title: Insights Into Epiretinal Membranes: Presence of Ectopic Inner Foveal Layers and a New Optical Coherence Tomography Staging Scheme.
abstract: OBJECTIVE
  To describe the presence of continuous ectopic inner foveal layers associated with epiretinal membranes (ERMs) and to present a new optical coherence tomography (OCT) staging system of ERMs.
  
  
  METHODS
  Retrospective multicenter observational case series.
  
  
  METHODS
  Clinical charts and spectral-domain OCT images of 194 eyes of 172 consecutive patients diagnosed with ERMs were reviewed and analyzed.
  
  
  RESULTS
  The presence of continuous ectopic inner foveal layers was identified in 63 out of 194 eyes (32.5%) and this morphology was significantly associated with lower visual acuity. ERMs were divided into 4 stages. Stage 1 (43 out of 194 eyes, 22.1%) ERMs were mild and thin and a foveal depression was present. Stage 2 (88 out of 194 eyes, 45.4%) ERMs were associated with widening of the outer nuclear layer and loss of the foveal depression. Stage 3 (51 out of 194 eyes, 26.3%) ERMs were associated with continuous ectopic inner foveal layers crossing the entire foveal area. In stages 1, 2, and 3 all retinal layers were clearly defined on OCT. Stage 4 ERMs (12 out of 194 eyes, 6.2%) were thick and associated with continuous ectopic inner foveal layers. In addition, retinal layers were disrupted. Visual acuity progressively declined from stage 1 through stage 4 (P < .001).
  
  
  CONCLUSIONS
  The presence of continuous ectopic inner foveal layers in ERMs is a newly described OCT finding associated with significant vision loss and is an essential element of a novel OCT-based grading scheme of ERMs that may influence visual prognosis.
authors.affiliation: Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California. Electronic address: a.govetto@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Govetto
authors.affiliation: Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lalane
authors.affiliation: Retinal Disorders and Ophthalmic Genetics Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California; Greater Los Angeles VA Healthcare Center, Los Angeles, California.
authors.forename: David
authors.initials: D
authors.lastname: Sarraf
authors.affiliation: Retina Division, Ophthalmology Department, Ramon y Cajal University Hospital, Madrid, Spain.
authors.forename: Marta S
authors.initials: MS
authors.lastname: Figueroa
authors.affiliation: Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, California.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Hubschman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019773:Epiretinal Membrane / Q000175:diagnosis*; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005584:Fovea Centralis / Q000000981:diagnostic imaging*; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity