Morphometric Spectral-Domain Optical Coherence Tomography Features of Epiretinal Membrane Correlate With Visual Acuity in Patients with Uveitis

doi:10.1016/j.ajo.2012.01.032

American Journal of Ophthalmology

Volume 154, Issue 1, July 2012, Pages 78-86.e1

https://doi.org/10.1016/j.ajo.2012.01.032 Get rights and content

Purpose

To identify visually significant spectral-domain optical coherence tomography (SD-OCT) features of epiretinal membranes (ERM) in patients with uveitis.

Design

Retrospective cohort and cross-sectional study.

Methods

Eighty consecutive eyes with uveitis and SD-OCT–documented ERM were included. Clinical data were collected at the time of diagnosis of ERM and at the final visit. SD-OCT images at the last visit were evaluated to identify fovea and ERM configuration and structural changes. Changes of 10% and 20% in central subfield thickness between initial and last SD-OCT were calculated and correlated with visual acuity (VA). An ERM thickness map was created using validated SD-OCT grading software.

Results

VA improved significantly in eyes with more than 12 months of follow-up (P = .03). Although inflammation activity and medical treatment methods were no different in eyes with more or less than 12 months of follow-up, 16 eyes in the subset with longer follow-up underwent cataract extraction and intraocular lens implantation. Kaplan-Meier analysis demonstrated few vision losses during the follow-up period. Change in central subfield thickness did not correlate with VA. Foveal center involvement (P < .001), focal attachment of the ERM (P = .003), and foveal inner segment and outer segment junction disruption (P = .006) were associated independently with lower VA. ERM was thinner in eyes with 20/40 or better VA (4.6 ± 0.6 μm) compared with eyes with VA of less than 20/200 (P = .02). Longer duration of ERM was associated with thicker ERM (P < .05).

Conclusions

In most eyes with uveitis and ERM, VA remains stable if ocular inflammation and comorbidities are addressed appropriately.

Section snippets

Methods

OCT images of 80 eyes of 54 consecutive uveitic patients with an SD-OCT–supported diagnosis of ERM in a referral uveitis clinic at the Doheny Eye Institute seen between August 2009 and November 2010 were collected and analyzed. The Institutional Review Board of the University of Southern California approved the data collection and analysis protocol. The study was in accordance with Health Insurance Portability and Accountability Act requirements. All cases were documented by either 1 or both of

Results

Eighty eyes of 54 consecutive patients with uveitis with an SD-OCT–supported diagnosis of ERM were included. Average patient age ± standard deviation at the time of data collection was 60.5 ± 13.7 years (range, 20 to 87 years); 35 patients (64.8%) were male. In 26 patients, both eyes had documented ERM and were included in the study. Anatomic classification of the uveitis in involved eyes revealed posterior uveitis (35 eyes; 43.7%), anterior uveitis (15 eyes; 18.7%), intermediate uveitis (15

Discussion

This study reveals clinically significant SD-OCT features of ERMs and the underlying retina in eyes of patients with uveitis. The presence of ERM in the fovea, focal attachment of ERM to the inner retina, and disruption of IS/OS junction are 3 independent factors associated with poor vision. The visual impact of ERMs involving the fovea is not surprising, because one would anticipate that the structural alterations produced by such membranes could lead to functional impairment.

One ERM feature

Hossein Nazari, MD, graduated from Zanjan University of Medical Science, Iran, in 1998. He completed his ophthalmology residency with honors at Tabriz University of Medical Sciences, followed by a vitreoretinal fellowship at Rassoul Akram Hospital, Tehran University of Medical Sciences. After graduation, he joined the Department of Ophthalmology at RassoulAkram Hospital, Tehran University of Medical Sciences, as assistant professor. He is currently doing a fellowship in ocular immunology and

