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Aziz K, Patel T, Canner JK, Swenor BK, Singh MS. Risk of Tertiary, Quaternary, and Quinary Proliferative Vitreoretinopathy: Analysis of a Nationwide Database (2010-2017). Ophthalmol Retina 2023:S2468-6530(23)00030-1. [PMID: 36717076 DOI: 10.1016/j.oret.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Primary proliferative vitreoretinopathy (PVR) is established as an important cause of the failed repair of a fresh retinal detachment (RD) and the consequent need for secondary repair. However, the burden of multiple repairs beyond the initial failure has not been studied in detail. We aimed to determine the association between primary PVR and the occurrence of tertiary, quaternary, and quinary RD repairs, using a nationwide database. DESIGN Retrospective cohort study of insurance claims. SUBJECTS Cases of rhegmatogenous RD that underwent primary surgical repair. METHODS Cases of primary RD repair from 2010 to 2017 were categorized based on the absence (P0 group) or presence (P1 group) of primary PVR. In each group, we analyzed the frequency of subsequent RD repair procedures with concurrent PVR. MAIN OUTCOME MEASURE The risk of secondary and higher multiples of PVR-associated RD repair. RESULTS A total of 27 137 cases were included, with 24 500 (90.3%) in the P0 group and 2637 (9.7%) in the P1 group. The frequency (%) of cases ultimately requiring secondary, tertiary, quaternary, and quinary repair in P0 versus P1 was 1.88 versus 10.24 (P < 0.001), 0.26 versus 2.50 (P < 0.001), 0.07 versus 0.64 (P < 0.001), and 0.03 versus 0.08 (P = 0.272), respectively. The risk of undergoing secondary repair was higher in the P1 than in the P0 group (hazard ratio [HR], 6.02; 95% confidence interval [CI], 5.24-6.92; P < 0.001). The risk of undergoing tertiary repair was also higher in the P1 than in the P0 group (HR, 1.67; CI, 1.23-2.28; P = 0.001). There was no difference in the risk of undergoing quaternary repair between the groups (HR, 0.76; CI, 0.41-1.40; P = 0.37). Senary repairs were not detected in this dataset. CONCLUSIONS Primary PVR may increase the risk of requiring multiple sequential retinal reattachment surgeries beyond the initial repair failure. Retinal detachment cases with primary PVR at the initial presentation of RD were more likely to undergo secondary and tertiary repairs than cases without primary PVR. Health care claims analysis may be a useful tool to study population-based estimates for multiple recurrences of RD in cases with PVR. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Kanza Aziz
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tapan Patel
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Mandeep S Singh
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Jung I, Na YJ, Lee SC, Lee MW. Reproducibility of each retinal layer thickness measurement in epiretinal membrane patients with ectopic inner foveal layers. Eye Vis (Lond) 2023; 10:3. [PMID: 36597171 PMCID: PMC9811706 DOI: 10.1186/s40662-022-00321-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/01/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND To identify the reliability of each retinal layer thickness measurement in epiretinal membrane (ERM) patients with ectopic inner foveal layers (EIFLs). METHODS Subjects were divided into two groups: ERM patients with EIFLs (Group 1) and without EIFLs (Group 2). The retinal layer thickness was measured twice, and intraclass correlation coefficient (ICC) and coefficient of variation (CV) values were calculated. RESULTS In Group 1, the CVs of the nerve fiber layer (NFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), and outer nuclear layer (ONL) were 22.39%, 13.12%, 13.37%, 13.21%, 15.09%, and 11.94%, while the ICCs were 0.431, 0.550, 0.440, 0.286, 0.279, and 0.503, respectively. In Group 2, the CVs were 18.20%, 10.59%, 10.65%, 13.27%, 14.75%, and 10.37%, while the ICCs were 0.788, 0.834, 0.830, 0.715, 0.226, and 0.439, respectively. The average central macular thickness (CMT) was significantly correlated with the CVs of NFL (coefficient = 0.317; P < 0.001), GCL (coefficient = 0.328; P < 0.001), and IPL (coefficient = 0.186; P = 0.042) in Group 1. CONCLUSIONS The reproducibility of the inner retinal layer thickness measurements in ERM patients with EIFLs was low compared to those without EIFLs. The reproducibility of the outer retinal layer thickness measurements, including OPL and ONL, was poor regardless of the presence of EIFLs in ERM patients. Additionally, the thicker the CMT in patients with EIFLs, the lower the reproducibility of the inner retinal layer thickness measurements.
