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Purpose <p>To compare retinal remodeling and predictors of visual outcomes in advanced epiretinal membranes with retinal break (RB + ERM) and without retinal break (RB − ERM).</p> Methods <p>Retrospective observational study conducted on consecutive patients with stage 3 and 4 ERM who underwent pars plana vitrectomy with ERM peeling. Baseline and post-operative clinical and optical coherence tomography parameters—including ectopic inner foveal layer (EIFL) thickness, and presence of hyperreflective foci (HF)—were assessed. Multivariate analyses were conducted separately for the two conditions to examine the relationship between postoperative best-corrected visual acuity (BCVA) and a set of predictor variables.</p> Results <p>A total of 80 eyes from 80 patients were included: RB-ERM (<i>n</i> = 55) and RB + ERM (<i>n</i> = 25). At baseline, RB + ERM showed higher proportion of stage 4 ERMs compared to RB-ERM (<i>p</i> = 0.004), greater EIFL thickness (<i>p</i> = 0.003), and a higher number of HF in the EIFL (<i>p</i> = 0.042). After surgery, RB + ERM exhibited significantly greater reduction in EIFL thickness (<i>p</i> = 0.036) and in HF count within the EIFL compared to RB-ERM (<i>p</i> = 0.023). BCVA improvement was similar between the two groups (<i>p</i> = 0.917). In RB-ERM, multivariate regression identified older age, worse baseline BCVA, greater baseline EIFL and central macular thickness (CMT), and higher HF count within the EIFL as significant predictors of worse postoperative BCVA (<i>p</i> &lt; 0.05), whereas in RB + ERM, presence of preoperative intraretinal cysts, and older age showed a significant association with worse BCVA after surgery (<i>p</i> &lt; 0.05).</p> Conclusions <p>RB + ERM demonstrated more pronounced retinal remodeling and distinct predictors of postoperative BCVA compared with RB-ERM, suggesting different underlying pathophysiology, despite similar improvements in visual outcomes. Further prospective and longitudinal studies incorporating histopathological analyses are warranted to confirm these observations.</p>

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Distinct retinal remodeling and visual prognostic factors in advanced epiretinal membranes with and without associated retinal break

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月3日

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  • Nicola Valsecchi,
  • Giulio Rapezzi,
  • Matteo Elifani,
  • Alessandro Finzi,
  • Antonio Moramarco,
  • Luigi Fontana,
  • Maurizio Mete

摘要

Purpose

To compare retinal remodeling and predictors of visual outcomes in advanced epiretinal membranes with retinal break (RB + ERM) and without retinal break (RB − ERM).

Methods

Retrospective observational study conducted on consecutive patients with stage 3 and 4 ERM who underwent pars plana vitrectomy with ERM peeling. Baseline and post-operative clinical and optical coherence tomography parameters—including ectopic inner foveal layer (EIFL) thickness, and presence of hyperreflective foci (HF)—were assessed. Multivariate analyses were conducted separately for the two conditions to examine the relationship between postoperative best-corrected visual acuity (BCVA) and a set of predictor variables.

Results

A total of 80 eyes from 80 patients were included: RB-ERM (n = 55) and RB + ERM (n = 25). At baseline, RB + ERM showed higher proportion of stage 4 ERMs compared to RB-ERM (p = 0.004), greater EIFL thickness (p = 0.003), and a higher number of HF in the EIFL (p = 0.042). After surgery, RB + ERM exhibited significantly greater reduction in EIFL thickness (p = 0.036) and in HF count within the EIFL compared to RB-ERM (p = 0.023). BCVA improvement was similar between the two groups (p = 0.917). In RB-ERM, multivariate regression identified older age, worse baseline BCVA, greater baseline EIFL and central macular thickness (CMT), and higher HF count within the EIFL as significant predictors of worse postoperative BCVA (p < 0.05), whereas in RB + ERM, presence of preoperative intraretinal cysts, and older age showed a significant association with worse BCVA after surgery (p < 0.05).

Conclusions

RB + ERM demonstrated more pronounced retinal remodeling and distinct predictors of postoperative BCVA compared with RB-ERM, suggesting different underlying pathophysiology, despite similar improvements in visual outcomes. Further prospective and longitudinal studies incorporating histopathological analyses are warranted to confirm these observations.