{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:00:53Z","timestamp":1784782853005,"version":"3.55.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005713","name":"Technische Universit\u00e4t M\u00fcnchen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005713","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Graefes Arch Clin Exp Ophthalmol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Predictive optical coherence tomography (OCT) biomarkers for functional outcome after epiretinal membrane (ERM) surgery could aid clinicians in treatment decisions. Available studies on biomarkers for epiretinal membrane surgery remain inconclusive on their predictive value. The aim was to evaluate the association of ERM stage and disorganization of retinal inner layers (DRIL) with functional outcomes after ERM surgery. The study was conducted at the Department of Ophthalmology at the TUM University Hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>For this retrospective cohort study, medical records were analyzed for a consecutive sample of patients diagnosed with idiopathic ERM between 01.01.2018 and 01.01.2023 and treated with ERM peeling. Clinical examination and OCT scans were evaluated prior to surgery, and at 1, 3, 6, and 12 months postoperatively. Patients with idiopathic epiretinal membrane were included if they had at least one follow-up examination between 3 and 12 months after surgery. Patients with secondary ERMs, other conditions affecting best-corrected visual acuity (BCVA), or a history of intraocular surgery (except for uncomplicated cataract surgery) were excluded. The criteria were met in 131 eyes of 126 patients, and the 12-month follow-up examination was completed in 64 eyes. Exploratory associations between functional outcomes (BCVA and metamorphopsia) 12 months after surgery and potential OCT biomarkers (ERM stage, DRIL) using regression analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The inclusion criteria were met for 131 eyes of 126 patients with a mean (SD) age of 70.3 (7.4) years. 62 (49.2%) patients were female, and 64 (50.8%) were male. Mean (SD) BCVA improved from 0.37 (0.21) logMAR to 0.15 (0.16) logMAR 12 months after surgery. Neither preoperative ERM stage (adjusted \u03b2=-0.003, 95% CI: -0.057-0.052,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.927) nor DRIL category (adjusted \u03b2\u2009=\u20090.014, 95% CI: -0.056-0.084,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.693) was associated with BCVA 12 months after surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Neither biomarker was associated with BCVA 12 months after surgery. BCVA at baseline remained the only significant parameter. Reported effect sizes can be used in future confirmatory studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00417-026-07391-1","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:11:57Z","timestamp":1784779917000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating ERM Stage and DRIL as predictive biomarkers for functional outcomes after iERM surgery"],"prefix":"10.1007","author":[{"given":"Chiara","family":"Sachs","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus","family":"Feucht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Maier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Bleidi\u00dfel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"issue":"3","key":"7391_CR1","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/ceo.13914","volume":"49","author":"AT Fung","year":"2021","unstructured":"Fung AT, Galvin J, Tran T (2021) Epiretinal membrane: A review. Clin Exp Ophthalmol 49(3):289\u2013308","journal-title":"Clin Exp Ophthalmol"},{"issue":"1","key":"7391_CR2","first-page":"34","volume":"110","author":"S Fraser-Bell","year":"2003","unstructured":"Fraser-Bell S, Guzowski M, Rochtchina E, Wang JJ, Mitchell P (2003) Five-year cumulative incidence and progression of epiretinal membranes: the Blue Mountains Eye Study. Ophthalmol Jan 110(1):34\u201340","journal-title":"Ophthalmol Jan"},{"issue":"3","key":"7391_CR3","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1007\/s10384-018-0581-x","volume":"62","author":"A Tanikawa","year":"2018","unstructured":"Tanikawa A, Shimada Y, Horiguchi M (2018) Comparison of visual acuity, metamorphopsia, and aniseikonia in patients with an idiopathic epiretinal membrane. Jpn J Ophthalmol 62(3):280\u2013285","journal-title":"Jpn J Ophthalmol"},{"issue":"3","key":"7391_CR4","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1038\/s41433-021-01681-0","volume":"36","author":"PY