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Affiliation(s)
- Il Jung
- grid.411143.20000 0000 8674 9741Department of Ophthalmology, Konyang University College of Medicine, #1643 Gwanjeo-Dong, Seo-Gu, Daejeon, Republic of Korea
| | - Yong-Jin Na
- grid.411143.20000 0000 8674 9741Department of Ophthalmology, Konyang University College of Medicine, #1643 Gwanjeo-Dong, Seo-Gu, Daejeon, Republic of Korea
| | - Sung-Chul Lee
- grid.411143.20000 0000 8674 9741Department of Ophthalmology, Konyang University College of Medicine, #1643 Gwanjeo-Dong, Seo-Gu, Daejeon, Republic of Korea
| | - Min-Woo Lee
- grid.411143.20000 0000 8674 9741Department of Ophthalmology, Konyang University College of Medicine, #1643 Gwanjeo-Dong, Seo-Gu, Daejeon, Republic of Korea ,grid.411143.20000 0000 8674 9741Konyang University Myunggok Medical Research Institute, Daejeon, Republic of Korea
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Taki Y, Ito Y, Takeuchi J, Ito H, Nakano Y, Sajiki AF, Horiguchi E, Ota H, Kataoka K, Terasaki H. Displacement of the retina and changes in the foveal avascular zone area after internal limiting membrane peeling for epiretinal membrane. Jpn J Ophthalmol 2023; 67:74-83. [PMID: 36370235 DOI: 10.1007/s10384-022-00964-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/15/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE We investigated the differences in displacement of the outer and inner macular retina toward the optic disc after vitrectomy with internal limiting membrane (ILM) peeling for epiretinal membrane (ERM). Foveal avascular zone (FAZ) area changes were also investigated. STUDY DESIGN Retrospective observational study METHODS: This retrospective observational case series included 45 eyes of 43 patients that underwent vitrectomy with ERM and ILM peeling for ERM and 38 normal eyes. The locations of the centroid of the FAZ (C-FAZ, center of the foveal inner retina) and foveal bulge (center of the foveal outer retina) were determined using 3×3mm superficial optical coherence tomography angiography. C-FAZ and foveal bulge displacements, and the pre- and postoperative FAZ areas and their associated factors, were investigated. RESULTS Postoperative C-FAZ dislocated significantly more toward the optic disc than in pre-operative or normal eyes (P<0.001). C-FAZ and foveal bulge displaced toward the optic disc after surgery; C-FAZ showed significantly greater displacement than foveal bulge (P<0.001). The pre- and postoperative FAZ areas were correlated (P=0.01). Preoperative FAZ areas ≧0.10mm2 were reduced after surgery, and FAZ areas < 0.10mm2 were increased, independent of foveal displacement. CONCLUSION ILM peeling during vitrectomy for ERM caused larger displacement of the inner and smaller displacement of the outer retinas, towards the optic disc. Postoperative changes in the FAZ area were dependent on the baseline FAZ area, but not on the foveal displacement. ILM may physiologically exert centrifugal tractional forces on the fovea.
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Guemes-Villahoz N, Diaz-Valle D, Fonollosa A, Jimenez-Santos M, Narvaez-Palazon C, Adan A. Spontaneous resolution of inflammatory epiretinal membrane: Case series and review of the literature. Eur J Ophthalmol 2023; 33:NP10-NP14. [PMID: 34334018 DOI: 10.1177/11206721211036291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Epiretinal membrane (ERM) represents a common complication of uveitis that may contribute independently to vision loss in patients with uveitis. Although spontaneous idiopathic ERM separation has been previously reported, to the best of our knowledge there are only two case reports in the scientific literature that depicts spontaneous regression of an inflammation-associated ERM. Spontaneous ERM separation is a rare but possible event, which occurs most often subsequent to posterior vitreous detachment. We present a case series of three patients with uveitis that exhibit the formation and subsequent spontaneous resolution of an inflammatory ERM.
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Affiliation(s)
- Noemi Guemes-Villahoz
- Department of Ophthalmology, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Diaz-Valle
- Department of Ophthalmology, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC) IIORC, Universidad Complutense de Madrid, ISCIII (OFTARED), Madrid, Spain
| | - Alex Fonollosa
- Department of Ophthalmology, Hospital de Cruces, Universidad del Pais Vasco, Vizcaya, Spain
| | - Maria Jimenez-Santos
- Department of Ophthalmology, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Carlos Narvaez-Palazon
- Department of Ophthalmology, Instituto de investigación sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Alfredo Adan
- Instituto Clínico de Oftalmología, Hospital Clínic, Barcelona, Spain
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Hetzel A, Neubauer J, Gelisken F. Clinical characteristics of patients with epiretinal membrane-Foveoschisis. Graefes Arch Clin Exp Ophthalmol 2022; 261:1579-1585. [PMID: 36576570 DOI: 10.1007/s00417-022-05940-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/23/2022] [Accepted: 12/10/2022] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The purpose of this study is to investigate the clinical and morphological characteristics of epiretinal membrane (ERM)-Foveoschisis. METHODS Medical charts of 2088 patients diagnosed with idiopathic ERM were screened and eyes with ERM-Foveoschisis were included. All eyes underwent a complete ophthalmological examination including spectral domain optical coherence tomography (SD-OCT). OCT features and best corrected visual acuity (BCVA) were analysed. ERM-Foveoschisis was defined as open, closed, elevated or flat based on the OCT features. Ellipsoidal zone (EZ) abnormality, intraretinal cystoid spaces, central foveal thickness (CFT), posterior vitreous detachment (PVD) and lens status were assessed. RESULTS One hundred-sixty-six patients (175 eyes) (72% female, mean age 70.46 years) were included. Incidence of ERM-Foveoschisis was 6.7%. Open type was seen in 86.8% and had a significantly better mean BCVA than closed type (p = 0.01). No statistically significant difference of mean BCVA was noted between the elevated and flat types. Mean BCVA was significantly lower in eyes with EZ abnormality (p = 0.03) and eyes with intraretinal cystoid spaces (p = 0.02). Patients with 'closed' ERM-Foveoschisis showed a significant higher median CFT than 'open' ERM-Foveoschisis (respectively, 364 µm and 176 µm, p < 0.001). A total of 81.9% eyes had PVD. CONCLUSION We differentiated four morphological types of ERM-Foveoschisis based on the OCT examination. Closed ERM-Foveoschisis presented with a higher CFT and lower BCVA than the open type. ERM-Foveoschisis with cystoid intraretinal spaces presented with a lower BCVA. The impact of the morphological types of the ERM-Foveoschisis on the clinical course and for therapy decision requires further long-term studies.
