Correlation of foveal avascular zone size with visual acuity and metamorphopsia in idiopathic macular epiretinal membrane eyes using optical coherence tomography angiography_Chinese Journal of Ocular Fundus Diseases

Authors：

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

Wuhan General Hospital of Chinese People’s Liberation Army, Wuhan 430070, China;

Corresponding author：

Zeng Miao, Email: zengmiao1982@163.com

Keywords：

Macula lutea; Membranes; Vision disparity; Tomography, optical coherence; Foveal avascular zone

DOI：

10.3760/cma.j.issn.1005-1015.2018.01.003

Video：

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Objective To analyze the correlation of foveal avascular zone (FAZ) size with visual acuity and metamorphopsia in idiopathic macular epiretinal membrane (IMEM) eyes. Methods This is a cross-sectional study, including 43 patients (43 eyes) with IMEM (IMEM group) and 35 health subjects (35 eyes) as control group. The best corrected visual acuity (BCVA) was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The severity of metamorphopsia was measured using M-charts. The FAZ areas were estimated with optical coherence tomography angiography (OCTA) in both the superficial and deep capillary plexus layers. The central macular thickness (CMT) was assessed with spectral-domain optical coherence tomography. There was no difference of logMAR BCVA and CMT between two groups (Z=−7.379, −7.560; P＜0.001). The differences of FAZ areas between the two groups were analyzed. The correlative analysis was performed to investigate the relationship between FAZ areas and visual acuity as well as metamorphopsia. Results The FAZ area in superficial and deep capillary plexus in IMEM group were smaller than those in control group (t=−30.316, −27.606; P＜0.001). In IMEM group, the mean M-score was 0.41±0.32; the horizontal and vertical M-score were 0.49±0.40 and 0.32±0.29, respectively. The horizontal M-score was higher than vertical M-score with the significant difference (Z=−2.000, P=0.046). In IMEM group, the FAZ area in superficial capillary plexus correlated inversely with metamorphopsia (r=−0.709, P＜0.001); the FAZ area in deep capillary plexus correlated inversely with metamorphopsia and BCVA (r=−0.533, −0.838; P＜0.001). Conclusions The FAZ areas are significantly decreased in IMEM eyes compared with normal eyes. Both superficial and deep FAZ areas are correlated with metamorphopsia, and deep FAZ area is also correlated with BCVA.

Citation： Zeng Miao, Chen Xiao, Hong Ling, Cai Chunyan, Yan Ying, Huang Zhijian. Correlation of foveal avascular zone size with visual acuity and metamorphopsia in idiopathic macular epiretinal membrane eyes using optical coherence tomography angiography. Chinese Journal of Ocular Fundus Diseases, 2018, 34(1): 8-12. doi: 10.3760/cma.j.issn.1005-1015.2018.01.003 Copy