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The aim of this study is to investigate temporal trends in multifocal ERG (mfERG) parameters and analyze their relationships with anatomic and functional markers in patients with birdshot chorioretinopathy (BSCR).
Prospective observational case series.
Sixteen BSCR patients were include and underwent 2 standardized follow-up (FU) visits within 5 years following a baseline examination, including mfERG, visual acuity (VA), visual field (VF), Lanthony desaturated panel D-15 test for color vision, quality of life (QoL), fluorescein and indocyanine green angiography, and optical coherence tomography (OCT).
A significant trend toward a decrease in absolute N1 amplitude values was observed over the follow-up period (P < .001) while N1 implicit time remained unchanged. In contrast, P1 amplitude decreased (P < .001) and P1 implicit time increased (P < .001) over the same period. No significant temporal change was found for VA, color vision score, foveal threshold, mean deviation of VF, and QoL. After adjusting for time to FU, increasing N1 and P1 IT were both associated with decreasing values of logMAR, foveal threshold, and QoL and with increasing color vision score and mean deviation of VF. A significant relationship was observed between decreasing P1 amplitude values and increasing mean deviation of VF. Lower absolute values of N1 amplitude were associated with venous vasculitis, whereas lower P1 amplitude values correlated with alteration of the outer retina in OCT.
Progressive deterioration in mfERG during a 5-year period is detected in BSCR, whereas classical functional test results were unchanged. This study suggests a better sensitivity of mfERG in monitoring the retinal function of BSCR patients.
Surgical Outcomes of Epiretinal Membranes in Patients with a History of Well-Controlled Preoperative Uveitis
2018, Ophthalmology Retina
Citation Excerpt :
Although the mean retinal thickness increased with time, vision did not statistically change.7 Nazari et al8 later described a larger series of 80 eyes and found that poorer vision was statistically associated with specific anatomic configurations: foveal ERM, focal ERM attachments, and inner segment/outer segment disruption. The surgical impact on VA varies.
To determine surgical outcomes in patients with uveitis who underwent surgery for epiretinal membrane.
Multicenter, interventional, retrospective, consecutive case series.
Patients with a history of controlled uveitis and concurrent visually significant epiretinal membrane.
All eyes underwent 23-gauge pars plana vitrectomy with membrane and internal limiting membrane peeling between 2011 and 2015. Demographic data, visual acuity, slit lamp and fundoscopic examination, and optical coherence tomography were reviewed preoperatively and postoperatively.
Visual acuity, mean central foveal thickness, macular cube volume, and uveitic activity preoperatively and postoperatively at 1, 3, and 6 months.
Fifteen patients (17 eyes) were included. The mean follow-up duration was 23.2 months. Seventeen eyes (88.2%) received intravenous methylprednisolone and 10 eyes (58.8%) received intraocular steroids at the time of surgery. There was a significant improvement in mean central foveal thickness (517 vs. 371 microns; P = 0.01) and macular cube volume (12.1 vs. 9.4 mm³; P = 0.01) 6 months postoperatively. There were no epiretinal membrane recurrences. There was a trend toward improved mean postoperative visual acuity at 6 months (0.8 [±0.6] vs. 0.6 [±0.6] logarithm of the minimum angle of resolution units; P = 0.36). All eyes were inactive at the final visit, but 5 eyes (29.4%) required further immunomodulatory therapy postoperatively. One eye developed increased intraocular pressure that required topical therapy.
Eyes with a history of controlled uveitis have low surgical recurrence rates that are comparable with those without uveitis. Most patients do not require escalation of immunomodulatory therapy after surgery.
Recent Advances in Ocular Imaging in Management of Uveitis and Related Intraocular Inflammations
2017, Advances in Ophthalmology and Optometry
Citation Excerpt :
MUST trial group showed that a 20% change in thickness predicts greater than 10-letter change in visual acuity with a sensitivity of 77% and a specificity of 75% [29]. Similarly, OCT analysis of epiretinal membrane thickness and extension has shown correlation with vision in patients with uveitis [27,30]. Macular thickness mapping is a very useful, objective tool for comparing retina thickness in successive visits.
Quantifying Retinal Microvascular Changes in Uveitis Using Spectral-Domain Optical Coherence Tomography Angiography
2016, American Journal of Ophthalmology
To quantify retinal capillary density and morphology in uveitis using spectral-domain optical coherence tomography angiography (SD-OCTA).
Cross-sectional, observational study.
Healthy and uveitic subjects were recruited from 2 tertiary care eye centers. Prototype SD-OCTA devices (Cirrus; Carl Zeiss Meditec, Inc, Dublin, California, USA) were used to generate 3 × 3-mm² OCTA images centered on the fovea. Subjects were placed into 3 groups based on the type of optical microangiography (OMAG) algorithm used for image processing (intensity and/or phase) and type of retinal segmentation (automatic or manual). A semi-automated method was used to calculate skeleton density (SD), vessel density (VD), fractal dimension (FD), and vessel diameter index (VDI). Retinal vasculature was assessed in the superficial retinal layer (SRL), deep retinal layer (DRL), and nonsegmented retinal layer (NS-RL). A generalized estimating equations model was used to analyze associations between the OCTA measures and disease status within each retinal layer. A P value < .05 was accepted as significant. Reproducibility and repeatability were assessed using the intraclass correlation coefficient (ICC).
The SD, VD, and FD of the parafoveal capillaries were lower in uveitic eyes compared with healthy eyes in all retinal segments. In addition, SD and VD were significantly lower in the DRL of subjects with uveitic macular edema. There was no correlation in any capillary parameters and anatomic classification of uveitis.