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Affiliation(s)
- Annegret Hetzel
- Department of Ophthalmology, Eberhard-Karls-University, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany.
| | - Jonas Neubauer
- Department of Ophthalmology, Eberhard-Karls-University, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Faik Gelisken
- Department of Ophthalmology, Eberhard-Karls-University, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
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Gonzalez-Cortes JH, Bilgic A, De Los Santos Polanco J, Treviño-Herrera AB, Sudhalkar A, Gonzalez-Cantu JE, Mohamed-Hamsho J. Spontaneous closure of an idiopathic macular hole after epiretinal membrane development. Am J Ophthalmol Case Rep 2022; 29:101767. [PMID: 36507466 PMCID: PMC9731824 DOI: 10.1016/j.ajoc.2022.101767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/23/2022] [Accepted: 11/28/2022] [Indexed: 12/09/2022] Open
Abstract
Purpose To report non-operative closure of an idiopathic full thickness macular hole (FTMH) spontaneous secondary to the development of a macular epiretinal membrane (ERM). Observations A 68-year-old woman, with no relevant medical history, and a 6-month history of decreased visual acuity in her right eye was diagnosed to have an idiopathic FTMH. The patient refused surgery and the FTMH was followed-up for seven years. The spectral domain optical coherent tomography follow-up showed the evolution of the FTMH and its spontaneous closure after development of an ERM. In the presence of an ERM with vitreo-papillary detachment, it is possible that the centripetal forces involved helped bring together the edges of the macular hole resulting in a possible spontaneous closure. Additionally and separately, the presence of an ERM may act as scaffolding for Muller cell migration and consequent macular hole closure. Conclusions and importance Development of an ERM was followed by non-operative FTMH closure in this specific case. It is important to note, that this is an extraordinary situation in which the patient had a favorable anatomical evolution despite having rejected conventional surgical intervention. Studies aimed at determining the mechanisms and situations in which these cases occur could provide answers that help us make more appropriate decisions. To our knowledge, the present case is the first in the literature to report a spontaneous closure of a FTMH secondary to the appearance and progression of a previously non-existent ERM.
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Affiliation(s)
- Jesus Hernan Gonzalez-Cortes
- Department of Ophthalmology, Autonomous University of Nuevo Leon (UANL), University Hospital and Faculty of Medicine, Monterrey, Nuevo Leon, Mexico,Department of Retina and Vitreous, Especialistas en Retina Medica y Quirurgica ERVOS, ISSSTE Constitucion, UNAM, Monterrey, Nuevo Leon, Mexico
| | - Alper Bilgic
- Department of Retina and Vitreous, Especialistas en Retina Medica y Quirurgica ERVOS, ISSSTE Constitucion, UNAM, Monterrey, Nuevo Leon, Mexico,Alpha Vision Augenarzt Praxis, Bremerhaven, Germany,Corresponding author. Alpha Vision Augenarzt Praxis, Buergermeister-Smidt Str. 162, 27568, Bremerhaven, Germany.
| | - Jefther De Los Santos Polanco
- Department of Retina and Vitreous, Especialistas en Retina Medica y Quirurgica ERVOS, ISSSTE Constitucion, UNAM, Monterrey, Nuevo Leon, Mexico
| | - Alan Baltazar Treviño-Herrera
- Department of Ophthalmology, Autonomous University of Nuevo Leon (UANL), University Hospital and Faculty of Medicine, Monterrey, Nuevo Leon, Mexico
| | - Aditya Sudhalkar
- Alpha Vision Augenarzt Praxis, Bremerhaven, Germany,MS Sudhalkar Medical Research Foundation, Baroda, India
| | - Jesus Emiliano Gonzalez-Cantu
- Department of Ophthalmology, Autonomous University of Nuevo Leon (UANL), University Hospital and Faculty of Medicine, Monterrey, Nuevo Leon, Mexico
| | - Jesus Mohamed-Hamsho
- Department of Ophthalmology, Autonomous University of Nuevo Leon (UANL), University Hospital and Faculty of Medicine, Monterrey, Nuevo Leon, Mexico
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Molina Martín JC, Piñero DP, García Conca V, Desco MC, Mataix-Boronat J, Balboa Alonso M. Changes in the Hyperreflective Bands of Outer Retinal Layers after Idiopathic Epiretinal Membrane Surgical Removal. Curr Eye Res 2022; 47:1609-1614. [PMID: 36189946 DOI: 10.1080/02713683.2022.2132513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Purpose: The purpose of this study was to describe the relationship between the outer retinal hyperreflective bands and visual acuity recovery after idiopathic epiretinal macular membrane (ERM) surgical removal.Methods: A prospective longitudinal non-comparative study was conducted that included a total of 68 patients with idiopathic ERM, who underwent consecutive 23 G pars plana vitrectomy (PPV) at San Juan University Hospital (Alicante, Spain) from January 2019 to January 2021. All patients underwent a complete preoperative standard ophthalmic examination, including measurement of best corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) examination. This protocol was repeated at 1 and 3 months after surgery.Results: Mean preoperative decimal BCVA was 0.30 ± 0.13 and disruption of the first, second, third and fourth outer retinal hyperreflective bands was observed by SD-OCT in 9 (27.9%), 27 (39.7%), 33 (48.5%) and 17 patients (25%), respectively. BCVA improved after ERM peeling at 1 and 3 months in all patients, regardless of the presence of disruption in any hyperreflective band. Significantly larger improvement of BCVA was found at 3 months after surgery in patients not showing disruption of hyperreflective bands 1 and 4 (p = 0.048 and 0.001, respectively).Conclusions: The integrity of the outer retinal hyperreflective bands by SD-OCT in patients with idiopathic ERM is a valuable tool to determine the visual prognosis of the surgical treatment of this condition. A successful recovery of hyperreflective bands 1 and 4 with ERM surgery may be a potential biomarker of the visual improvement achieved due to their important anatomical relation with cone photoreceptors at the foveal level.
