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Abstract Introduction Diabetic macular oedema (DMO) is a complication of diabetic retinopathy that can result in vision loss. The disease can impact different spheres of a patient’s life, including physical and psychological health, work, and activities of daily living, entailing an important use of healthcare and non-healthcare resources. This study aimed to estimate the socio-economic burden of DMO in Spain. Methods The burden of DMO was estimated from a societal perspective, per patient, year of treatment since diagnosis, and type of treatment. Four categories were considered: direct healthcare costs (DHC), direct non-healthcare costs (DNHC), labour productivity losses (LPL), and intangible costs (IC) associated with loss of quality of life. Average annual costs were calculated by multiplying the resources used per patient by their corresponding unit price (or financial proxy). For a more accurate estimation, differences in resource use between treatments (intravitreal anti-vascular endothelial growth factor injections of ranibizumab or aflibercept, and intravitreal dexamethasone implants) and year since diagnosis (first, second, and third year or beyond) were considered and presented separately. The reference year for costs was 2021. Results The average annual costs of DMO in the first year of treatment after diagnosis was estimated at €18,774, €17,512, and €16,188 per patient treated with ranibizumab, aflibercept, and dexamethasone, respectively. This burden would be reduced to €15,783, €15,701, and €12,233 in the second year, and to €15,119, €15,043, and €12,790 in the third year, respectively. Diagnosis of DMO entails an additional one-off cost of €485. DHC accounted for the greatest proportion of total annual costs per patient, independent of the year, with LPL also making an important contribution to total costs. Conclusions The socio-economic impact of DMO on patients, the healthcare system, and society at large is substantial. The constant increase in its prevalence accentuates the need for planning and implementation of healthcare strategies to prevent vision loss and reduce the socio-economic burden of the disease.

Abstract Introduction Neovascular age-related macular degeneration (nAMD) is a progressive retinal disease that causes severe and irreversible vision loss. The disease can therefore have a significant impact on the life of patients’ and their families. The aim of this study was to evaluate the socio-economic burden of nAMD in Spain. Methods The annual cost per patient with nAMD was estimated for the first, second, and third year (or beyond) of treatment since diagnosis. Several cost categories were considered including direct healthcare costs (DHC), direct non-healthcare costs (DNHC), labor productivity losses (LPL), and intangible costs (IC) related to loss of quality of life. The average annual cost per patient was estimated by assigning a unit price or financial proxy to the resources consumed per patient. Reference year of costs was 2021. Results The mean annual cost of nAMD was estimated at €17,265, €15,403, and €14,465 per patient in the first, second, and third year of treatment after diagnosis. There was an additional one-off cost of €744 associated with the diagnosis of nAMD. DHC accounted for most of the total annual cost per patient independent of the year of treatment since diagnosis (48% in year 1; 42% in year 2; 39% in year 3). Similarly, DNHC had an important contribution to the total costs (32% in year 1; 35% in year 2; 37% in year 3), followed by IC (20% in year 1; 23% in year 2; 24% in year 3), while the contribution of patients’ LPL was minimal. Conclusion This study estimated a high economic burden associated with nAMD for patients and their families, the healthcare system, and society at large. There is a need to improve the management of these patients to reduce the impact of nAMD disease progression.

Abstract Geographic atrophy is an eye disease that greatly interferes with the daily lives of patients and their families, posing a serious threat to the aging European demographic. Over the past 30 months, this initiative has assembled leading experts in the field of ophthalmology to share insights on the necessary policy steps that need to be taken to overcome this challenge on an EU-wide scale. Through analyzing best practices in Germany, Italy, France, and Spain, this consensus paper sets out a series of policy recommendations, which, if implemented, could greatly benefit all individuals affected by geographic atrophy. Amongst other features, these countries have provided valuable examples of awareness campaigns and an overall commitment to inclusive and comprehensive policies. The policy recommendations emerging from this paper include the adoption of comprehensive screening programs, retinal disease screening in the EU Driving License Directive, the development of a white paper at the European Commission, and the creation of Council recommendations on eye health screening. Given the significant improvements made at the national level throughout the EU, countries will require unitary support at the European level to further develop their policies and successfully address the burden of geographic atrophy.