Quantitative analysis of parafoveal capillary density and morphology in uveitis demonstrates significantly lower capillary density and complexity. SD-OCTA algorithms are robust enough to detect these changes and can provide a novel diagnostic index of disease for uveitis subjects.
Epidemiology of epiretinal membrane in a large cohort of patients with uveitis
2014, Ophthalmology
To identify clinical characteristics associated with the presence of epiretinal membrane (ERM) in patients with uveitis.
Case-control study.
Five hundred ninety-eight subjects seen in a single tertiary referral clinic between January 1, 2008, and December 31, 2011, who were diagnosed with uveitis.
Spectral-domain optical coherence tomography (SD OCT) images of all subjects were reviewed to assess for ERM. A multivariate logistic regression analysis was performed to compare characteristics of subjects with ERM (cases) with characteristics of subjects without ERM (controls). A second multivariate analysis assessed the relationship between ERM and visual acuity. Fundus photographs were reviewed to compare SD OCT ascertainment of ERM with photographic ascertainment.
Presence or absence of ERM on OCT imaging.
Of 598 uveitic participants, 246 (41%) were found to have ERM in at least 1 eye on SD OCT imaging. The prevalence of ERM by Standardization of Uveitis Nomenclature anatomic subtype was 28.1% for anterior uveitis, 57.0% for intermediate uveitis, and 43.4% for posterior uveitis and panuveitis. Multivariate analysis showed that the following clinical factors were associated significantly with ERM: older age (3% increased risk per year of age; 95% confidence interval [CI], 1.02–1.05), intermediate uveitis (odds ratio [OR], 3.41; 95% CI, 1.67–6.96), posterior uveitis and panuveitis (OR, 1.81; 95% CI, 1.09–3.01), male sex (OR, 1.59; 95% CI, 1.05–2.42), and history of cataract surgery (OR, 1.78; 95% CI, 1.13–2.79). When adjusted for covariates, eyes with ERM had a mean logarithm of the minimum angle of resolution visual acuity of 0.58 (20/76) versus 0.48 (20/60) in non-ERM eyes (P = 0.039). Of OCT-defined ERMs in this cohort, 38% were not detectable on fundus photographs.
Epiretinal membrane is a common complication of uveitis that is associated with patient age, intermediate uveitis, posterior uveitis, panuveitis, male sex, and previous cataract surgery. It can contribute independently to vision loss in uveitic eyes. In uveitis, OCT is more sensitive than fundus photography for identification of ERM.
Epiretinal membranes in uveitic macular edema: Effect on vision and response to therapy
2014, American Journal of Ophthalmology
Citation Excerpt :
In addition, the presence of preoperative epiretinal membrane in patients undergoing vitrectomy for complicated chronic endogenous or autoimmune uveitis was a predictor for postoperative reduction in the number of drugs required,19 suggesting that epiretinal membrane removal (or perhaps the vitrectomy itself) may reduce the long-term burden of therapy. A retrospective review of 80 eyes with epiretinal membrane and uveitis found that 50% of epiretinal membranes demonstrated a focal attachment pattern with underlying retinal surface corrugation,6 similar to the percentage of epiretinal membranes with retinal surface wrinkling in our group (44%). In both groups, retinal surface wrinkling was associated with worse visual acuity outcomes.
To evaluate the effects of epiretinal membranes on the response of uveitic macular edema to therapy and on visual acuity outcomes.
Retrospective case series.
One hundred four eyes of 77 patients with uveitic macular edema were identified at a tertiary care center. Epiretinal membranes were diagnosed when identified by 2 investigators' grading of spectral-domain optical coherence tomography and scored for the presence or absence of surface wrinkling. Outcomes included best-corrected visual acuity, central subfield thickness, and rates of macular edema improvement (>20% reduction in central subfield thickness) and resolution (reduction of central subfield thickness to <315 μm) at 3 and 6 months follow-up.
Seventy-two eyes of 59 patients had an epiretinal membrane on presentation. Eyes without epiretinal membranes and with epiretinal membranes without surface wrinkling were not significantly different at presentation or at 3 and 6 months follow-up. Conversely, eyes with an epiretinal membrane with retinal surface wrinkling had a greater proportion of eyes with 20/200 or worse visual acuity at presentation, and had worse mean acuities at 3 months (20/94 vs 20/35 for eyes without an epiretinal membrane, P = .002) and at 6 months follow-up (20/110 vs 20/36 for eyes without an epiretinal membrane, P = .02). At 6 months of follow-up the mean central subfield thicknesses were: eyes without an epiretinal membrane, 338 ± 23 μm; and eyes with an epiretinal membrane and surface wrinkling, 405 ± 22 μm (P = .05).
In eyes with epiretinal membranes and retinal surface wrinkling, uveitic macular edema had a poorer visual acuity response to medical therapy and thicker maculae at 6 months.

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Original articleMorphometric Spectral-Domain Optical Coherence Tomography Features of Epiretinal Membrane Correlate With Visual Acuity in Patients with Uveitis

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Ophthalmology

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

The multicenter uveitis steroid treatment trial: rationale, design, and baseline characteristics

Am J Ophthalmol

The impact of optical coherence tomography on surgical decision making in epiretinal membrane and vitreomacular traction

Trans Am Ophthalmol Soc

Three dimensional spectral-domain optical coherence tomography images of the retina in the presence of epiretinal membranes

Am J Ophthalmol

Correlation between thickening of the inner and outer retina and visual acuity in patients with epiretinal membrane

Retina

Disruption of the photoreceptor inner segment/outer segment layer on spectral domain-optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes

Retina

Spectral domain optical coherence tomography for imaging ERM, retinal edema, and vitreomacular interface

Retina

Original article
Morphometric Spectral-Domain Optical Coherence Tomography Features of Epiretinal Membrane Correlate With Visual Acuity in Patients with Uveitis