Clinical characteristics of patients with epiretinal membrane-Foveoschisis

Abstract

Purpose: The purpose of this study is to investigate the clinical and morphological characteristics of epiretinal membrane (ERM)-Foveoschisis.

Methods: Medical charts of 2088 patients diagnosed with idiopathic ERM were screened and eyes with ERM-Foveoschisis were included. All eyes underwent a complete ophthalmological examination including spectral domain optical coherence tomography (SD-OCT). OCT features and best corrected visual acuity (BCVA) were analysed. ERM-Foveoschisis was defined as open, closed, elevated or flat based on the OCT features. Ellipsoidal zone (EZ) abnormality, intraretinal cystoid spaces, central foveal thickness (CFT), posterior vitreous detachment (PVD) and lens status were assessed.

Results: One hundred-sixty-six patients (175 eyes) (72% female, mean age 70.46 years) were included. Incidence of ERM-Foveoschisis was 6.7%. Open type was seen in 86.8% and had a significantly better mean BCVA than closed type (p = 0.01). No statistically significant difference of mean BCVA was noted between the elevated and flat types. Mean BCVA was significantly lower in eyes with EZ abnormality (p = 0.03) and eyes with intraretinal cystoid spaces (p = 0.02). Patients with 'closed' ERM-Foveoschisis showed a significant higher median CFT than 'open' ERM-Foveoschisis (respectively, 364 µm and 176 µm, p < 0.001). A total of 81.9% eyes had PVD.

Conclusion: We differentiated four morphological types of ERM-Foveoschisis based on the OCT examination. Closed ERM-Foveoschisis presented with a higher CFT and lower BCVA than the open type. ERM-Foveoschisis with cystoid intraretinal spaces presented with a lower BCVA. The impact of the morphological types of the ERM-Foveoschisis on the clinical course and for therapy decision requires further long-term studies.

Keywords: Degenerative lamellar macular hole; Epiretinal membrane; Foveoschisis; Lamellar macular hole; Optical coherence tomography; Tractional lamellar hole.

Fig. 1

SD-OCT B-Scans of the open and closed type ERM-Foveoschisis. a The ERM (white arrowheads) spares the fovea in open type ERM-Foveoschisis. Note the separation of the outer nuclear layer from the outer plexiform layer (open white arrowheads) and the intraretinal cystoid spaces (black arrowhead). b The ERM covers the fovea in closed type ERM-Foveoschisis (arrowhead)

Fig. 2

SD-OCT B-Scans of the elevated and flat type ERM-Foveoschisis. a The edges of the foveal border are higher than the retinal surface in elevated type ERM-Foveoschisis (arrowhead). b The edges of the foveal borders are on the same level with the rest of the foveal surface, defined as flat type of ERM-Foveoschisis (arrowhead)