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Affiliation(s)
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, San Vicente del Raspeig, Spain
| | - Victor García Conca
- Department of Ophthalmology, University Hospital San Juan de Alicante, Sant Joan d'Alacant, Spain
| | | | | | - María Balboa Alonso
- Department of Ophthalmology, University Hospital San Juan de Alicante, Sant Joan d'Alacant, Spain
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Johari M, Khani S, Amini A, Bolkheir A. Effect of peripheral laser photocoagulation retinopexy on macular morphology and optic nerve fiber layer thickness; a prospective case series. BMC Ophthalmol 2022; 22:453. [PMID: 36434550 PMCID: PMC9700918 DOI: 10.1186/s12886-022-02681-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The goal of the research was to determine the incidence of microstructural alterations in the macula and optic nerve head (ONH) occurred in eyes treated with peripheral laser photocoagulation retinopexy. METHODS Patients with retinal breaks, retinal holes, retinal dialysis, and lattice degenerations who required peripheral laser photocoagulation retinopexy were recruited in this prospective case series investigation. We performed preoperative and postoperative evaluations, including best corrected visual acuity (BCVA), slit lamp examination, intraocular pressure (IOP) measurement, funduscopic examination, and macular and ONH optical coherence tomography (OCT). RESULTS Thirty-three eyes of the twenty-three patients enrolled in this study, 14 of which were female. The mean age of the sample was 45.12 ± 9.12 years. The mean refractive error was - 2.45 ± 1.12 Diopters (D). The most prevalent reason for peripheral laser photocoagulation retinopexy was retinal thinning with symptomatic lattice degeneration (90%), followed by retinal hole and break (7%) and retinal dialysis (3%). Between preoperative and postoperative (6-month) evaluation, there was no statistically significant difference in BCVA (P = 0.82), IOP (P = 0.54), central foveal thickness in macular OCT (P = 0.39), or global retinal nerve fiber layer (RNFL) thickness (P = 0.51). There was no association between changes in central foveal thickness and global RNFL thickness and total laser spot numbers (r = - 0.17 P = 0.21, r = 0.06 P = 0.60, respectively). None of patients developed cystoid macular edema (CME) or macular epiretinal membrane (ERM) . CONCLUSION We found that OCT parameters were not significantly affected by laser retinopexy in patients with high-risk peripheral retinal lesions, also none of our patients had developed ERM, vitromacular traction or CME at 6 months follow up periods.
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Affiliation(s)
- Mohammadkarim Johari
- grid.412571.40000 0000 8819 4698Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Salman Khani
- grid.412571.40000 0000 8819 4698Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdulrahim Amini
- grid.412237.10000 0004 0385 452XHormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Alireza Bolkheir
- grid.412571.40000 0000 8819 4698Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Al-Khersan H, Shaheen AR, Flynn HW, Smiddy WE. Natural History and Surgical Timing for Idiopathic Epiretinal Membrane. Ophthalmol Retina 2022; 6:978-984. [PMID: 35272083 DOI: 10.1016/j.oret.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE This study assessed the prevalence of progression to surgery on idiopathic epiretinal membrane (iERM) and compared the results with those of immediate surgery. DESIGN Retrospective study with nested case-control comparison. SUBJECTS Patients with mild iERM at initial presentation METHODS: A retrospective study with a nested case-control study was conducted to compare the outcomes of those who later progressed to surgery ("deferred surgery") with those of a control group that underwent surgery within 6 months of initial presentation ("immediate surgery"). MAIN OUTCOME MEASURES The prevalence of performing vitrectomy with membrane peeling after initial deferral, features associated with deferred surgery, and the visual acuity (VA) outcomes of surgery compared with those with immediate surgery. RESULTS A total of 413 patients were included in the base study cohort: 369 did not undergo iERM peeling, whereas 44 (10.7%) underwent deferred surgery at a mean duration of 18.1 months after initial presentation. The factor most associated with later progression to surgery, determined using a multivariate analysis, was symptoms at initial presentation (odds ratio [95% confidence interval], 8.75 [3.80-20.15]; P < 0.0001). The immediate surgical group (controls) had a poorer logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) at presentation compared with the deferred surgery group (cases), but this decreased in the latter group to about the same preoperative level immediately before the deferred surgery (typically why they underwent surgery). The final logMAR BCVA was similar in the deferred and immediate surgical groups when only pseudophakic cases were analyzed. An analysis of the change from preoperative BCVA (instead of initial) to final BCVA showed no difference in the magnitude of change between the pseudophakic subgroups of the deferred and immediate surgery groups (median [interquartile range] preoperative VA of 0.52 [0.40-0.60] in the deferred surgery group and 0.44 [0.39-0.60] in the immediate surgery group [P = 0.7256]). Within the deferred and immediate surgery groups, the median change from preoperative BCVA to final BCVA in the pseudophakic subgroups was 0.22 (P = 0.0082) in the former and 0.21 (P = 0.0001) in the latter. CONCLUSIONS The vast majority of eyes with iERM remain stable after initial presentation. The deferral of surgery in the minority of patients who progress does not have a disadvantageous final outcome compared with immediate surgery.
