Longitudinal ganglion cell complex remodeling and visual recovery after ERM removal in eyes without severe foveal disorganization

Abstract Purpose To characterize longitudinal ganglion cell complex (GCC) remodeling after epiretinal membrane (ERM) surgery in eyes without severe foveal disorganization and to evaluate its association with visual recovery across baseline ectopic inner foveal layer (EIFL) phenotypes. Methods This retrospective longitudinal study included 91 eyes with stage 1–3 idiopathic ERM. Eyes were classified according to the presence or absence of EIFL. Spectral-domain optical coherence tomography was performed preoperatively and at 1, 3, 6, and 12 months postoperatively. Linear mixed-effects models with time-varying covariates were used to evaluate factors associated with longitudinal changes in best-corrected visual acuity (BCVA). In addition, exploratory univariable linear regression was performed to assess the association between changes in GCC thickness and changes in BCVA from baseline to 12 months. Results Eyes with EIFL had significantly worse baseline BCVA and greater baseline GCC thickness; however, final BCVA and GCC thickness did not differ between groups. In multivariate mixed-effects modeling, time ( P < 0.001) and time-varying GCC thickness ( P = 0.008) were independently associated with longitudinal BCVA changes, whereas baseline EIFL status was not. The association between time-varying GCC thickness and longitudinal BCVA was also observed separately in both groups. In an exploratory analysis of changes from baseline, greater reduction in GCC thickness was associated with greater visual improvement (B = 0.10 per µm on the BCVA × 100 scale, P = 0.003; R² = 0.12). Conclusions In eyes without severe foveal disorganization undergoing ERM surgery, time-varying GCC thickness was associated with longitudinal visual recovery across baseline EIFL phenotypes, supporting a relationship between dynamic inner retinal remodeling and postoperative functional improvement.