Purpose

To investigate correlations between clinical and histopathologic characteristics of idiopathic epiretinal membrane (ERM).

Design

Retrospective interventional case series.

Participants

In total, 87 eyes from 87 patients with idiopathic ERM who underwent pars plana vitrectomy with peeling of the ERM from 2019 to 2020 were included.

Methods

The outcomes of clinical ophthalmic examination, including measurement of best-corrected visual acuity (BCVA) and spectral-domain OCT (SD-OCT), before and after surgery were reviewed. Surgical specimens were fixed in formalin and embedded in paraffin for histologic and immunohistochemical analysis.

Main Outcomes Measures

The association between morphological characteristics revealed on SD-OCT images and the cellular composition of the surgically excised ERM demonstrated with immunohistochemical staining were the main outcome measures. Changes in the BCVA and central macular thickness (CMT) were assessed through a comparison of preoperative and postoperative measurements.

Results

Based on SD-OCT morphological characteristics in the foveal area, 15 cases were classified into group 1A (mainly outer retinal thickening), 39 into group 1B (more tenting of the outer retina and distorted inner retina), and 33 into group 1C (prominent inner retina thickening). Overall, postoperative final BCVA and CMT at 1 year improved in all groups. Patients who presented with a better initial BCVA exhibited a more favorable final BCVA. Epiretinal membranes in group 1C demonstrated the greatest decrease in CMT compared with those in groups 1B and 1A, but the final CMT did not differ among the groups. A negative correlation between the density of hyalocytes (P = 0.003) and myofibroblasts (P = 0.047) was noted between the 3 groups. Total cell density and glial cell density of the ERMs were strongly associated with poor final BCVA and BCVA improvement.

Conclusions

The present study provides new histopathologic information regarding the formation and progression of idiopathic ERM. Glial cell proliferation plays a predominant role in these processes. Epiretinal membranes with high cellularity and glial cell density may cause damage to the retina structure, resulting in poor postoperative visual outcomes. These findings provide additional evidence supporting early surgical intervention in patients with idiopathic ERM reported with visual disturbance.

中文翻译：

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特发性视网膜前膜临床和组织病理学特征的相关性

目的

旨在研究特发性视网膜前膜 (ERM) 的临床和组织病理学特征之间的相关性。

设计

回顾性介入病例系列。

参加者

总共纳入了 87 名特发性 ERM 患者的 87 只眼，这些患者在 2019 年至 2020 年间接受了睫状体玻璃体切除术并剥离了 ERM。

方法

回顾了手术前后临床眼科检查的结果，包括最佳矫正视力 (BCVA) 和光谱域 OCT (SD-OCT) 的测量。手术标本在福尔马林中固定并包埋在石蜡中用于组织学和免疫组织化学分析。

主要成果措施

SD-OCT 图像显示的形态学特征与免疫组织化学染色显示的手术切除的 ERM 的细胞组成之间的关联是主要的结果测量指标。通过比较术前和术后测量值来评估 BCVA 和中央黄斑厚度 (CMT) 的变化。

结果

根据中央凹区SD-OCT形态特征，15例分为1A组（主要为外层视网膜增厚），39例分为1B组（外层视网膜隆起较多，内层视网膜变形），33例分为1C组（突出内层视网膜增厚）。总体而言，所有组术后 1 年的最终 BCVA 和 CMT 都有所改善。具有更好初始 BCVA 的患者表现出更有利的最终 BCVA。与 1B 和 1A 组相比，1C 组的视网膜前膜表现出 CMT 的最大降低，但最终的 CMT 在各组之间没有差异。透明细胞密度 ( P  = 0.003) 与肌成纤维细胞 ( P = 0.047) 在 3 组之间被注意到。ERM 的总细胞密度和神经胶质细胞密度与较差的最终 BCVA 和 BCVA 改善密切相关。

结论

本研究提供了有关特发性 ERM 的形成和进展的新组织病理学信息。神经胶质细胞增殖在这些过程中起主要作用。具有高细胞结构和神经胶质细胞密度的视网膜前膜可能会对视网膜结构造成损伤，从而导致术后视觉效果不佳。这些发现提供了额外的证据，支持对报告有视力障碍的特发性 ERM 患者进行早期手术干预。