaucomatous eyes (P = .003 and P = .002, respectively) and remained unchanged in glaucomatous eyes (P = .400 and P = .700, respectively). This study reports a high frequency of microcystoid macular changes in the inner nuclear layer in eyes with concomitant epiretinal membrane and glaucomatous optic neuropathy. In glaucomatous eyes, pars plana vitrectomy with epiretinal and internal limiting membrane peel was ineffective in the treatment of microcystoid macular changes.