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Affiliation(s)
- Hasenin Al-Khersan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Abdulla R Shaheen
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Parra-Mora E, da Silva Cruz LA. LOCTseg: A lightweight fully convolutional network for end-to-end optical coherence tomography segmentation. Comput Biol Med 2022; 150:106174. [PMID: 36252364 DOI: 10.1016/j.compbiomed.2022.106174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/31/2022] [Accepted: 10/01/2022] [Indexed: 11/03/2022]
Abstract
This article presents a novel end-to-end automatic solution for semantic segmentation of optical coherence tomography (OCT) images. OCT is a non-invasive imaging technology widely used in clinical practice due to its ability to acquire high-resolution cross-sectional images of the ocular fundus. Due to the large variability of the retinal structures, OCT segmentation is usually carried out manually and requires expert knowledge. This study introduces a novel fully convolutional network (FCN) architecture designated by LOCTSeg, for end-to-end automatic segmentation of diagnostic markers in OCT b-scans. LOCTSeg is a lightweight deep FCN optimized for balancing performance and efficiency. Unlike state-of-the-art FCNs used in image segmentation, LOCTSeg achieves competitive inference speed without sacrificing segmentation accuracy. The proposed LOCTSeg is evaluated on two publicly available benchmarking datasets: (1) annotated retinal OCT image database (AROI) comprising 1136 images, and (2) healthy controls and multiple sclerosis lesions (HCMS) consisting of 1715 images. Moreover, we evaluated the proposed LOCTSeg with a private dataset of 250 OCT b-scans acquired from epiretinal membrane (ERM) and healthy patients. Results of the evaluation demonstrate empirically the effectiveness of the proposed algorithm, which improves the state-of-the-art Dice score from 69% to 73% and from 91% to 92% on AROI and HCMS datasets, respectively. Furthermore, LOCTSeg outperforms comparable lightweight FCNs' Dice score by margins between 4% and 15% on ERM segmentation.
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Affiliation(s)
- Esther Parra-Mora
- Department of Electrical and Computer Engineering, University of Coimbra, Coimbra, 3030-290, Portugal; Instituto de Telecomunicações, Coimbra, 3030-290, Portugal.
| | - Luís A da Silva Cruz
- Department of Electrical and Computer Engineering, University of Coimbra, Coimbra, 3030-290, Portugal; Instituto de Telecomunicações, Coimbra, 3030-290, Portugal.
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Antonio-Aguirre B, Swenor B, Canner JK, Singh MS. Risk of Cystoid Macular Edema after Cataract Surgery in Retinitis Pigmentosa: An Analysis of United States Claims from 2010 to 2018. Ophthalmol Retina 2022; 6:906-913. [PMID: 35513237 DOI: 10.1016/j.oret.2022.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Cataract surgery is commonly performed to improve vision in patients with retinitis pigmentosa (RP). However, the risk of postoperative cystoid macular edema (CME) in RP remains unclear. Here, we leveraged a large multiyear claims database to estimate the risk of CME after cataract surgery in patients with and without RP. DESIGN Retrospective multicenter cohort. SUBJECTS Patients aged 18 to 65 years who underwent single-phase cataract surgery between January 1, 2020, and December 31, 2018. Identified using the IBM MarketScan claims database. METHODS We evaluated the baseline characteristics and outcomes and estimated the hazard ratio (HR) using a multivariable mixed-effects approach. The eyes of patients with RP were categorized as group R1, and those without diagnoses of RP by the time of surgery were categorized as group R0. MAIN OUTCOME MEASURES Incident postoperative CME in the same eye that underwent cataract extraction within 12 months of the procedure. RESULTS We included 468 123 patients and 615 645 eyes. This included 124 eyes with RP (R1) and 615 521 without RP (R0). The mean ages were 50.5 ± 9.8 years in R1 and 57.9 ± 6.1 years in R0. The cumulative incidence of CME at 12 months was 5.8% (95% confidence interval [CI] 1.2%-10.3%) in R1, and it was 1.1% (95% CI 1.1%-1.2%) in R0. On average, CME was reported in R1 subjects 3.9 weeks later than in R0 subjects (95% CI 2.04-6.5 weeks; P <0.001). The subjects in R1 had 4.83 (95% CI 2.13-10.93, P <0.001) times the risk of CME compared to the subjects in R0. A stratified analysis showed that epiretinal membrane (ERM) decreased the risk of CME in R1 (HR 0.12 [95% CI 0.48-0.97; P = 0.004]) but increased it in R0 (HR, 4.32 [95% CI 3.13-5.95; P <0.001]). CONCLUSIONS The cataract surgery-related risk of CME among patients with RP may be >4 times that among people without RP. Men and individuals aged 18 to 34 and 55 to 65 years may be at the greatest risk, whereas ERM may lower the risk. Further study is warranted to stratify the risk by RP genotype and phenotype and illuminate the natural history, angiographic features, and functional consequences of postoperative CME.
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Affiliation(s)
- Bani Antonio-Aguirre
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | - Bonnielin Swenor
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland; Johns Hopkins Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland
| | - Joseph K Canner
- Johns Hopkins Surgery Center for Outcomes Research, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Mandeep S Singh
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland; Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland.
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Szigiato AA, Antaki F, Javidi S, Touma S, Duval R, Cordahi G, Olivier S, Rezende FA. Risk factors for epiretinal membrane formation and peeling following pars plana vitrectomy for primary rhegmatogenous retinal detachment, an OCT guided analysis. Int J Retina Vitreous 2022; 8:70. [PMID: 36180942 PMCID: PMC9524009 DOI: 10.1186/s40942-022-00418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate the rate and risk factors of epiretinal membrane (ERM) formation and need for ERM peeling after pars plana vitrectomy (PPV) for uncomplicated primary rhegmatogenous retinal detachment (RRD). Methods Retrospective, single-center, cohort study of 119 consecutive patients (119 eyes) that underwent RRD repair using PPV. The primary outcomes were ERM formation, classified using an optical coherence tomography grading system, and the rate of ERM peeling. Visual acuity, postoperative complications, and risk factors for ERM formation and peeling were also identified. Results Postoperative ERM formation occurred in 69 eyes (58.0%); 56 (47.1%) were stage 1, 9 (7.6%) stage 2, 3 (2.5%) stage 3, and 1 (0.8%) stage 4. Only 6 (5.0%) eyes required secondary PPV for a visually significant ERM, with a mean time to reoperation of 488 ± 351 days. Risk factors for ERM formation included intraoperative cryotherapy, more than 1000 laser shots, 360° laser photocoagulation, and choroidal detachment (p < 0.01). Eyes with more than 3 tears had a trend towards increased ERM surgery (p = 0.10). Conclusions Visually significant ERM formation following PPV for primary RRD was uncommon in this cohort (5%). Half of the ERMs were detected after the first post-operative year, indicating that this complication may be underreported in studies with only 1-year follow-up.