Abstract Background The purpose is to report the second case, to our knowledge, of suspected paclitaxel-induced phototoxic maculopathy following pars plana vitrectomy surgery. Case presentation 63-year-old phakic female who underwent an uneventful phaco-vitrectomy to treat a complete macular hole, developing macular phototoxicity in the post-operatively period that could not be explained by the surgery itself and could only be attributed to a possible photosensitization induced by the previous use of paclitaxel. Conclusions The use of paclitaxel has been widely extended as a chemotherapy drug to treat breast cancer. It works by altering the intracellular microtubular reorganization and, based on this mechanism of action, photosensitivity has been previously described. We report a case of suspected paclitaxel-induced macular phototoxicity following ocular endoillumination during vitrectomy surgery.

Abstract Background The aim of this study was to determine the 25-hydroxy vitamin D (25(OH)D) levels in age-related macular degeneration (AMD) patients. Methods Age-related macular degeneration (AMD) patients were classified into four groups: early AMD (N = 10), intermediate AMD (N = 12), advanced atrophic AMD (N = 19) and advanced neovascular AMD (N = 52) after undergoing fundus photography. Serum 25(OH)D levels of all subjects were evaluated. From a random control group of 326 patients whose 25(OH)D levels had been measured, a group of 93 were selected to match the age range of the AMD group. We measured 25(OH)D levels during the same period to rule out seasonal variation. Results A total of 93 AMD patients (36 males and 57 females) and 93 healthy individuals (39 males and 54 females) were enrolled in this study with the mean age of 78.96 ± 8.46 vs. 78.80 ± 8.35, respectively. The patients affected by AMD had statistically significant lower 25(OH)D levels (15 ± 10 ng/mL) than the healthy subjects control group (21 ± 14 ng/mL) (p = 0.004). However, the median 25(OH)D levels in early AMD, intermediate AMD, advanced atrophic AMD and advanced neovascular AMD (12.5 ± 7.3; 15 ± 11; 15 ± 8 and 17 ± 11.5, respectively) were not statistically significant (p = 0.442). Conclusion This study shows that patients affected by AMD had lower vitamin D levels compared to healthy subjects. Further research is necessary to investigate the possible association between 25(OH)D levels and AMD.

La afectación ocular secundaria a candidemia suele ocurrir frecuentemente en pacientes cuyo estado de salud se encuentra comprometido, ya sea por déficits inmunitarios, presencia de catéteres o cirugías recientes. Por ello es necesario realizar un diagnóstico temprano unido a un seguimiento estrecho de la enfermedad. Actualmente existen diversas opciones de diagnóstico por imagen que nos permiten llevar a cabo esta evaluación, permitiéndonos hacer un seguimiento del proceso inflamatorio e infeccioso, así como identificar las complicaciones que pueden surgir en este. Presentamos el caso de una paciente mujer de 22 años con coriorretinitis por cándida en el contexto de un ingreso hospitalario por reintervención de cirugía bariátrica. Durante el trascurso de la enfermedad fue tratada con antifúngicos intravenosos, pasando a tratamiento intravítreo con voriconazol y aflibercept en el ojo derecho por la progresión de la infección y la aparición de una membrana neovascular coroidea, detectada por medio de la imagen multimodal.

