Changes of foveal avascular zone size and correlation between foveal avascular zone size and metamorphopsia before and after idiopathic macular epiretinal membrane surgery_Chinese Journal of Ocular Fundus Diseases

Authors：

Zeng Miao ,  Chen Xiao , Cai Chunyan , Hong Ling , Ding Qin , Yan Ying , Huang Zhijian

Central Theater Command General Hospital of Chinese People's Liberation Army, Wuhan 430070, China;

Corresponding author：

Chen Xiao, Email: zengmiao1982@163.com

Keywords：

Macula lutea; Membranes; Vitrectomy; Tomography, optical coherence; Foveal avascular zone; Metamorphopsia

DOI：

10.3760/cma.j.cn511434-20181213-00426

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To observe the changes of foveal avascular zone (FAZ) size before and after surgery in idiopathic macular epiretinal membrane (IMEM) eyes and analyze the correlation of FAZ with metamorphopsia.Methods A retrospective case series study. From August 2016 to October 2017, 42 eyes of 38 patients affected with IMEM diagnosed in Central Theater Command General Hospital of Chinese People's Liberation Army were enrolled in this study. All the patients underwent a 25G pars plana vitrectomy (PPV) with IMEM removal and ininternal limiting membrane (ILM) peeling. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The severity of metamorphopsia was measured using M-charts. The FAZ areas were evaluated with OCT angiography in both the superficial and deep capillary plexus layers. The central macular thickness (CMT) were assessed with spectral-domain OCT before and after surgery. The logMAR BCVA was 0.61±0.21. The M-score was 0.66±0.38. The CMT of fovea was 337.71±57.63 μm. The FAZ areas in superficial and deep capillary plexus were 0.113±0.037 mm² and 0.202±0.03 mm², respectively. The differences in BCVA, M-score and FAZ area before and 1, 3, 6, 12 months after surgery were analyzed by ANOVA. The Spearman rank correlation analysis was performed to investigate the relationship between FAZ areas, visual acuity and metamorphopsia.Results At 12 month after surgery, the FAZ areas in superficial and deep capillary plexus were 0.146±0.021 mm² and 0.240±0.019 mm², respectively. Compared with baseline, the the FAZ areas in superficial and deep capillary plexus after surgery significantly increased (F=8.484, 14.346; P＜0.001,＜0.001). The postoperative logMAR BCVA 0.47±0.19, M-score 0.12±0.22 and CMT 270.60±33.27 μm were significantly improved compared with baseline (F=5.044, 17.763, 13.545; P=0.001,＜0.001,＜0.001). The preoperative FAZ area in superficial capillary plexus correlated negatively with preoperative M-score (r=－0.816, P＜0.001); the preoperative FAZ area in deep capillary plexus correlated negatively with preoperative BCVA and M-score (r=－0.422, －0.882; P=0.005,＜0.001). The postoperative FAZ area in superficial capillary plexus correlated negatively with preoperative and postoperative M-score (r=－0.791,－0.716; P＜0.001,＜0.001). The postoperative FAZ area in deep capillary plexus correlated negatively with BCVA and preoperative and postoperative M-score (r=－0.343, －0.330, －0.732, －0.694; P=0.026, 0.033,＜0.001,＜0.001).Conclusions PPV with ILM peeling can effectively restore the FAZ areas in superficial and deep capillary plexus, improve the visual acuity and metamorphopsia in patients with IMEM. Both superficial and deep plexus FAZ areas correlated negatively with metamorphopsia, and deep plexus FAZ area also correlated negatively with BCVA.

Citation： Zeng Miao, Chen Xiao, Cai Chunyan, Hong Ling, Ding Qin, Yan Ying, Huang Zhijian. Changes of foveal avascular zone size and correlation between foveal avascular zone size and metamorphopsia before and after idiopathic macular epiretinal membrane surgery. Chinese Journal of Ocular Fundus Diseases, 2020, 36(3): 205-210. doi: 10.3760/cma.j.cn511434-20181213-00426 Copy