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Affiliation(s)
| | - Fares Antaki
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada
| | - Simon Javidi
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada
| | - Samir Touma
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada
| | - Renaud Duval
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada
| | - Ghassan Cordahi
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada
| | - Sebastien Olivier
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada
| | - Flavio A Rezende
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada.
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63
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Torres-Villaros H, Louis-Philippe S, Amari F, Giocanti-Aurégan A, Janicot L. Macular toxicity of vital dye after pars plana vitrectomy for idiopathic epiretinal membrane: A case report. Am J Ophthalmol Case Rep 2022; 27:101588. [PMID: 35637750 PMCID: PMC9142655 DOI: 10.1016/j.ajoc.2022.101588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose To describe the first reported case of outer retinal damage following the use of Membrane Blue Dual for epiretinal membrane (ERM) surgery. Observations A 74-year-old female underwent pars plana vitrectomy and ERM peeling assisted with Membrane Blue Dual for an idiopathic ERM. Postoperatively, the patient reported a decline in visual acuity with a central scotoma. Fundus examination revealed a well-defined retinal whitening in the peeling area which evolved into pigmentary changes as confirmed by fundus autofluorescence. Optical coherence tomography (OCT) showed loss of outer retinal layers and irregular mottling of the retinal pigment epithelium. Fundus and OCT appearance remained unchanged after 4 months and the central scotoma also persisted. Conclusions and Importance ERM surgery assisted with Membrane Blue Dual can induce major changes in retinal pigment epithelium and outer retinal layers. This adverse event which probably results from combined light and dye toxicity should be considered by all surgeons even though its occurrence is rare.
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Affiliation(s)
- Héloïse Torres-Villaros
- Department of Ophthalmology, Avicenne Hospital, 125, rue de Stalingrad, 93000, Bobigny, France
| | - Steven Louis-Philippe
- Department of Ophthalmology, Avicenne Hospital, 125, rue de Stalingrad, 93000, Bobigny, France
| | - Fatima Amari
- Department of Ophthalmology, Avicenne Hospital, 125, rue de Stalingrad, 93000, Bobigny, France
| | - Audrey Giocanti-Aurégan
- Department of Ophthalmology, Avicenne Hospital, 125, rue de Stalingrad, 93000, Bobigny, France
| | - Lucie Janicot
- Department of Ophthalmology, Avicenne Hospital, 125, rue de Stalingrad, 93000, Bobigny, France
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64
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Marlow ED, Bakhsh SR, Reddy DN, Farley ND, Williams GA, Mahmoud TH. Combined epiretinal and internal limiting membrane retracting door flaps for large macular holes associated with epiretinal membranes. Graefes Arch Clin Exp Ophthalmol 2022; 260:2433-2436. [PMID: 35230476 DOI: 10.1007/s00417-022-05608-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To assess the closure rate of large full-thickness macular holes (FTMH) associated with epiretinal membrane (ERM) with a combined epiretinal and internal limiting membrane retracting door flap. METHODS Retrospective chart review of patients treated at a single tertiary retina practice between January 2017 and November 2019. Individuals with FTMH larger than 400 μm and co-diagnosis of ERM who underwent surgical repair with an ERM flap were included. Patients underwent pars plana vitrectomy with peeling of ERM that was positioned as a retracting door flap to cover the FTMH. Primary outcome was closure rate at 6 months following surgery. Final surgical success rate and visual acuity were secondary outcomes. RESULTS Among 7 eyes of 7 patients, 6 eyes achieved primary surgical success and final surgical success rate was achieved in all 7 eyes with a large FTMH repaired with ERM flap. The mean minimum linear diameter of the FTMH was 681 μm ± 295. All patients had follow-up greater than 6 months, with a mean duration of 17 months (range 14-23 months). Visual acuity improved from a mean of 0.9 ± 0.3 logMar (20/160) before surgery to 0.3 ± 0.5 logMar (Snellen 20/40), postoperatively. CONCLUSION Large FTMH with concurrent ERM that are managed with an ERM flap have high single-surgery success rate.
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Affiliation(s)
- Elizabeth D Marlow
- Associated Retinal Consultants, Royal Oak, MI, USA.,Bay Area Retina Associates, Walnut Creek, CA, USA
| | - Saaquib R Bakhsh
- William Beaumont School of Medicine, Oakland University, Neuroscience Bldg, Suite LL-20, 3555 W, 13 Mile Road, Royal Oak, MI, USA
| | - Devasis N Reddy
- William Beaumont School of Medicine, Oakland University, Neuroscience Bldg, Suite LL-20, 3555 W, 13 Mile Road, Royal Oak, MI, USA
| | | | - George A Williams
- Associated Retinal Consultants, Royal Oak, MI, USA.,William Beaumont School of Medicine, Oakland University, Neuroscience Bldg, Suite LL-20, 3555 W, 13 Mile Road, Royal Oak, MI, USA
| | - Tamer H Mahmoud
- Associated Retinal Consultants, Royal Oak, MI, USA. .,William Beaumont School of Medicine, Oakland University, Neuroscience Bldg, Suite LL-20, 3555 W, 13 Mile Road, Royal Oak, MI, USA.