Patricia Udaondo,1 Alfredo Adan,2 Luis Arias-Barquet,3 Francisco J Ascaso,4 Francisco Cabrera-López,5 Verónica Castro-Navarro,6 Juan Donate-López,7 Alfredo García-Layana,8 Francisco Javier Lavid,9 Mariano Rodríguez-Maqueda,10 José María Ruiz-Moreno11 1Department of Ophthalmology, Hospital Universitario y Politecnico la FE, Valencia, Spain; 2Department of Ophthalmology, Hospital Clinic Barcelona, Barcelona, Spain; 3Department of Ophthalmology, University Complex Bellvitge, Barcelona, Spain; 4Department of Ophthalmology, Hospital Universitario Lozano Blesa, Zaragoza, Spain; 5Department of Ophthalmology, Hospital Universitario Insular, Las Palmas de Gran Canaria, Spain; 6Department of Ophthalmology, Hospital General Universitario, Valencia, Spain; 7Department of Ophthalmology, Hospital Clínico San Carlos, Madrid, Spain; 8Department of Ophthalmology, Clínica Universitaria de Navarra, Pamplona, Spain; 9Department of Ophthalmology, Hospital Punta Europa, Algeciras, Cádiz, Spain; 10Department of Ophthalmology, Hospital Virgen del Rocío, Sevilla, Spain; 11Department of Ophthalmology, Hospital Puerta de Hierro, Majadahonda, Madrid, SpainCorrespondence: Patricia UdaondoAiken Prevención y Cirugía ocular, Pizarro, 15 Bajo, Valencia, 46004, SpainTel +34647869228Email draudaondo@gmail.comPurpose: This paper aimed to present daily-practice recommendations for the management of diabetic macular edema (DME) patients based on available scientific evidence and the clinical experience of the consensus panel.Methods: A group of Spanish retina experts agreed to discuss different aspects related with the clinical management of DME patients.Results: Panel was mainly focused on therapeutic objectives in DME management; definition terms; and role of biomarkers as prognostic and predictive factors to intravitreal treatment response. The panel recommends to start DME treatment as soon as possible in those eyes with a visual acuity less than 20/25 (always according to the retina unit capacity). Naïve patient was defined, in a strict manner, as a patient who, up to that moment, had never received any treatment. A refractory DME patient may be defined as the one who did not achieve a complete resolution of the disease, regardless of the treatment administered. Different optical coherence tomography biomarkers, such as disorganization of the retinal inner layers, hyperreflective dots, and cysts, have been identified as prognostic factors.Conclusion: This document has sought to lay down a set of recommendations and to identify key issues that may be useful for the daily management of DME patients.Keywords: diabetes, diabetic macular edema, optical coherence tomography, inflammation, biomarkers, consensus

Abstract Background Hyperreflective lesions at the level of ganglion cell (GCL) and inner plexiform retinal layers (IPL) by optical coherence tomography (OCT) and cotton wool spots in the examination of the eye fundus have recently been described as findings in patients with COVID-19 infection. Case report We report the case of a 42-year-old healthy Caucasian male anesthetist who had treated COVID-19 patients during the previous 5 weeks and suddenly presented with a temporal relative scotoma in his left eye. Best-corrected visual acuity was 20/20 for the left eye, and no discromatopsy or afferent pupillary defect was present. Visual field test was performed, with no significant findings associated with the focal loss of sensitivity described by the patient. The anterior segment was unremarkable on slit lamp examination in both eyes. Fundus examination of the left eye showed no significant findings. A placoid, hyperreflective band at the level of the GCL and IPL was visible in OCT which spared the outer retina, at the time of diagnosis and 1 month later. An oropharyngeal swab test was performed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid (RNA), immunoglobulin G (IgG) and immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA) determination. Real-time reverse-transcriptase polymerase chain reaction (RT-PCR) was negative. ELISA testing and a third rapid antibody detection test performed 7 days after the onset of symptoms were positive. Conclusions Ocular signs and symptoms in COVID-19 cases are rarely reported, but may be underestimated, especially those that affect the retina and occur in asymptomatic or paucisymptomatic cases. We present a case of COVID-19 diagnosis based on retinal ophthalmic examination.

