The visual outcomes of idiopathic epiretinal membrane removal in eyes with ectopic inner foveal layers and preserved macular segmentation



To analyze the functional impact of ectopic inner foveal layers (EIFL), along with other clinical and optical coherence tomography biomarkers, on patients with epiretinal membrane (ERM) and preserved foveal layers’ segmentation undergoing ERM removal.


Retrospective review of consecutive patients with ERM who underwent pars plana vitrectomy with ERM peeling from December 2018 to December 2019. Baseline factors including age, gender, lens status, phacoemulsification at the time of surgery, tamponade agent, dye used for ERM and internal limiting membrane (ILM) enhancement, ILM peeling, best-corrected visual acuity (BCVA) and central macular thickness (CMT), presence and thickness of EIFL, thickness of outer nuclear layer (ONL), presence of a cotton ball, subfoveal state of photoreceptors, and presence of cystoid macular edema were included in a multivariable model having the BCVA at 12 months as the main outcome. The changes in EIFL and ONL thickness over time were also analyzed.


Fifty-one patients (58 eyes, 23 eyes in the no EIFL group, and 35 eyes in the EIFL group) were enrolled. The BCVA significantly improved over 12 months after surgery, regardless of the presence of EIFL (p < 0.001). Eyes with no EIFL had better BCVA at month 3 (p = 0.04), but this difference was no longer detectable at 6 and 12 months. The presence of EIFL was not associated with the final BCVA (p = 0.9), while the CMT at 12 months correlated with EIFL thickness (r = 0.8, p = 0.008).


Patients with EIFL could reach optimal visual acuity in the absence of disorganization of the inner retinal layers but should be warned of potentially longer healing times. None of the morphologic signs included in this study precluded good visual recovery on long-term follow-up.

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Data availability

Data are available upon request to the corresponding authors.

Code availability

Statistical software (R) and statistical packages used for this study are open access and adequate reference is provided.


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Author information




Michele Coppola: conceptualization, writing—original draft

Maria Vittoria Cicinelli, Maria Brambati, Alessandro Marchese: methodology, writing—review and editing

Emma Clara Zanzottera, Antonio Peroglio Deiro, Michal Post: visualization, data curation

Francesco Bandello: project administration, supervision

Corresponding author

Correspondence to Maria Vittoria Cicinelli.

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Ethics approval and consent to participate

The study received the approval of the San Gerardo ASST Monza IRB. Patients signed written consent at the time of enrollment to be included in observational clinical research studies.

Conflict of interest

The authors declare that they have no conflict of interest.

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Supplementary Information

Supplementary Fig 1

Percentage of missing data. EIFL: ectopic inner foveal layer; ONL: outer nuclear layer; VA: visual acuity; CMT: central macular thickness (PDF 5 kb).


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Coppola, M., Brambati, M., Cicinelli, M.V. et al. The visual outcomes of idiopathic epiretinal membrane removal in eyes with ectopic inner foveal layers and preserved macular segmentation. Graefes Arch Clin Exp Ophthalmol (2021).

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  • Epiretinal membrane
  • Ectopic inner foveal layer
  • Pars plana vitrectomy
  • Optical coherence tomography
  • Biomarkers