Chua","year":"2022","unstructured":"Chua PY, Sandinha MT, Steel DH (2022) Idiopathic epiretinal membrane: progression and timing of surgery. Eye (Lond) 36(3):495\u2013503","journal-title":"Eye (Lond)"},{"key":"7391_CR5","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1111\/aos.12537","volume":"93","author":"LM Scheerlinck","year":"2015","unstructured":"Scheerlinck LM, Rvd V, Leeuwen R (2015) Predictive factors for postoperative visual acuity in idiopathic epiretinal membrane: a systematic review. Acta Ophthalmol 93:203\u2013213","journal-title":"Acta Ophthalmol"},{"issue":"4","key":"7391_CR6","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1097\/IAE.0000000000002486","volume":"40","author":"G Gonz\u00e1lez-Saldivar","year":"2020","unstructured":"Gonz\u00e1lez-Saldivar G, Berger A, Wong D, Juncal V, Chow DR (2020) Ectopic inner foveal layer classification scheme predicts visual outcomes after epiretinal membrane surgery. Retina 40(4):710\u2013717","journal-title":"Retina"},{"key":"7391_CR7","doi-asserted-by":"publisher","first-page":"225","DOI":"10.2147\/OPTH.S76847","volume":"9","author":"T Kinoshita","year":"2015","unstructured":"Kinoshita T, Imaizumi H, Miyamoto H et al (2015) Changes in metamorphopsia in daily life after successful epiretinal membrane surgery and correlation with M-CHARTS score. Clin Ophthalmol 9:225\u2013233","journal-title":"Clin Ophthalmol"},{"issue":"12","key":"7391_CR8","doi-asserted-by":"publisher","first-page":"1741","DOI":"10.1136\/bjophthalmol-2019-315432","volume":"104","author":"JP Hubschman","year":"2020","unstructured":"Hubschman JP, Govetto A, Spaide RF et al (2020) Optical coherence tomography-based consensus definition for lamellar macular hole. Br J Ophthalmol 104(12):1741\u20131747","journal-title":"Br J Ophthalmol"},{"key":"7391_CR9","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.ajo.2017.10.011","volume":"184","author":"A Govetto","year":"2017","unstructured":"Govetto A, Bhavsar KV, Virgili G et al (2017) Tractional abnormalities of the central foveal bouquet in epiretinal membranes: clinical spectrum and pathophysiological perspectives. Am J Ophthalmol 184:167\u2013180","journal-title":"Am J Ophthalmol"},{"key":"7391_CR10","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.ajo.2016.12.006","volume":"175","author":"A Govetto","year":"2017","unstructured":"Govetto A, Lalane RA 3rd, Sarraf D, Figueroa MS, Hubschman JP (2017) Insights into epiretinal membranes: presence of ectopic inner foveal layers and a new optical coherence tomography staging scheme. Am J Ophthalmol 175:99\u2013113","journal-title":"Am J Ophthalmol"},{"issue":"10","key":"7391_CR11","doi-asserted-by":"publisher","first-page":"1652","DOI":"10.1038\/s41433-018-0153-9","volume":"32","author":"S Doguizi","year":"2018","unstructured":"Doguizi S, Sekeroglu MA, Ozkoyuncu D, Omay AE, Yilmazbas P (2018) Clinical significance of ectopic inner foveal layers in patients with idiopathic epiretinal membranes. Eye 32(10):1652\u20131660","journal-title":"Eye"},{"issue":"1","key":"7391_CR12","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1097\/IAE.0000000000004258","volume":"45","author":"R Mansilla","year":"2025","unstructured":"Mansilla R, Bande MF, Mera P, Ruiz-Oliva F, Marticorena J, Blanco-Teijeiro MJ (2025) Spectral-domain optical coherence tomography insights into idiopathic epiretinal membrane surgery outcomes. Retina 45(1):14\u201322","journal-title":"Retina"},{"issue":"8","key":"7391_CR13","doi-asserted-by":"publisher","first-page":"2193","DOI":"10.1007\/s00417-021-05102-6","volume":"259","author":"M Coppola","year":"2021","unstructured":"Coppola M, Brambati M, Cicinelli MV et al (2021) The visual outcomes of idiopathic epiretinal membrane removal in eyes with ectopic inner foveal layers and preserved macular segmentation. Graefes Arch Clin Exp Ophthalmol 259(8):2193\u20132201","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"issue":"8","key":"7391_CR14","doi-asserted-by":"publisher","first-page":"2139","DOI":"10.1007\/s00417-021-05110-6","volume":"259","author":"M Ortoli","year":"2021","unstructured":"Ortoli M, Blanco-Garavito R, Blautain B, Mastorakos N, Souied EH, Glacet-Bernard A (2021) Prognostic factors of idiopathic epiretinal membrane surgery and evolution of alterations of the central cone bouquet. Graefes Arch Clin Exp Ophthalmol 259(8):2139\u20132147","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"7391_CR15","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/j.ajo.2018.08.037","volume":"196","author":"D Zur","year":"2018","unstructured":"Zur