Photo Credit: yogenyogeny

The following is a summary of “Microcystoid macular edema in epiretinal membrane: not a retrograde maculopathy,” published in the January 2025 issue of Ophthalmology by Govetto et al. 

Researchers conducted a retrospective study to examine the incidence, clinical spectrum, and pathophysiology of microcystoid macular edema (MME) in 2 cohorts of individuals with epiretinal membrane (ERM) and idiopathic full-thickness macular hole (FTMH).  

They reviewed clinical charts, structural and en-face optical coherence tomography (OCT), and fluorescein angiography (FA) images of individuals with ERM and FTMH who underwent surgery with pars plana vitrectomy and internal limiting membrane (ILM) peel, with at least 6 months of follow-up. Additionally, the histopathology analysis of 2 specimens with 2 human retinas and 1 human ILM was performed.  

The results showed that 172 participants, including 123 with ERM and 49 with FTMH, were followed for an average of 9.1 ± 4.7 and 8.2 ± 3.6 months, respectively. Preoperatively, MME was observed in 27 out of 123 ERM eyes (21.9%) and none of the 49 FTMH eyes (P <0.001) while, MME was significantly associated with advanced ERM stages (P <0.001) and was typically found beneath areas of continuous ERM-ILM adherence. The FA in 46 ERM eyes revealed capillary leakage in 36.4% of eyes without MME or cystoid macular edema (CME), 39% of eyes with MME, and increased hyperfluorescence in CME. Postoperatively, new-onset MME occurred in 13 out of 84 ERM eyes (15.5%) and 1 FTMH eye (2%, P =0.014). The MME resolved in 7 out of 40 ERM eyes with preoperative or postoperative MME (17.9%) by 2.8 ± 1.5 months post-surgery and MME evolution was variable after surgery, and the association between MME and postoperative best-corrected visual acuity was significant only in univariate analysis (P =0.037). Histopathology showed anatomical continuity between Müller cells and ERM, indicating a higher risk of iatrogenic damage in ERM eyes during ILM peeling.  

Investigators concluded that postoperative MME was common in ERM and rare in FTMH, indicating that ILM peeling alone might not cause MME, with ERM-related MME likely resulting from Müller cell disruption and iatrogenic damage, while the characteristics of MME and CME might overlap. 

Source: ajo.com/article/S0002-9394(25)00004-2/abstract