Original StudyASSOCIATED FACTORS AND SURGICAL OUTCOMES OF MICROCYSTOID MACULAR EDEMA AND CONE BOUQUET ABNORMALITIES IN EYES WITH EPIRETINAL MEMBRANECicinelli, Maria Vittoria MD*,†,‡; Post, Michal MD*,§; Brambati, Maria MD*,†,‡; Rabiolo, Alessandro MD†; Pignatelli, Francesco MD¶; Szaflik, Jacek P. MD§; Bandello, Francesco MD†,‡; Coppola, Michele MD* Author Information *Ophthalmology Unit, Azienda Ospedaliera di Monza, Monza, Italy; †School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; ‡Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy; §Department of Ophthalmology, SPKSO Ophthalmic Hospital, Medical University of Warsaw, Poland; and ¶Department of Ophthalmology, SS Annunziata Hospital, Taranto, Italy. Reprint requests: Maria Vittoria Cicinelli, MD, Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; e-mail: [email protected] None of the authors has any financial/conflicting interests to disclose. All the authors contributed to the conception or design of the work, the acquisition, analysis, interpretation of data, drafting the work, and revising it critically for important intellectual content. Each of the co-authors has seen and agrees with the content of this manuscript and the way their name is listed. M. V. Cicinelli and Michal Post: Conceptualization, Writing—Original Draft. A. Rabiolo: Methodology. M. Brambati and F. Pignatelli: Visualization and Data Curation. J. P. Szaflik: Writing—Review & Editing and Supervision. M. Coppola and F. Bandello: Project administration and Supervision. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.retinajournal.com). M. V. Cicinelli and M. Post are co-first authors. Retina: August 2022 - Volume 42 - Issue 8 - p 1455-1464 doi: 10.1097/IAE.0000000000003492 Buy SDC Metrics AbstractIn Brief Purpose: To investigate the associated features and the surgical outcomes in eyes with microcystoid macular edema (MME) and cone bouquet abnormalities (CBA) undergoing epiretinal membrane peeling. Methods: Retrospective study including patients who underwent pars plana vitrectomy for idiopathic epiretinal membrane. Factors associated with MME and CBA at baseline and their regression were identified with logistic regression models. Postoperative visual acuity was evaluated with linear mixed models from baseline to 12 months. Risk factors for new or worsened macular edema were explored with a Cox regression model. Results: One hundred and eighty-seven eyes are included in this study; 30 eyes (16%) had MME and 53 eyes (28%) had CBA preoperatively. Microcystoid macular edema was associated with severe epiretinal membrane stage (odds ratio [95% confidence interval] = 3.6 [1.3–12.7], P = 0.02); CBA was inversely associated with ectopic inner foveal layer thickness (odds ratio [95% confidence interval] = 0.97 [0.97–0.99] for each 1-μm EIFL increase, P = 0.006). Eyes with MME had worse visual acuity after epiretinal membrane peeling (P = 0.01) and were at risk of macular edema worsening (hazard ratio [95% confidence interval] = 2.22 [1.01–5.16], P = 0.04). Older age was associated with MME persistence (odds ratio [95% confidence interval] = 2.46 [1.06–6.82] for each 10-year increase, P = 0.04). No significant associations were found for CBA. Conclusion: Although CBA had no prognostic consequences, MME was associated with suboptimal visual recovery and less efficient control of inflammation after surgery. Degeneration of Müller cells may have an alleged role, and further imaging and functional tests are warranted. Preoperative microcystoid macular edema in eyes with macular pucker is associated with worse vision after pucker peeling and increased risk of postsurgical macular edema worsening.