D, Iglicki M, Feldinger L et al (2018) Disorganization of retinal inner layers as a biomarker for idiopathic epiretinal membrane after macular surgery-The DREAM study. Am J Ophthalmol 196:129\u2013135","journal-title":"Am J Ophthalmol"},{"issue":"9","key":"7391_CR16","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1136\/bjo.37.9.521","volume":"37","author":"M Amsler","year":"1953","unstructured":"Amsler M (1953) Earliest symptoms of diseases of the macula. Br J Ophthalmol 37(9):521\u201337","journal-title":"Br J Ophthalmol"},{"issue":"9","key":"7391_CR17","doi-asserted-by":"publisher","first-page":"4012","DOI":"10.1167\/iovs.03-0117","volume":"44","author":"C Matsumoto","year":"2003","unstructured":"Matsumoto C, Arimura E, Okuyama S, Takada S, Hashimoto S, Shimomura Y (2003) Quantification of metamorphopsia in patients with epiretinal membranes. Invest Ophthalmol Vis Sci 44(9):4012\u20136","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"11","key":"7391_CR18","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1001\/jamaophthalmol.2014.2350","volume":"132","author":"JK Sun","year":"2014","unstructured":"Sun JK, Lin MM, Lammer J et al (2014) Disorganization of the retinal inner layers as a predictor of visual acuity in eyes with center-involved diabetic macular edema. JAMA Ophthalmol 132(11):1309\u201316","journal-title":"JAMA Ophthalmol"},{"issue":"3","key":"7391_CR19","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.1177\/1120672120932094","volume":"31","author":"TF Fernandes","year":"2021","unstructured":"Fernandes TF, Sousa K, Azevedo I et al (2021) Baseline visual acuity and interdigitation zone as predictors in idiopathic epiretinal membranes: a retrospective cohort study. Eur J Ophthalmol 31(3):1291\u20131298","journal-title":"Eur J Ophthalmol"},{"issue":"10","key":"7391_CR20","doi-asserted-by":"publisher","first-page":"1878","DOI":"10.1097\/IAE.0000000000004559","volume":"45","author":"I De Clerck","year":"2025","unstructured":"De Clerck I, Zeyen A, Sierens L et al (2025) Surgical outcomes, validation of govetto staging, and postsurgical macular edema in idiopathic epiretinal membranes: A Large Retrospective Study. RETINA 45(10):1878\u20131885","journal-title":"RETINA"},{"issue":"2","key":"7391_CR21","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1097\/IAE.0000000000001940","volume":"39","author":"A Govetto","year":"2019","unstructured":"Govetto A, Virgili G, Rodriguez FJ, Figueroa MS, Sarraf D, Hubschman JP (2019) Functional and anatomical significance of the ectopic inner foveal layers in eyes with idiopathic epiretinal membranes: Surgical Results at 12 Months. Retina Feb 39(2):347\u2013357","journal-title":"Retina Feb"},{"issue":"8","key":"7391_CR22","doi-asserted-by":"publisher","first-page":"780","DOI":"10.1111\/aos.14336","volume":"98","author":"M Alkabes","year":"2020","unstructured":"Alkabes M, Fogagnolo P, Vujosevic S, Rossetti L, Casini G, De Cill\u00e0 S (2020) Correlation between new OCT parameters and metamorphopsia in advanced stages of epiretinal membranes. Acta Ophthalmol 98(8):780\u2013786","journal-title":"Acta Ophthalmol"},{"key":"7391_CR23","doi-asserted-by":"publisher","first-page":"7931654","DOI":"10.1155\/2019\/7931654","volume":"2019","author":"J Mao","year":"2019","unstructured":"Mao J, Wu H, Liu C et al (2019) Changes in Metamorphopsia, Visual Acuity, and Central Macular Thickness after Epiretinal Membrane Surgery in Four Preoperative Stages Classified with OCT B-Scan Images. J Ophthalmol 2019:7931654","journal-title":"J Ophthalmol"},{"issue":"9","key":"7391_CR24","doi-asserted-by":"publisher","first-page":"1756","DOI":"10.1097\/IAE.0000000000003522","volume":"42","author":"A Watanabe","year":"2022","unstructured":"Watanabe A, Ishida M, Shibata M et al (2022) One-year outcomes of metamorphopsia and retinal displacement after epiretinal membrane surgery. Retina 42(9):1756\u20131761","journal-title":"Retina"},{"issue":"7","key":"7391_CR25","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1111\/aos.15092","volume":"100","author":"K Yanagida","year":"2022","unstructured":"Yanagida K, Wakabayashi Y, Usui Y et al (2022) Ectopic inner foveal layer as a factor associated with metamorphopsia after vitrectomy for epiretinal membrane. Acta Ophthalmol 100(7):775\u2013780","journal-title":"Acta Ophthalmol"},{"issue":"2","key":"7391_CR26","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1097\/IAE.0000000000004672","volume":"46","author":"A Quarta","year":"2026","unstructured":"Quarta A, Ruggeri ML, De Santis Ciacci C, Tartaro R, Toto L, Mastropasqua