Spectral domain optical coherence tomography characterization of pediatric epiretinal membranes

Abstract

Purpose: To compare the macular morphology of pediatric versus adult eyes with epiretinal membrane (ERM) using spectral domain optical coherence tomography and identify characteristics associated with postoperative visual acuity.

Methods: This retrospective study analyzed spectral domain optical coherence tomography from pediatric subjects and a randomly selected cohort of adult subjects with ERM. Morphologic retinal and ERM features were graded by two masked spectral domain optical coherence tomography readers and compared with a postoperative change in visual acuity.

Results: Pediatric ERMs (age, 0.3-16.5 years) were more confluently attached to the retina than adult ERMs (age, 40-88 years; P = 0.009) and had less fibrillary appearance of the inner retina when separation was present (P = 0.044). Pediatric ERMs were associated with more vessel dragging (P = 0.019) and less external limiting membrane (P = 0.001) and inner segment band visibility (P = 0.010), with a trend toward foveal sparing by ERM (P = 0.051) and "taco" retinal folds (P = 0.052) compared with adult eyes. Visual acuity improvement was associated with intact (P = 0.048) and smooth (P = 0.055, trend) inner segment band in children and with smooth inner segment band (P = 0.083, trend) and visible external limiting membrane (P = 0.098, trend) in adults.

Conclusion: We identified morphologic differences between pediatric and adult ERM on spectral domain optical coherence tomography. Similar to adults, photoreceptor integrity with pediatric ERM seems to predict better visual acuity changes after surgical ERM removal.

Figures

Figure 1. Vessel Traction Score for Cellophane Macular Reflex and Premacular Fibrosis Epiretinal Membranes

Fundus photographs demonstrate both types of epiretinal membrane (ERM) and vessel traction scoring. Superior and inferior temporal veins are measured at a distance of two optic nerve heads from the center of the optic disc. A displays a 68 year old subject with idiopathic cellophane macular reflex ERM (note the lack of retinal folds). B displays an 11 year old subject with a premacular fibrosis-type ERM (with associated retinal folds) secondary to a combined hamartoma of the retina and retinal pigment epithelium. C Both temporal veins fall within sector 0 for the adult. D For the child, the superior temporal vein falls within sector 2 and the inferior temporal vein within sector 1.

Figure 2. Fibrillary Separation of Epiretinal Membrane in an Adult with “Ripple Folds” and Intact, Smooth Outer Bands

Infrared fundus image (left) and SDOCT image (right) of a 65 year old subject with idiopathic epiretinal membrane (ERM) with “ripple” folds on SDOCT. Traction lines on fundus image classify ERM as premacular fibrosis. A Separation of the ERM from the inner retinal surface with fibrillary changes on the inner retinal contour. B Undisrupted external limiting membrane. C Smooth, undisrupted inner segment band.

Figure 3. Epiretinal Membrane With Minimal Separation and a Smooth Retinal Contour in a Child with a “Taco” Fold and Disrupted Outer Bands

Infrared fundus image (left) and SDOCT image (right) of a 16 year old subject with an epiretinal membrane (ERM) with “taco” fold secondary to previous retinal detachment. Retinal folds on fundus image classify ERM as premacular fibrosis. A Separation of the ERM from the inner retinal surface with no fibrillary changes on the inner retinal contour with an underlying single, deep “taco” fold. B Disrupted external limiting membrane. C Disrupted inner segment band with ragged inner segment band to the left.