Abstract Background The DRCR.net Protocol T clinical trial assessed the comparative efficacy and safety of anti-VEGF treatments including aflibercept, ranibizumab and bevacizumab in diabetic macular edema (DME). Post -hoc analyses showed that after a 12-week induction period, there was still DME resolution in an increasing number of patients through week 24. Purpose To assess clinical and cost consequences of extending the anti-VEGF loading dose from 3 to 6 monthly injections in patients with persistent DME in Spain. Methods From a hospital pharmacy perspective, a cost-consequence analysis model was developed to estimate the incremental cost needed to obtain an additional response at month 6. To estimate drug treatment costs, ex-factory prices (€, 2019) were considered for aflibercept, ranibizumab and bevacizumab. Response/nonresponse rates at 3/6 months were obtained from the Protocol T 24-week post hoc analysis (n = 546). Persistent DME was present in 50.8 and 31.6% of the 190 aflibercept-treated patients at month 3 and month 6, respectively. Of the 176 ranibizumab- and 180 bevacizumab-treated patients, 53.2 and 72.9%, respectively, had persistent DME at month 3, and 41.5 and 65.6%, respectively, had persistent DME at month 6. Sensitivity analysis considered the split of bevacizumab vials. Results Extending the loading dose in nonresponder patients would cost €214,862.57, €208,488.98 and €134,483.16 to obtain 37, 21 and 13 additional aflibercept, ranibizumab and bevacizumab responder patients, respectively. The total number of extended injections (months 3–6) used in patients with persistent DME at month 6 was 180, 219 and 354 for aflibercept, ranibizumab and bevacizumab, respectively. Conclusions To extend the anti-VEGF loading dose from 3 to 6 injections necessitates investing €5882.77 (8 injections), €10,091.03 (14 injections) and €10,198.59 (30 injections) per additional responder patient (3-month nonresponders and 6-month responders) to aflibercept, ranibizumab and bevacizumab, respectively. For the total of patients treated, on average €7927.02 (14 injections) per additional responder patient would be needed.

Purpose. To analyse the vascular density of the choroid in a keratoconus (KC) population using swept-source optical coherence tomography (SS-OCT). Methods. Prospective, noninterventional study that analysed 97 eyes from 52 KC patients and 145 eyes from 89 healthy controls. The sample was divided in four different age groups. Inclusion criteria were topographic diagnosis of KC using Pentacam, axial length shorter than 26 mm, good quality of the images, and no other systemic or ocular diseases. A 12 mm horizontal single-line SS-OCT b-scan was performed to create a choroidal thickness (CT) profile. Validated automated segmentation and binarization were used in order to analyse choroidal, stromal, and vascular areas. Results. The percentage of choroidal vascularity (vascular area/total area) was 56.6% in KC patients vs. 49.4% in controls. Aged-adjusted choroidal, stromal, and vascular areas and corrected choroidal percentage of vascularity are statistically increased in KC patients when compared with healthy controls (p

Context. Geographic atrophy (GA) is usually measured manually using fundus autofluorescence (FAF) images, lacking a reliable, automatic method to do so. Aims. To determine the accuracy and repeatability of new software to automatically quantify GA areas associated to age-related macular degeneration (AMD) by swept-source optical coherence tomography (SS-OCT). Settings and Design. Tertiary referral hospital in Spain. Cross-sectional and noninterventional. Methods and Material. Forty-six eyes from 33 AMD patients with GA, without previous choroidal neovascularization, were scanned using a SS-OCT (Topcon Corporation, Japan), including three consecutive 7 × 7 mm OCT scans. Three independent masked observers manually measured the GA area using FAF images. These measures were compared to the three automatic determinations of the GA. Lesions were classified according to their morphology and number as regular/irregular and single/multiple. Statistical Analysis Used. Intraclass correlation coefficients (ICCs) were estimated to study the agreement between the three physicians in manual measurements. ICC through a two-way mixed effects model was used for the software measures, and Lin’s concordance correlation coefficient (CCC) was used to analyse the agreement between the physicians and the software. Results. The mean age was 76.3 ± 11.7 years. Eighteen cases showed regular lesions, and 30 showed single lesions. The CCC between manual and automatic measures was 0.95 for the whole sample. The CCC for the area according to the lesion type was 0.92 and 0.97; it was 0.99 for single lesions and 0.89 for multiple lesions. The ICC between the three physicians was 0.94 for the whole sample and 0.88 in multiple lesions. The ICC between the three automatic measures for the area was 0.98 for the whole sample, regular or irregular lesions, and single or multiple lesions. Conclusions. The accuracy of this new software is substantial for the area with a high degree of repeatability agreement, being very precise in single lesions.