R (2026) Hyperreflective retinal spots in epiretinal membranes: Evolving Significance Across Disease Stages. Retina 46(2):383\u2013389","journal-title":"Retina"},{"issue":"6","key":"7391_CR27","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1097\/IAE.0000000000004429","volume":"45","author":"A Quarta","year":"2025","unstructured":"Quarta A, Zeppa L, Ruggeri ML et al (2025) The role of gliosis in idiopathic epiretinal membranes: New Insights. Retina 45(6):1117\u20131124","journal-title":"Retina"},{"issue":"5","key":"7391_CR28","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0197034","volume":"13","author":"MR Romano","year":"2018","unstructured":"Romano MR, Cennamo G, Grassi P, Sparnelli F, Allegrini D, Cennamo G (2018) Changes in macular pigment optical density after membrane peeling. PLoS One 13(5):e0197034","journal-title":"PLoS One"},{"issue":"9","key":"7391_CR29","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1136\/bjo-2024-327109","volume":"109","author":"A Quarta","year":"2025","unstructured":"Quarta A, Toto L, Gironi M et al (2025) Stage-specific dynamics of macular pigment optical density as a prognostic biomarker in epiretinal membrane surgery. Br J Ophthalmol 109(9):1043\u20131048","journal-title":"Br J Ophthalmol"},{"key":"7391_CR30","doi-asserted-by":"publisher","DOI":"10.1016\/j.exer.2026.110850","volume":"264","author":"YB Wu","year":"2026","unstructured":"Wu YB, Chen YQ, Mao JB, Ye X, Wang CX, Shen LJ (2026) Immunofluorescence analysis of internal limiting membrane: insights into formation of inner retinal dimples. Exp Eye Res 264:110850","journal-title":"Exp Eye Res"},{"issue":"5","key":"7391_CR31","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1167\/tvst.12.5.23","volume":"12","author":"YH Kim","year":"2023","unstructured":"Kim YH, Song MS, Togloom A et al (2023) Bidirectional Dimples After Internal Limiting Membrane Peeling for a Macular Hole. Transl Vis Sci Technol 12(5):23","journal-title":"Transl Vis Sci Technol"},{"key":"7391_CR32","doi-asserted-by":"publisher","DOI":"10.1016\/j.survophthal.2026.03.004","author":"A Quarta","year":"2026","unstructured":"Quarta A, Feo A, Boscia G et al (2026) Inner retinal surface abnormalities: imaging phenotypes, quantitative features, and mechanistic insights across surgical and nonsurgical conditions. Surv Ophthalmol Epub ahead of print. https:\/\/doi.org\/10.1016\/j.survophthal.2026.03.004","journal-title":"Surv Ophthalmol"},{"issue":"6","key":"7391_CR33","first-page":"1887","volume":"45","author":"J Textor","year":"2016","unstructured":"Textor J, Zander B, Gilthorpe MK, Liskiewicz M, Ellison GT (2016) Robust causal inference using directed acyclic graphs: the R package \u2018dagitty\u2019. Int J Epidemiol 45(6):1887\u20131894","journal-title":"Int J Epidemiol"}],"container-title":["Graefe's Archive for Clinical and Experimental Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00417-026-07391-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00417-026-07391-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00417-026-07391-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:11:59Z","timestamp":1784779919000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00417-026-07391-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":33,"alternative-id":["7391"],"URL":"https:\/\/doi.org\/10.1007\/s00417-026-07391-1","relation":{},"ISSN":["0721-832X","1435-702X"],"issn-type":[{"value":"0721-832X","type":"print"},{"value":"1435-702X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"assertion":[{"value":"25 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 July 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors used artificial intelligence tools to assist with language editing and to improve readability of the manuscript. The authors take full responsibility for the content, interpretation, and conclusions presented in this work.","order":1,"name":"Ethics","label":"AI use statement","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethical approval was obtained from the Ethics Committee of the Technical University of Munich (EK no.: 2023-250-S-KH).","order":2,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"NF has received honoraria for lectures from Roche, Bayer, and Novartis, and travel support from Roche. MM has received honoraria for lectures from Roche, Bayer, AbbVie and Novartis, and travel support from Roche and Bayer. NB has received honoraria for lectures from Roche, Bayer and Novartis, and travel support from Roche and Bayer.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}