The Role of Gliosis in Idiopathic Epiretinal Membranes: New Insights

Purpose: To compare cloudy and clear epiretinal membranes (ERMs) using Multicolor Scanning Laser Ophthalmoscopy (MC-SLO) per stage and to assess gliotic components' impact on postoperative visual outcomes in patients undergoing surgery. Methods: Baseline and 6-month measurements included Snellen acuity (SA), central retinal thickness (CRT), the presence of microcystic macular edema (MME), outer retinal cysts (ORCs), and disruptions of the ellipsoid zone (EZ) and external limiting membrane (ELM). In addition, a quantitative analysis of gliosis using MC-SLO was performed. This study primarily evaluated postoperative SA improvement, CRT reduction, the prevalence of ERM remnants and inner retinal dimples. In addition, the relationship between gliotic components and postoperative outcomes was analyzed. Results: In Stage 2 ERMs, clear ERMs had a higher incidence of ERM remnants after surgery (81.8% vs. 30.8%, P = 0.037). Both groups experienced visual acuity improvement (clear ERMs: +25 ETDRS letter score, cloudy ERMs: +15 ETDRS letter score P = 0.013). In Stage 3 ERMs, no significant differences in SA or CRT changes were noted, but clear ERMs showed more inner retinal dimples ( P = 0.015). Gliosis area and EIFL thickness showed a significant correlation in cloudy Stage 3 ERMs ( P = 0.011). Conclusion: Clear and cloudy ERMs differ in postoperative recovery. Cloudy Stage 2 ERMs have less functional recovery but fewer remnants than clear ERMs. In Stage 3, gliosis correlates with EIFL thickness, and clear ERMs exhibit more inner retinal dimples.