Study Links Epiretinal Membrane Formation to Diabetic Retinopathy Severity and Cumulative Anti-VEGF Therapy

🎙️ Podcast Focus

• Host: Dr. Rajesh Rao (University of Michigan).
• Guest: Dr. Shinji Kakihara (Northwestern University & Shinju University).
• Paper Discussed: “Epiretinal Membrane is Associated with Diabetic Retinopathy Severity and Cumulative Anti-VEGF Injections” (Ophthalmology Science, Vol. 5, Issue 3, May–June 2025).

📊 Study Overview

• Design: Cross-sectional study of 207 eyes (24% without ERM).
• Exclusions: Eyes with diabetic macular edema (to ensure OCTA accuracy).
• Data Collected: Age, sex, hypertension, ischemic heart disease, lens status, number of anti-VEGF injections, OCTA perfusion metrics.

🔑 Key Findings

• ERM Prevalence: Majority were mild stage 1; 5 eyes had stage 2 ERM.
• Risk Factors (multivariate analysis):
  • Independent associations:
    • Diabetic retinopathy (DR) severity
    • Cumulative anti-VEGF injections
  • Not independently significant after adjustment: OCTA perfusion deficits.
• Interpretation:
  • High anti-VEGF burden may reflect more severe disease activity not captured by DR grading.
  • Chronic VEGF suppression may promote fibrotic remodeling (similar to “anti-VEGF crunch” in proliferative DR).
  • ERM formation may represent a milder fibrotic manifestation.

🧠 Pathophysiology Insights

• OCTA Findings: Higher perfusion deficits in deep capillary plexus in ERM eyes, but not independently predictive after adjustment.
• Speculation: Ischemia may activate Müller cells and microglia, contributing to fibrotic remodeling.

🚀 Future Directions

• Need for longitudinal studies to establish causality.
• Potential RCTs: Comparing newer anti-VEGF agents (e.g., faricimab) vs. first-generation agents to assess differential ERM risk.

🎧 Podcast Closing

• Encouragement to rate/review the podcast and follow on social media.
• Acknowledgment of editorial team and editors-in-chief of the Ophthalmology journals.

👉 In essence: ERM in diabetic patients is independently associated with DR severity and cumulative anti-VEGF injections, suggesting both disease activity and treatment burden contribute to risk. OCTA ischemia signals may play a role but were not independently predictive in this dataset.

• ---

  Key takeaway: Among multiple systemic, ocular, and imaging variables, only DR severity and anti‑VEGF treatment burden were independently linked to ERM formation.

• OCTA ischemia signals showed univariate association but were not independent predictors after adjustment.

• Clinical implication: ERM risk may reflect both underlying disease severity and treatment‑related fibrotic remodeling.