Five eyes of four patients were studied to analyze the structure of the inner wall of optic and chorioretinal colobomas using swept-source optical coherence tomography (SS-OCT). The colobomatous cavities and their relationship with adjacent structures were examined. SS-OCT permitted the study of the colobomatous cavities in all cases. In four of those cases, a Y-shaped intercalary membrane (ICM) was identified, with an origin in the retinal nerve fiber layer (RNFL), which covered the coloboma and in one case the coloboma was in contact with the vitreous cavity. Vitreous adhesion to the internal wall of the coloboma was found in three cases. No clinical or tomographic maculopathy was observed in any patient. High-resolution deep penetration SS-OCT allows in vivo study of optic and chorioretinal colobomas, identifying the RNFL as the main component of the ICM overlying the colobomatous cavities.

Abstract Background To correlate retina-choroidal anatomy as assessed via swept-source OCT (SS-OCT) with retinal function as determined by best-corrected visual acuity (BCVA) and multifocal electroretinogram (mfERG). Methods Thirty-three eyes from 33 patients including 16 with neovascular AMD (nvAMD) and 17 controls were included. Patients were included in the present study after a complete ophthalmologic examination, including BCVA, slit-lamp study, intraocular pressure measurement, dilated fundus examination after tropicamide instillation, SD-OCT, SS-OCT, fundus photographs and mfERG. Age, sex, BCVA, number of anti-VEGF intravitreal injections in the nvAMD group, were recollected. Outer retinal and choroidal thickness were determined at the fovea and 500 μm temporal, superior, nasal and inferior. First-order response from mfERG was collected. P1 amplitude was recorded in R1, R2 and the average of R1 + R2. The measurements recollected from the SS-OCT, mfERG and BCVA were compared. Results Better BCVA was found with thicker outer retina foveal thickness (r = 0.349; P = 0.047), with thicker subfoveal choroidal thickness (r = 0.443; P = 0.010), and with higher amplitude in P1 at R1 (r = 0.346; P = 0.037). Outer retina foveal thickness did not correlate with P1 amplitude at R1 (r = 0.072; P = 0.692), R2 (r = 0.265; P = 0.137) either with the average P1 amplitude at R1 + R2 (r = 0.253; P = 0.156). A thicker subfoveal choroidal thickness was related with higher amplitude in P1 at R1 (r = 0.383; P = 0.028), R2 (r = 0.409; P = 0.018) and the average of R1 + R2 (r = 0.419; P = 0.015). Conclusions Choroidal thickness demonstrated a positive correlation with retinal function in the sample studied, so a thicker choroid is related to a better retinal function measured with mfERG and BCVA.

Purpose. To compare the macular choroidal thinning between young healthy, aged healthy, young high myopic, and aged type 2 diabetic (T2D) patients using the Early Treatment Diabetic Retinopathy Study (ETDRS) grid and three-dimensional (3D) maps. Methods. A prospective study including 102 eyes of 51 healthy young subjects, 60 eyes of 30 healthy aged subjects, 24 eyes of 12 high myopic patients, and 110 eyes of 55 T2D patients. Choroidal thickness (CT) was examined with swept-source optical coherence tomography Triton DRI (Topcon Corporation, Tokyo, Japan). The choroid was automatically segmented using the software algorithm, and mean CT values of a 6 × 6 mm macular cube were exported. 3D maps were created to represent CT, and its values were compared using the ETDRS grid. Results. Mean age was 27.31 ± 3.95, 66.41 ± 7.54, 27.69 ± 3.89, and 66.48 ± 7.59 years in young healthy, aged healthy, young high myopic, and T2D patients, respectively. CT was not shown to be uniform, as superior and central zones were thicker. All ETDRS sectors were always thicker (p