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65
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Jeon S, Choi A, Kwon H. Clinical outcomes after implantation of extended depth-of-focus AcrySof® Vivity® intraocular lens in eyes with low-grade epiretinal membrane. Graefes Arch Clin Exp Ophthalmol 2022; 260:3883-3888. [PMID: 35796821 DOI: 10.1007/s00417-022-05751-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/18/2022] [Accepted: 06/29/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate the clinical outcomes of extended depth-of-focus (EDoF) AcrySof® Vivity® intraocular lens in eyes with low-grade epiretinal membrane (ERM). METHODS Forty-five eyes with low-grade ERM and history of Vivity implantation were compared with 50 age-matched controls with Vivity implantation and no ERM. Eyes with ERM showing widening of the outer nuclear layer and loss of the foveal depression, but no ectopic inner foveal layer or outer retinal defect were eligible. Corrected and uncorrected distant visual acuity (CDVA and UDVA), uncorrected intermediate and near visual acuity (UIVA and UNVA), contrast sensitivity detected by area under the log contrast sensitivity function (AULCSF), Strehl ratio, area ratio, and occurrence of dysphotopsia were compared between groups. RESULTS UDVA and CDVA were similar between groups (UDVA: 0.01 ± 0.05 vs 0.03 ± 0.06, P = 0.154; CDVA: 0.00 ± 0.00 vs 0.00 ± 0.02, P = 0.125). UIVA and mesopic AULCSF were significantly worse in eyes with ERM compared to those with no ERM (UIVA: 0.09 ± 0.09 vs 0.14 ± 0.10, P = 0.028; mesopic AULCSF: 1.26 ± 0.15 vs 1.17 ± 0.10, P = 0.013). The occurrence of dysphotopsia was similar in both groups (glare: P = 0.465; halo: P = 0.218; starburst: P = 0.457). DISCUSSION Eyes with low-grade ERM showed comparable outcomes to eyes without ERM after Vivity IOL implantation. Implantation of this newly developed EDoF IOL with low addition can be of benefit to eyes with low-grade, reversible ERM that is limited to the inner retina.
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Affiliation(s)
- Sohee Jeon
- Keye Eye Center, 326 Teheran-ro, Gangnam-gu, Seoul, Republic of Korea.
| | - Ayoung Choi
- Keye Eye Center, 326 Teheran-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Hyunggoo Kwon
- Keye Eye Center, 326 Teheran-ro, Gangnam-gu, Seoul, Republic of Korea
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66
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Khodabande A, Riazi-Esfahani H, Ghassemi H, Mirzaei A, Abbas H, Mirghorbani M. Structural and functional outcomes of pars plana vitrectomy in patients with lamellar macular hole. Taiwan J Ophthalmol 2022; 12:430-436. [PMID: 36660132 PMCID: PMC9843581 DOI: 10.4103/tjo.tjo_9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/04/2022] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To investigate the short-term functional and microstructural outcomes of pars plana vitrectomy (PPV) without gas tamponade in lamellar macular holes (LH). MATERIALS AND METHODS In this prospective case series, LH cases diagnosed by optical coherence tomography (OCT) underwent PPV with epiretinal membrane (ERM) removal and internal limiting membrane peeling without gas tamponade. All patients underwent a complete ophthalmologic examination, including best-corrected visual acuity (BCVA) and OCT imaging preoperatively and 3 months after the surgery. RESULTS Among 22 eyes, 10 degenerative (Deg) LH, 8 tractional (Trac) LH, and 4 mixed-type LH were assessed. After the surgery, anatomical closure occurred in 20 eyes (91%) without any significant difference between LH subgroups. Comparing preoperative and postoperative values, no significant changes was detected regarding BCVA neither totally (P = 0.5) nor in subgroups (P for Deg = 1.0, Trac = 0.71, Mix = 0.18). The overall central foveal thickness was increased significantly after surgery (P < 0.01), but in subgroup analysis, the increase was significant only for Trac LH (P = 0.02). The tractional LH eyes had less ellipsoid zone (EZ) disruptions compared to Deg or mixed subgroups before surgery. There were no changes in EZ integrity before and after the surgery. In regression analysis, no correlation was found between demographic or clinical characteristics and anatomical closure or BCVA improvement postoperatively. CONCLUSION PPV resulted in 91% anatomical closure of all cases of LH but without functional improvement in short-term. Further prospective clinical trials with larger sample size and longer follow-up would be required to confirm the clinical significance of these findings.
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Affiliation(s)
- Alireza Khodabande
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hafez Ghassemi
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Mirzaei
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. Arash Mirzaei, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran. E-mail:
| | - Haider Abbas
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mirghorbani
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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67
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Fernández Berdasco K, Castro Navarro J, González Castaño CN, Rodríguez Villa S, García Fernández M. Retrospective study of secondary implantation of retroiridial fixation lenses in patients without capsular support: functional results and complications. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:317-322. [PMID: 35676024 DOI: 10.1016/j.oftale.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/13/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The correction of aphakia when there is no adequate capsular support remains a therapeutic challenge. The use of retroiridial fixation lenses has been extended given their lower complication rate compared to other available options. MATERIAL AND METHODS Retrospective study including all cases operated with an Artisan® retropupillary aphakia implant. RESULTS 33 eyes were included out of a total of 28 patients. The follow-up period has been 38.55 months (1-96). 32.3% had a lens dislocation and 67.7% had an intraocular lens dislocation. The previous mean best corrected visual acuity (BCVA) was 1.18 ± 0.79 logMAR and post-intervention 0.36 ± 0.62 (p < 0.01). 93.8% of the patients presented a final BCVA equal to or better and 62.5% an improvement of 3 or more lines. The most frequent complication was corectopia (31.3%) and hypotony in the immediate postoperative period (21.9%). An epiretinal membrane (ERM) developed in 18.8% and cystic macular oedema (CME) in 9.4%. The presence of complications in the postoperative period did not statistically influence the final BCVA. CONCLUSIONS The retropupillary Artisan® lens allows the correction of aphakia with satisfactory visual results and a low rate of complications.
