Morphologic Assessment of Photoreceptors after Idiopathic Epiretinal Membrane Surgery with Adaptive-Optics SLO

Purpose This study aims to quantitatively assess morphological alterations in cone cells following idiopathic epiretinal membrane (IERM) surgery using adaptive optics scanning light ophthalmoscopy (AO-SLO) and to correlate these findings with retinal structure, retina vascular characteristic and visual function. Method This cross-sectional analysis involved seventeen eyes from 17 patients who underwent ERM surgery, compared to a control group of 35 demographically matched subjects. Comprehensive ophthalmologic evaluations were performed, including AO-SLO, spectral-domain optical coherence tomography (SD-OCT), and spectral-domain optical coherence tomography angiography (SD-OCTA). The study focused on assessing post-surgery cone density, dispersion, and regularity, as well as their relationship with visual function, macular structure, and macular vessel characteristics. Result A significant reduction in cone densities and regularity, along with a substantial increase in cone dispersion, were observed in all quadrants of eyes after ERM surgery compared to healthy eyes (mean cone densities: t=-4.76; P < 0.001; mean cone regularity: t=-5.11, P < 0.001; mean cone dispersion: t = 5.56, P < 0.001). Negative correlations were found between cone densities and best-corrected visual acuity (BCVA) (ρ=-0.62, P < 0.001). Additionally, average cone density correlated negatively with inner retinal thickness, particularly in the inferior quadrants (ρ = -0.42, P = 0.03), and with vascular density of the superficial capillary plexus (SCP) in the fovea (ρ = -0.39, P = 0.04), as indicated by OCTA. Conclusion The assessments of cone morphology using AO-SLO demonstrated persistent deviations from typical photoreceptor arrangements after ERM surgery, which are significantly associated with incomplete recovery of visual function. AO-SLO serves as an effective quantitative tool for identifying photoreceptor abnormalities in eyes after ERM surgery.