Luis Arias,1–3 Francisco Gómez-Ulla,2–4 José M Ruiz-Moreno2,3,51Ophthalmology Department, Bellvitge University Hospital, C/Feixa Llarga, L’Hospitalet de Llobregat, Barcelona, 2Spanish Vitreoretinal Society (SERV), C/Xosé Chao Rego, Santiago de Compostela, 3RETICS OFTARED, Institute of Health Carlos III, C/Sinesio Delgado, Madrid, 4Gómez-Ulla Eye Institute, Santiago de Compostela, 5Department of Ophthalmology, Albacete University Hospital, Avenida de Almansa s/n, Albacete, Spain Purpose: To compare the effects of intravitreal ranibizumab in monotherapy (group A) and combined with photodynamic therapy (PDT) with verteporfin (group B) in retinal angiomatous proliferation (RAP) treatment.Methods: This was a multicentric, prospective, randomized clinical study conducted with parallel groups. The study eye in both groups received ranibizumab on days 1, 30, and 60 (loading dose); group B received PDT additionally on day 1. Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) testing and optical coherence tomography were performed monthly, and fluorescein angiography and indocyanine green angiography were performed quarterly. Retreatment criteria were leakage in fluorescein angiography or indocyanine green angiography, mean foveal thickness increase ≥100 µm, or VA decrease ≥5 letters.Results: Twenty patients were recruited (ten patients in each group). Six eyes had previous treatment (three eyes in group A and three eyes in group B), so only 14 eyes were naïve. At 12-month follow-up, mean VA improved +1.5 letters in group A and +5.6 letters in group B (analysis of variance test; P>0.05). Two patients (20%) in both groups gained ≥15 letters (chi-square test; P>0.05). Mean changes in greatest linear dimension and in foveal thickness were not statistically significant between groups of treatment (analysis of variance test; P>0.05). Mean retreatments per patient were 1.8 (group A) and 0.9 (group B) (Mann–Whitney U-test; P>0.05). One patient died due to underlying disease not related to study medication.Conclusion: Intravitreal ranibizumab administered in monotherapy or combined with PDT was efficacious in terms of VA stabilization in patients with RAP.Keywords: age-related macular degeneration, intravitreal injection, photodynamic therapy, ranibizumab, retinal angiomatous proliferation, verteporfin

Purpose. To evaluate anatomical retinal changes measured by spectral-domain optical coherence tomography (SD-OCT), after applying photodynamic therapy (PDT) for treatment of chronic central serous chorioretinopathy (CSC). Methods. A retrospective analysis was conducted on 43 patients (48 eyes) with chronic CSC treated with PDT. Visual acuity (VA), central retinal thickness (CRT), outer nuclear layer (ONL) thickness, subretinal fluid (SRF), and photoreceptor ellipsoid zone (EZ) measured by SD-OCT were collected at baseline and at 3, 6, and 12 months after PDT. Differences between normally distributed variables were calculated by a paired-sample t-test; p

A group of members of the Spanish Retina and Vitreous Society (SERV) and of the Working Group of Ocular Health of the Spanish Society of Diabetes (SED) updated knowledge regarding the diagnosis and treatment of diabetic retinopathy (DR) based on recent evidence reported in the literature. A synthesis of this consensus forms the basis of the present review, which is intended to inform clinicians on current advances in the field of DR and their clinical applicability to patients with this disease. Aspects presented in this article include screening procedures of DR, new technologies in the early diagnosis of DR, control of risk factors in the different stages of the disease, indications of panretinal laser photocoagulation, efficacy of intravitreal antiangiogenic agents and steroids, and surgical options for treating DR-related complications. Practical information regarding periodicity of screening procedures in patients with type 1 and type 2 diabetes, ophthalmological controls according to the stage of retinopathy and complications, and criteria and degree of urgency for referral of a DR patient to the ophthalmologist are also presented.