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2.	Nelis P, Alten F, Clemens CR, et al. Quantification of changes in foveal capillary architecture caused by idiopathic epiretinal membrane using OCT angiography[J]. Graefe's Arch Clin Exp Ophthalmol, 2017, 255(7): 1319-1324. DOI: org/10.1007/s00417-017-3640-y.
3.	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: org/10.1167/iovs.05-0694.
4.	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.
5.	Matsumoto C, Arimura E, Okuyama S, et al. Quantification of metamorphopsia in patients with epiretinal membranes[J]. Invest Ophthalmol Vis Sci, 2003, 44(9): 4012-4016. DOI: org/10.1167/iovs.03-0117.
6.	McLeod D, Hiscott PS, Grierson I. Age-related cellular proliferation at the vitreoretinal juncture[J]. Eye (Lond), 1987, 1(Pt 2)(2): 263-281. DOI: org/10.1038/eye.1987.46.
7.	Smiddy WE, Maguire AM, Green WR, et al. Idiopathic epiretinal membranes. Ultrastructural characteristics and clinicopathologic correlation[J]. Ophthalmology, 1989, 96(6): 811-821. DOI: org/10.1016/S0161-6420(89)32811-9.
8.	Folk JC, Adelman RA, Flaxel CJ, et al. Idiopathic epiretinal membrane and vitreomacular traction preferred practice pattern guidelines[J]. Ophthalmology, 2016, 123(1): 152-181. DOI: org/10.1016/j.ophtha.2015.10.048.
9.	Yagi T, Sakata K, Funatsu H, et al. Evaluation of perifoveal capillary blood flow velocity before and after vitreous surgery for epiretinalmembrane[J]. Graefe's Arch Clin Exp Ophthalmol, 2011, 250(3): 459-460. DOI: org/10.1007/s00417-011-1618-8.
10.	Jia Y, Tan O, Tokayer J, et al. Split-spectrum amplitude-decorrelation angiography with optical coherence tomography[J]. Opt Express, 2012, 20(4): 4710-4725. DOI: org/10.1364/oe.20.004710.
11.	Schwartz DM, Fingler J, Kim DY, et al. Phase-variance optical coherence tomography: a technique for noninvasive angiography[J]. Ophthalmology, 2014, 121(1): 180-187. DOI: org/10.1016/j.ophtha.2013.09.002.
12.	Samara WA, Say EA, Khoo CT, et al Correlation of foveal avascular zone size with foveal morphology in normal eyes using optical coherence tomography angiography[J]. Retina, 2015, 35(11): 2188-2195. DOI: org/10.1097/iae.0000000000000847.
13.	La Spina C, Carnevali A, Marchese A, et al. Reproducibility and reliability of optical coherence tomography angiography for foveal avascular zone evaluation and measurement in different settings[J]. Retina, 2017, 37(9): 1636-1641. DOI: 10.1097/IAE.0000000000001426.
14.	Casselholmde Salles M, Kvanta A, Amrén U, et al. Optical coherence tomography angiography in central retinal vein occlusion: correlation between the foveal avascular zone and visual acuity[J]. Invest Ophthalmol Vis Sci, 2016, 57(9): 242-246. DOI: org/10.1167/iovs.15-18819.
15.	Hussain N, Hussain A. Diametric measurement of foveal avascular zone in healthy young adults using optical coherence tomography angiography[J]. Int J Retina Vitreous, 2016, 2(12): 27-32. DOI: org/10.1186/s40942-016-0053-8.
16.	Hashimoto Y, Saito W, Saito M, et al. Retinal outer layer thickness increases after vitrectomy for epiretinal membrane, and visual improvement positively correlates with photoreceptor outer segment length[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 252(2): 219-226. DOI: org/10.1007/s00417-013-2432-2.
17.	Nishi Y, Shinoda H, Uchida A, et al. Detection of early visual impairment in patients with epiretinal membrane[J]. Acta Ophthalmol, 2013, 91(5): 353-357. DOI: org/10.1111/aos.12060.
18.	Okamoto F, Sugiura Y, Okamoto Y, et al. Inner nuclear layer thickness as a prognostic factor for metamorphopsia after epiretinal membrane surgery[J]. Retina, 2015, 35(10): 2107-2114. DOI: 10.1097/IAE.0000000000000602.
19.	Arimura E, Matsumoto C, Okuyama S, et al. Retinal contraction and metamorphopsia scores in eyes with idiopathic epiretinal membrane[J]. Invest Ophthalmol Vis Sci, 2005, 46(8): 2961-2966. DOI: org/10.1167/iovs.04-1104.
20.	Yoshimi S, Fumiki O, Yoshifumi O, et al. Relationship between metamorphopsia and intraretinal cysts within the fluid cuff after surgery for idiopathic macular hole[J]. Retina, 2017, 37(1): 70-75. DOI: org/10.1097/iae.0000000000001136.

