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Nam, Dong Heun MD, PhD*,†; Desouza, Philip J. BS; Hahn, Paul MD, PhD*; Tai, Vincent MS*; Sevilla, Monica B. MS*; Tran-Viet, Du BS*; Cunefare, David BS*,§; Farsiu, Sina PhD*,§; Izatt, Joseph A. PhD*,§; Toth, Cynthia A. MD*,§

doi: 10.1097/IAE.0000000000000534
Original Study

Purpose: To report the intraoperative optical coherence tomography findings in idiopathic epiretinal membrane (ERM) with connecting strands and to describe the postoperative outcomes.

Methods: A retrospective, case series study within a prospective observational intraoperative optical coherence tomography imaging study was performed. Epiretinal membranes with connecting strands were characterized on preoperative spectral domain optical coherence tomography images and assessed against corresponding intraoperative (after internal limiting membrane [ILM] peeling) and postoperative spectral domain optical coherence tomography images.

Results: Eleven locations of the connecting strands in 7 eyes were studied. The connecting strands had visible connections from the inner retinal surface to the ERM in all locations, and the reflectivity was moderate in 8 locations and high in 3 locations. After ERM and ILM peeling, disconnected strands were identified in all of the intraoperative optical coherence tomography images. The reflectivity of the remaining intraoperative strands was higher than that of the preoperative lesions and appeared as “finger-like” and branching projections. The remaining disconnected lesions were contiguous with the inner retinal layers. Postoperatively, the intraoperative lesions disappeared completely in all locations, and recurrent formation of ERM was not identified in any eyes.

Conclusion: In ERM eyes with connecting strands, intraoperative spectral domain optical coherence tomography imaging showed moderately to highly reflective sub-ILM finger-like lesions that persist immediately after membrane and ILM peeling. Postoperatively, the hyperreflective lesions disappeared spontaneously without localized nerve fiber layer loss. The sub-ILM connecting strands may represent glial retinal attachments.

In ERM eyes with connecting strands, intraoperative SD-OCT imaging showed sub-ILM finger-like lesions after membrane peeling. Postoperatively, the hyperreflective lesions disappeared spontaneously. The connecting strands observed in idiopathic ERM eyes may be a sub-ILM glial proliferation that regresses after ILM peeling.

*Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina;

Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea;

Duke University School of Medicine, Durham, North Carolina; and

§Department of Biomedical Engineering, Pratt School of Engineering, Durham, North Carolina.

Reprint requests: Cynthia A. Toth, MD, Duke University Eye Center, 2351 Erwin Road, Box 3802, Durham, NC 27710; e-mail:

Supported in part by the Hartwell Foundation, Andrew Family Foundation, Research to Prevent Blindness, the National Center for Research Resources Grant 1UL1RR024128-01, and the National, Eye Institute Grant 1R01EY023039-01.

C. A. Toth receives research support from Genentech and through an equipment loan from Bioptigen, Inc. She also receives royalties for surgical technology licensed by Duke to Alcon Laboratories. Duke University has an equity interest in Bioptigen, Inc. J. A. Izatt is a cofounder of Bioptigen, Inc and has corporate, intellectual property, and equity interests in this company. S. Farsiu has a related pending patent corresponding to this technology. None of the other authors have any conflicting interests to disclose.

© 2015 by Ophthalmic Communications Society, Inc.