1.	Okamoto F, Sugiura Y, Okamato Y, et al. Associations between metamorphopsia and foveal microstructure in patients with epiretinal membrane[J]. Invest Ophthalmol Vis Sci, 2012, 53(11): 6770-6775. DOI: 10.1167/iovs.12-9683.
2.	Bouwens MD, Meurs JC. Sine Amsler charts: a new method for the follow-up of metamorphopsia in patients undergoing macular pucker surgery[J]. Graefe's Arch Clin Exp Ophthalmol, 2003, 241(2): 89-93. DOI: 10.1007/s00417-002-0613-5.
3.	Kim JH, Kang SW, Kong MG, et al. Assessment of retinal layers and visual rehabilitation after epiretinal membrane removal[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(4): 1055-1064. DOI: 10.1007/s00417-012-2120-7.
4.	Kinoshita T, Imaizumi H, Okushiba U, et al. Time course of changes in metamorphopsia, visual acuity, and OCT parameters after successful epiretinal membrane surgery[J]. Invest Ophthalmol Vis Sci, 2012, 53(7): 3592-3597. DOI: 10.1167/iovs.12-9493.
5.	Yu DY, Cringle SJ, Su EN. Intraretinal oxygen distribution in the monkey retina and the response to systemic hyperoxia[J]. Invest Ophthalmol Vis Sci, 2005, 46(12): 4728-4733. DOI: 10.1167/iovs.05-0694.
6.	Di G, Weihong Y, Xiao Z, et al. A morphological study of the foveal avascular zone in patients with diabetes mellitus using optical coherence tomography angiography[J]. Graefe's Arch Clin Exp Ophthalmol, 2016, 254(5): 873-879. DOI: 10.1007/s00417-015-3143-7.
7.	Pournaras CJ, Donati G, Brazilikos PD, et al. Macular epiretinal membranes[J]. Semin Ophthalmol, 2000, 15(2): 100-107. DOI: 10.1053/soph.2000.7207.
8.	曾苗, 陈晓, 洪玲, 等. 特发性黄斑前膜患眼玻璃体切割联合内界膜剥除手术前后视力和视物变形与黄斑形态结构的相关性[J]. 中华眼底病杂志, 2017, 33(4): 378-382. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.012.Zeng M, Chen X, Hong L, et al. Correlation of visual acuity and metamorphopsia with foveal morphology before and after vitrectomy with internal limiting membrane peeling in idiopathic macular epiretinal membrane eyes[J]. Chin J Ocul Fundus Dis, 2017, 33(4): 378-382. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.012.
9.	Bu SC, Kuijer R, Li XR, et al. Idiopathic epiretinal membrane[J]. Retina, 2014, 34(12): 2317-2335. DOI: 10.1097/iae.0000000000000349.
10.	Snead DR, James S, Snead MP, et al. Pathological changes in the vitreoretinal junction 1: epiretinal membrane formation[J]. Eye(Lond), 2008, 22(10): 1310-1317. DOI: 10.1038/eye.2008.36.
11.	Sandali O, El Sanharawi M, Basli E, et al. Epiretinal membrane recurrence: incidence, characteristics, evolution, and preventive and risk factors[J]. Retina, 2013, 33(10): 2032-2038. DOI: 10.1097/IAE.0b013e31828d2fd6.
12.	Kwok AK, Lai TY, Yuen KS. Epiretinal membrane surgery with or without internal limiting membrane peeling[J]. Clin Exp Ophthalmol, 2005, 33(4): 379-385. DOI: 10.1111/j.1442-9071.2005.01015.x.
13.	Ripandelli G, Scarinci F, Piaggi P, et al. Macular pucker: to peel or not to peel the internal limiting membrane? A microperimetric response[J]. Retina, 2015, 35(3): 498-507. DOI: 10.1097/IAE.0000000000000330.
14.	Scupola A, Grimaldi G, Abed E, et al. Arcuate nerve fiber layer changes after internal limiting membrane peeling in idiopathic epiretinal membrane[J]. Retina, 2018, 38(9): 1777-1785. DOI: 10.1097/IAE.0000000000001768.
15.	Romano MR, Cennamo G, Schiemer S, et al. Deep and superficial OCT angiography changes after macular peeling: idiopathic vs diabetic epiretinal membranes[J]. Graefe's Arch Clin Exp Ophthalmol, 2017, 255(4): 681-689. DOI: 10.1007/s00417-016-3534-4.
16.	Clark A, Balducci N, Pichi F, et al. Swelling of the arcuate nerve fiber layer after internal limiting membrane peeling[J]. Retina, 2012, 32(8): 1608-1613. DOI: 10.1097/IAE.0b013e3182437e86.
17.	Kitagawa Y, Shimada H, Shinojima A, et al. Foveal avascular zone area analysis using optical coherence tomography angiography before and after idiopathic epiretinal membrane surgery[J]. Retina, 2019, 39(2): 339-346. DOI: 10.1097/IAE.0000000000001972.
18.	Samara WA, Say EA, Khoo CT, et al. Correlation of foveal avascualar zone size with foveal morphology in normal eyes using optical coherence tomography angiography[J]. Retina, 2015, 35(11): 2188-2195. DOI: 10.1097/IAE.0000000000000847.
19.	Kumagai K, Uemura A, Furukawa M, et al. Decrease of the foveal avascular zone area after internal limiting membrane peeling: single case study[J]. Int Med Case Rep J, 2017, 10: 81-85. DOI: 10.2147/IMCRJ.S129174.
20.	Bovey EH, Uffer S, Achache F. Surgery for epimacular membrane: impact of retinal internal limiting membrane removal on functional outcome[J]. Retina, 2004, 24(5): 728-735. DOI: 10.1097/00006982-200410000-00007.
21.	Tadayoni R, Paques M, Massin P, et al. Dissociated optic nerve fiber layer appearance of the fundus after idiopathic epiretinal membrane removal[J]. Ophthalmology, 2001, 108(12): 2279-2283. DOI: 10.1016/S0161-6420(01)00856-9.
22.	Bouwens MD, De JF, Mulder P, et al. Results of macular pucker surgery: 1- and 5- year follow-up[J]. Graefe's Arch Clin Exp Ophthalmol, 2008, 246(12): 1693-1697. DOI: 10.1007/s00417-008-0909-1.
23.	García-Fernández M, Castro Navarro J, González Castaño C, et al. Epiretinal membrane surgery: anatomic and functional outcomes[J]. Arch Soc Esp Oftalmol, 2013, 88(4): 139-144. DOI: 10.1016/j.oftale.2012.07.003.

