Turkiye Klinikleri Journal of Ophthalmology

.: ORIGINAL RESEARCH
Importance of Ectopic Inner Foveal Layer Staging in Idiopathic Epiretinal Membrane: Cross-Sectional, Retrospective Research
Ektopik İç Foveal Tabaka Evrelemesinin İdiyopatik Epiretinal Membranda Önemi: Kesitsel, Geriye Dönük Araştırma
Mehmet İÇÖZa , Mücella ARIKAN YORGUNb , Yelda YILDIZ TASÇIc , Yasin TOKLUb
aClinic of Ophthalmology, Yozgat City Hospital, Yozgat, Türkiye
bDepartment of Ophthalmology, Yıldırım Beyazıt University Faculty of Medicine, Ankara, Türkiye
cClinic of Ophthalmology, Ankara City Hospital, Ankara, Türkiye
Turkiye Klinikleri J Ophthalmol. 2024;33(1):7-14
doi: 10.5336/ophthal.2023-98823
Article Language: EN
Full Text
ABSTRACT
 Objective: To determine the significance of the presence of ectopic inner foveal layer (EIFL) in cases with idiopathic epiretinal membrane (iERM). Material and Methods: Optical coherence tomography (OCT) images of 140 cases with iERM at the initial examination were evaluated. According to their EIFL staging,the cases were divided into four stages. For all cases, best corrected visual acuity (BCVA) and obtained from OCT measurements, including the central foveal thickness (CFT), central retinal thickness (CRT), maximum retinal thickness (MRT), inner nuclear layer (INL) thickness, outer nuclear layer (ONL) thickness, inner retinal layer (IRL) thickness,outer retinal layer (ORL) thickness, and ganglion cell layer+inner plexiform layer (GCL+IPL) thicknesses, as well as total photoreceptor length (TPL), photoreceptor outer segment length (PROSL), photoreceptor deformity index (PDI), and inner retinal layer irregularity index (IRLII) were recorded. In cases where the retinal layers were clearly visualized, ORL damage, foveal bulge, and the presence of the cotton ball sign were evaluated. Results: According to EIFL staging, there were 22 cases in Stage 1, 45 cases in Stage 2, 44 cases in Stage 3, and 29 cases in Stage 4. BCVA was higher in Stages 1 and 2 than in Stages 3 and 4 (p<0.001). CFT, CRT, MRT, GCL+IPL thicknesses, and IRL and IRLII values increased higher as the EIFL stage increased (p<0.001 for all). INL, ONL, and ORL thicknesses, TPL, PROSL, and PDI were similar between the groups (p>0.05 for all). As the EIFL stage increased, ORL damage and the presence of the cotton ball sign were detected at a higher rate (p<0.001), whereas foveal bulge was observed less frequently (p=0.004). Conclusion: The presence of EIFL is associated with worse visual acuity in cases with iERM. As the EIFL stage increases, IRL thickness and ORL damage become more common.

Keywords: Ectopic inner foveal layer; idiopathic epiretinal membrane; inner retina; stage; visual acuity
ÖZET
 Amaç: Çalışmanın amacı, idiyopatik epiretinal membranlı (iERM) olgularda, ektopik iç foveal tabaka (EİFT) varlığının önemini belirlemektir. Gereç ve Yöntemler: iERM'si olan 140 olgunun, başlangıç muayenelerindeki optik koherens tomografi (OKT) görüntüleri değerlendirildi. EİFT evrelemesine göre olgular 4 evreye ayrıldı. Tüm olguların en iyi düzeltilmiş görme keskinlikleri (EİDGK) ile OKT görüntülerinden elde edilen; santral foveal kalınlık (SFK), santral retinal kalınlık (SRK), maksimum retinal kalınlık (MRK), iç nükleer tabaka (İNT), dış nükleer tabaka (DNT), iç retinal tabaka (İRT), dış retinal tabaka (DRT), gangliyon hücre tabaka+iç pleksiform tabaka (GHT+İPT) kalınlıkları ile toplam fotoreseptör uzunluğu (TFU), fotoreseptör dış segment uzunluğu (FDSU), fotoreseptör deformite indeks (FDİ) ve iç retinal tabaka düzensizlik indeks (İRTDİ) değerleri kaydedildi. Ek olarak retinal tabakaların net değerlendirilebildiği olgularda dış retinal katman hasarı, foveal bulge ve pamuk topu varlığı değerlendirildi. Bulgular: EİFT evrelemesine göre Evre 1'de 22, Evre 2'de 45, Evre 3'te 44, Evre 4'te 29 olgu mevcut idi. EİDGK, Evre 1 ve 2'de Evre 3 ve 4'e göre daha yüksek idi (p<0,001). SFK, SRK, MRK, GHT+İPT, İRT ve İRTDİ değerlerinin EİFT evresi arttıkça daha yüksek olduğu gözlendi (tüm değerlerde, p<0,001). İNT, DNT, DRT, TFU, FDSU ve FDİ değerleri evreler arasında benzerdi (tüm değerlerde p>0,05). Dış retinal tabaka hasarı ve pamuk topu varlığı evre yükseldikçe daha çok gözlenirken, foveal bulge daha az saptandı (p<0,001, p=0,004). Sonuç: iERM olgularında EİFT varlığı daha kötü görme keskinliğiyle ilişkilidir. EİFT evresi arttıkça iç retinal katman kalınlıkları artar ve dış retinal katman hasarı daha sık görülür.

Anahtar Kelimeler: Ektopik iç foveal tabaka; idiyopatik epiretinal membran; iç retina; evre; görme keskinliği
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