Jose G Garcia-Garcia,1,2 Jose M Ruiz-Moreno,1 Kristina Holm,2 Sten Andréasson,2 Monica Lövestam-Adrian21Department of Ophthalmology, University of Castilla La Mancha, Albacete, Spain; 2Department of Ophthalmology, University of Lund, Lund, SwedenPurpose: To study the relationship between macular function assessed by multifocal electroretinogram (mfERG) and morphological changes evaluated with optical coherence tomography (OCT) and fundus photography in patients with drusen maculopathy.Methods: Ten patients (age 71 ± 5 years) with drusen maculopathy were compared to fifteen healthy control patients (age 67 ± 7 years). One eye per patient was examined with OCT, color fundus pictures, and mfERG (103 hexagons) recorded in nine areas corresponding to the nine areas of the OCT retinal map. Drusen density for every separated area was registered.Results: All nine areas in the maculopathy group demonstrated prolonged implicit time compared to healthy controls; the mean value for the maculopathy group was 31.3 milliseconds (95% confidence intervals [CI]: 30.9–31.6) vs 27.9 milliseconds (95% CI: 27.5–28.2; P = 0.006) for the control group. The amplitude in the foveal area was lower in the maculopathy group; the mean value for the maculopathy group was 25.1 nV/deg2 (95% CI: 18.4–31.7) vs 33.9 nV/deg2 (95% CI: 27–40.9; P = 0.03) for the control group. mfERG in the maculopathy group demonstrated no differences in areas with or without drusen. There was no correlation between the retinal thickness assessed with OCT and the mfERG response.Conclusion: Eyes with drusen maculopathy demonstrated functional changes compared to healthy controls evaluated with mfERG. Drusen seems to be associated with general macular dysfunction.Keywords: multifocal electroretinogram, drusen maculopathy, optical coherence tomography, macular dysfunction

E Cobos,1 L Arias,1 JM Ruiz-Moreno,2,3 MJ Rubio,1 P Garcia-Bru,1 JM Caminal,1 J Catala,1 J Arruga11Department of Ophthalmology, Bellvitge University Hospital, Barcelona, Spain; 2Department of Ophthalmology, Castilla La Mancha University, Albacete, Spain; 3Alicante Institute of Ophthalmology, VISSUM, Vitreo-Retinal Unit, Alicante, SpainObjective: To demonstrate whether the preoperative integrity of the inner segment/outer segment (IS/OS) junction of photoreceptors studied by spectral-domain optical coherence tomography (SD-OCT) is a prognostic factor in epiretinal membrane surgery.Methods: We retrospectively studied patients with an idiopathic epiretinal membrane who underwent a 23-gauge vitrectomy to remove this membrane. Best-corrected visual acuity (BCVA) and SD-OCT scans were examined before and 6 months after the surgery. We studied the retinal microstructure, especially the IS/OS junction of the photoreceptors, and evaluated the intergroup differences between patients with an intact layer and those with an irregular or disrupted layer. We applied both the Wilcoxon and Mann–Whitney tests for statistical analysis.Results: In total, 51 eyes from 51 enrolled patients were examined in this study. The postoperative BCVA was significantly better for eyes that had an intact IS/OS junction than for eyes that had an irregular or disrupted IS/OS junction, as preoperatively observed with SD-OCT scans (P < 0.001). We also observed an important association between disrupted IS/OS junctions and the presence of cystic macular edema (P < 0.01).Conclusion: The presence of an intact IS/OS junction on the preoperative SD-OCT scan was an important predictor of better visual recovery after epiretinal membrane surgery. Keywords: epiretinal membrane, photoreceptors, inner segment/outer segment junction, spectral-domain optical coherence tomography