1. Okamoto F, Sugiura Y, Okamato Y, et al. Associations between metamorphopsia and foveal microstructure in patients with epiretinal membrane[J]. Invest Ophthalmol Vis Sci, 2012, 53(11): 6770-6775. DOI: 10.1167/iovs.12-9683.
2. Bouwens MD, Meurs JC. Sine Amsler charts: a new method for the follow-up of metamorphopsia in patients undergoing macular pucker surgery[J]. Graefe's Arch Clin Exp Ophthalmol, 2003, 241(2): 89-93. DOI: 10.1007/s00417-002-0613-5.
3. Kim JH, Kang SW, Kong MG, et al. Assessment of retinal layers and visual rehabilitation after epiretinal membrane removal[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 251(4): 1055-1064. DOI: 10.1007/s00417-012-2120-7.
4. Kinoshita T, Imaizumi H, Okushiba U, et al. Time course of changes in metamorphopsia, visual acuity, and OCT parameters after successful epiretinal membrane surgery[J]. Invest Ophthalmol Vis Sci, 2012, 53(7): 3592-3597. DOI: 10.1167/iovs.12-9493.
5. Yu DY, Cringle SJ, Su EN. Intraretinal oxygen distribution in the monkey retina and the response to systemic hyperoxia[J]. Invest Ophthalmol Vis Sci, 2005, 46(12): 4728-4733. DOI: 10.1167/iovs.05-0694.
6. Di G, Weihong Y, Xiao Z, et al. A morphological study of the foveal avascular zone in patients with diabetes mellitus using optical coherence tomography angiography[J]. Graefe's Arch Clin Exp Ophthalmol, 2016, 254(5): 873-879. DOI: 10.1007/s00417-015-3143-7.
7. Pournaras CJ, Donati G, Brazilikos PD, et al. Macular epiretinal membranes[J]. Semin Ophthalmol, 2000, 15(2): 100-107. DOI: 10.1053/soph.2000.7207.
8. 曾苗, 陈晓, 洪玲, 等. 特发性黄斑前膜患眼玻璃体切割联合内界膜剥除手术前后视力和视物变形与黄斑形态结构的相关性[J]. 中华眼底病杂志, 2017, 33(4): 378-382. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.012.Zeng M, Chen X, Hong L, et al. Correlation of visual acuity and metamorphopsia with foveal morphology before and after vitrectomy with internal limiting membrane peeling in idiopathic macular epiretinal membrane eyes[J]. Chin J Ocul Fundus Dis, 2017, 33(4): 378-382. DOI: 10.3760/cma.j.issn.1005-1015.2017.04.012.
9. Bu SC, Kuijer R, Li XR, et al. Idiopathic epiretinal membrane[J]. Retina, 2014, 34(12): 2317-2335. DOI: 10.1097/iae.0000000000000349.
10. Snead DR, James S, Snead MP, et al. Pathological changes in the vitreoretinal junction 1: epiretinal membrane formation[J]. Eye(Lond), 2008, 22(10): 1310-1317. DOI: 10.1038/eye.2008.36.
11. Sandali O, El Sanharawi M, Basli E, et al. Epiretinal membrane recurrence: incidence, characteristics, evolution, and preventive and risk factors[J]. Retina, 2013, 33(10): 2032-2038. DOI: 10.1097/IAE.0b013e31828d2fd6.
12. Kwok AK, Lai TY, Yuen KS. Epiretinal membrane surgery with or without internal limiting membrane peeling[J]. Clin Exp Ophthalmol, 2005, 33(4): 379-385. DOI: 10.1111/j.1442-9071.2005.01015.x.