1. Seung ML, Kang YP, Han JK, et al. Association between tangential contraction and early vision loss in idiopathic epiretinal membrane[J]. Retina, 2017, 37(1): 1-9. DOI: org/10.1097/iae.0000000000001559.
2. Nelis P, Alten F, Clemens CR, et al. Quantification of changes in foveal capillary architecture caused by idiopathic epiretinal membrane using OCT angiography[J]. Graefe's Arch Clin Exp Ophthalmol, 2017, 255(7): 1319-1324. DOI: org/10.1007/s00417-017-3640-y.
3. 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: org/10.1167/iovs.05-0694.
4. 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.
5. Matsumoto C, Arimura E, Okuyama S, et al. Quantification of metamorphopsia in patients with epiretinal membranes[J]. Invest Ophthalmol Vis Sci, 2003, 44(9): 4012-4016. DOI: org/10.1167/iovs.03-0117.
6. McLeod D, Hiscott PS, Grierson I. Age-related cellular proliferation at the vitreoretinal juncture[J]. Eye (Lond), 1987, 1(Pt 2)(2): 263-281. DOI: org/10.1038/eye.1987.46.
7. Smiddy WE, Maguire AM, Green WR, et al. Idiopathic epiretinal membranes. Ultrastructural characteristics and clinicopathologic correlation[J]. Ophthalmology, 1989, 96(6): 811-821. DOI: org/10.1016/S0161-6420(89)32811-9.
8. Folk JC, Adelman RA, Flaxel CJ, et al. Idiopathic epiretinal membrane and vitreomacular traction preferred practice pattern guidelines[J]. Ophthalmology, 2016, 123(1): 152-181. DOI: org/10.1016/j.ophtha.2015.10.048.
9. Yagi T, Sakata K, Funatsu H, et al. Evaluation of perifoveal capillary blood flow velocity before and after vitreous surgery for epiretinalmembrane[J]. Graefe's Arch Clin Exp Ophthalmol, 2011, 250(3): 459-460. DOI: org/10.1007/s00417-011-1618-8.
10. Jia Y, Tan O, Tokayer J, et al. Split-spectrum amplitude-decorrelation angiography with optical coherence tomography[J]. Opt Express, 2012, 20(4): 4710-4725. DOI: org/10.1364/oe.20.004710.
11. Schwartz DM, Fingler J, Kim DY, et al. Phase-variance optical coherence tomography: a technique for noninvasive angiography[J]. Ophthalmology, 2014, 121(1): 180-187. DOI: org/10.1016/j.ophtha.2013.09.002.
12. Samara WA, Say EA, Khoo CT, et al Correlation of foveal avascular zone size with foveal morphology in normal eyes using optical coherence tomography angiography[J]. Retina, 2015, 35(11): 2188-2195. DOI: org/10.1097/iae.0000000000000847.
13. La Spina C, Carnevali A, Marchese A, et al. Reproducibility and reliability of optical coherence tomography angiography for foveal avascular zone evaluation and measurement in different settings[J]. Retina, 2017, 37(9): 1636-1641. DOI: 10.1097/IAE.0000000000001426.
14. Casselholmde Salles M, Kvanta A, Amrén U, et al. Optical coherence tomography angiography in central retinal vein occlusion: correlation between the foveal avascular zone and visual acuity[J]. Invest Ophthalmol Vis Sci, 2016, 57(9): 242-246. DOI: org/10.1167/iovs.15-18819.
15. Hussain N, Hussain A. Diametric measurement of foveal avascular zone in healthy young adults using optical coherence tomography angiography[J]. Int J Retina Vitreous, 2016, 2(12): 27-32. DOI: org/10.1186/s40942-016-0053-8.
16. Hashimoto Y, Saito W, Saito M, et al. Retinal outer layer thickness increases after vitrectomy for epiretinal membrane, and visual improvement positively correlates with photoreceptor outer segment length[J]. Graefe's Arch Clin Exp Ophthalmol, 2013, 252(2): 219-226. DOI: org/10.1007/s00417-013-2432-2.
17. Nishi Y, Shinoda H, Uchida A, et al. Detection of early visual impairment in patients with epiretinal membrane[J]. Acta Ophthalmol, 2013, 91(5): 353-357. DOI: org/10.1111/aos.12060.
18. Okamoto F, Sugiura Y, Okamoto Y, et al. Inner nuclear layer thickness as a prognostic factor for metamorphopsia after epiretinal membrane surgery[J]. Retina, 2015, 35(10): 2107-2114. DOI: 10.1097/IAE.0000000000000602.
19. Arimura E, Matsumoto C, Okuyama S, et al. Retinal contraction and metamorphopsia scores in eyes with idiopathic epiretinal membrane[J]. Invest Ophthalmol Vis Sci, 2005, 46(8): 2961-2966. DOI: org/10.1167/iovs.04-1104.
20. Yoshimi S, Fumiki O, Yoshifumi O, et al. Relationship between metamorphopsia and intraretinal cysts within the fluid cuff after surgery for idiopathic macular hole[J]. Retina, 2017, 37(1): 70-75. DOI: org/10.1097/iae.0000000000001136.

Chinese Journal of Ocular Fundus Diseases

Correlation of foveal avascular zone size with visual acuity and metamorphopsia in idiopathic macular epiretinal membrane eyes using optical coherence tomography angiography

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