Assessment of microcystoid macular edema in postoperative epiretinal membrane using adaptive optics scanning laser ophthalmoscopy and swept-source optical coherence tomography: a pilot study.

PURPOSE: To characterize multimodal imaging features and potential mechanisms of microcystoid macular edema (MME) in epiretinal membrane (ERM), and explore postoperative heterogeneity in retinal structure and visual recovery. METHODS: This pilot study included patients with idiopathic ERM postoperatively. Patients were categorized into MME and non-MME (NMME) groups based on postoperative SS-OCT findings. Postoperative multimodal retinal imaging features were detected using adaptive optics scanning laser ophthalmoscopy (AO-SLO) and swept-source optical coherence tomography (SS-OCT) and compared between the two groups. RESULTS: A total of 40 eyes of 40 patients were enrolled in the current study. There was no significant difference in baseline characteristics between the two group (All P > 0.050). AO-SLO revealed microcysts, waxy membranes, hyperreflective foci, hyporeflective zones, and microfolds. Dissociated optic nerve fiber layer was observed in 29 eyes (72.5%), comprising 17 eyes in the NMME group and 12 eyes in the MME group (P = 0.279). Compared with the NMME group, the MME group showed increased central retinal thickness (P = 0.016), inner nuclear layer thickness (P = 0.016), and vessel density in the deep vascular complex (P = 0.029), along with thinner retinal nerve fiber layer (P = 0.019). CONCLUSIONS: Postoperative MME in ERM may be associated with ERM-induced traction, Müller cell dysfunction, and remodeling of retinal structure and microcirculation. In this pilot study, the presence of postoperative MME may reflect a distinct pattern of biological injury and recovery in ERM. AO-SLO and SS-OCT provide insights into biological heterogeneity, aiding personalized postoperative evaluation.