13. Ripandelli G, Scarinci F, Piaggi P, et al. Macular pucker: to peel or not to peel the internal limiting membrane? A microperimetric response[J]. Retina, 2015, 35(3): 498-507. DOI: 10.1097/IAE.0000000000000330.
14. Scupola A, Grimaldi G, Abed E, et al. Arcuate nerve fiber layer changes after internal limiting membrane peeling in idiopathic epiretinal membrane[J]. Retina, 2018, 38(9): 1777-1785. DOI: 10.1097/IAE.0000000000001768.
15. Romano MR, Cennamo G, Schiemer S, et al. Deep and superficial OCT angiography changes after macular peeling: idiopathic vs diabetic epiretinal membranes[J]. Graefe's Arch Clin Exp Ophthalmol, 2017, 255(4): 681-689. DOI: 10.1007/s00417-016-3534-4.
16. Clark A, Balducci N, Pichi F, et al. Swelling of the arcuate nerve fiber layer after internal limiting membrane peeling[J]. Retina, 2012, 32(8): 1608-1613. DOI: 10.1097/IAE.0b013e3182437e86.
17. Kitagawa Y, Shimada H, Shinojima A, et al. Foveal avascular zone area analysis using optical coherence tomography angiography before and after idiopathic epiretinal membrane surgery[J]. Retina, 2019, 39(2): 339-346. DOI: 10.1097/IAE.0000000000001972.
18. Samara WA, Say EA, Khoo CT, et al. Correlation of foveal avascualar zone size with foveal morphology in normal eyes using optical coherence tomography angiography[J]. Retina, 2015, 35(11): 2188-2195. DOI: 10.1097/IAE.0000000000000847.
19. Kumagai K, Uemura A, Furukawa M, et al. Decrease of the foveal avascular zone area after internal limiting membrane peeling: single case study[J]. Int Med Case Rep J, 2017, 10: 81-85. DOI: 10.2147/IMCRJ.S129174.
20. Bovey EH, Uffer S, Achache F. Surgery for epimacular membrane: impact of retinal internal limiting membrane removal on functional outcome[J]. Retina, 2004, 24(5): 728-735. DOI: 10.1097/00006982-200410000-00007.
21. Tadayoni R, Paques M, Massin P, et al. Dissociated optic nerve fiber layer appearance of the fundus after idiopathic epiretinal membrane removal[J]. Ophthalmology, 2001, 108(12): 2279-2283. DOI: 10.1016/S0161-6420(01)00856-9.
22. Bouwens MD, De JF, Mulder P, et al. Results of macular pucker surgery: 1- and 5- year follow-up[J]. Graefe's Arch Clin Exp Ophthalmol, 2008, 246(12): 1693-1697. DOI: 10.1007/s00417-008-0909-1.
23. García-Fernández M, Castro Navarro J, González Castaño C, et al. Epiretinal membrane surgery: anatomic and functional outcomes[J]. Arch Soc Esp Oftalmol, 2013, 88(4): 139-144. DOI: 10.1016/j.oftale.2012.07.003.

Chinese Journal of Ocular Fundus Diseases

Changes of foveal avascular zone size and correlation between foveal avascular zone size and metamorphopsia before and after idiopathic macular epiretinal membrane surgery

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content