Subtyping stage 3 epiretinal membrane: a comprehensive study of ectopic inner foveal layers architecture and its clinical implications

Aims To evaluate the visual function and foveal architecture in patients with stage 3 idiopathic epiretinal membrane (iERM). Methods A cross-sectional observational study included 56 eyes of 52 patients with stage 3 iERM. The patients were classified into type A ectopic inner foveal layers (EIFL) and type B EIFL based on the presence of a continuous hyporeflective band. Visual function and foveal microarchitecture were assessed in enrolled eyes. Best-corrected visual acuity (BCVA), metamorphopsia scores, retinal sensitivity and optical coherence tomography (OCT)/OCT angiography features were compared between two subtypes. Result The BCVA in type A EIFL and type B EIFL was 0.22 logarithm of minimal angle of resolution (logMAR) (0.15 logMAR, 0.40 logMAR) and 0.53 +/- 0.23 logMAR, respectively (p=0.002). Type B EIFL had higher average metamorphopsia scores, especially horizontal metamorphopsia scores, than type A (p=0.013, p=0.007, respectively). Type B EIFL had worse central 2 degrees foveal sensitivity than type A (p=0.034). Type B EIFL had thicker central foveal thickness and EIFL thickness (514.08 +/- 73.80 mu m vs 444.41 +/- 56.57 mu m, p=0.001; 159.75 +/- 78.30 mu m vs 48.44 +/- 18.37 mu m, p<0.0001; respectively). The foveal avascular zone area of type B EIFL was smaller than that of type A (0.042 +/- 0.022 mm(2) vs 0.077 +/- 0.039 mm(2), p<0.0001). The vessel density and flow area of the superficial vascular complex in type B EIFL were larger than those in type A (both p=0.001). Conclusions Type B EIFL demonstrated significantly worse visual function than type A EIFL, along with marked differences in foveal microstructure and microvasculature. Our study complements the current staging of iERM and helps determine the optimal timing of iERM surgery.