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Affiliation(s)
- K Fernández Berdasco
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | - J Castro Navarro
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - C N González Castaño
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - S Rodríguez Villa
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - M García Fernández
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Patheja RS. Preoperative ocular coherence tomographic prognosticators of visual acuity after idiopathic epiretinal membrane surgery. Int Ophthalmol 2022. [PMID: 35583682 DOI: 10.1007/s10792-022-02317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To provide a current review of the evidence for the utility of preoperative ocular coherence tomography (OCT) parameters in prognosticating postoperative visual acuity and visual improvement after idiopathic epiretinal membrane surgery. To determine which OCT bio-markers are most useful in this regard and where future studies may apply more emphasis. METHODS An extensive search of the PubMed database was performed for studies investigating this relationship. Key search terms included: idiopathic, epiretinal membrane, surgery, peel, vitrectomy, vision, outcomes, visual acuity, ocular coherence tomography, central foveal thickness, foveal contour, foveal morphology, ectopic inner foveal layers, inner retinal layers, inner retinal irregularity index, outer retinal layers, ellipsoid zone, interdigitation zone, photoreceptor outer segment length, central bouquet abnormality, staging, choroidoscleral irregularity, ganglion cell and nerve fibre layers, inner and outer plexiform layers, inner and outer nuclear layers. Forty-nine peer-reviewed articles were included in this review. These consisted of 28 retrospective studies [1-3,13,16-18,20,23-29,32-36,38,40,42-47], 17 prospective studies[6-12,14,19,21,22,30,31,37,41,48,49], 2 reviews [4,39] and 2 systematic reviews [5,15]. CONCLUSION The weight of literary evidence seems to support photoreceptor integrity as the most consistent OCT marker of better postoperative visual acuity. This includes analysis of ellipsoid and interdigitation zones as well as photoreceptor outer segment length. However, the newer OCT staging system proposed by Govetto et al. (2017) fulfils a need for a clinically useful and evidence-based OCT classification. It may be the way forward in prognosticating ERM surgical outcomes by preoperative stratification. There is insufficient evidence to suggest the other discussed parameters in this review as useful prognosticators of postoperative visual acuity.
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69
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Miyazawa K, Sakimoto S, Kanai M, Shiraki A, Takahashi S, Shiraki N, Maruyama K, Sakaguchi H, Nishida K. Vascular tortuosity analysis in eyes with epiretinal membrane imaged by optical coherence tomography angiography. BMC Ophthalmol 2022; 22:198. [PMID: 35501767 PMCID: PMC9063110 DOI: 10.1186/s12886-022-02420-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background This study aimed to evaluate macular vessel tortuosity using optical coherence tomography angiography (OCTA) and its association with visual outcomes in eyes undergoing surgery for epiretinal membrane (ERM). Methods The study included 22 consecutive patients who underwent vitrectomy for ERM between May 2019 and July 2020 and OCTA at Osaka University Hospital. All patients underwent ophthalmologic examinations, including swept-source OCTA. Standard vitrectomy was performed, and the patients were followed up for 6 months postoperatively. Distortion of retinal vessels was calculated using two parameters: the actual vessel length in the vessel section (VL) and the direct vessel branching point distance (BD) in the three quadrants (nasal, temporal, and superior-inferior) of the macula. We analyzed the correlation between these parameters and visual outcomes. Results Significantly longer VL was found at 1, 3, and 6 months postoperatively (p = 0.006, 0.008, and 0.022, respectively) in the temporal quadrant compared to baseline temporal VL. Significantly shorter VL was found in nasal quadrants at 1 and 3 months (p = 0.046 and p = 0.018) in the comparison of nasal baseline VL. VL/BDs were correlated with the same postoperative best-corrected visual acuity (BCVA) at 1, 3, and 6 months (p = 0.035, 0.035, and 0.042, respectively) in the superior-inferior quadrant. A significant association of changes in VL and BCVA was found at 3 and 6 months postoperatively in the nasal quadrant (p = 0.018 and 0.0455, respectively). Conclusions Changes in vascular distortion after ERM surgery can be measured using OCTA. The change in vessels around the macula became more linear; this was associated with visual outcomes after surgery.
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Affiliation(s)
- Kosuke Miyazawa
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Rm. E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Susumu Sakimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Rm. E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan. .,Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Osaka, Japan.
| | - Masanori Kanai
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Rm. E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Akihiko Shiraki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Rm. E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shizuka Takahashi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Rm. E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Nobuhiko Shiraki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Rm. E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kazuichi Maruyama
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Rm. E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hirokazu Sakaguchi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Rm. E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Department of Ophthalmology, Gifu University Graduate School of Medicine, Yanagido, Gifu, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Rm. E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.,Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Osaka, Japan
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Arrevola-Velasco L, Beltran J, Gimeno MJ, Ortega-Usobiaga J, Druchkiv V, Llovet-Osuna F, Baviera-Sabater J. Visual outcomes after vitrectomy for epiretinal membrane in pseudophakic eyes with a diffractive trifocal intraocular lens: a retrospective cohort study. BMC Ophthalmol 2022; 22:39. [PMID: 35086499 PMCID: PMC8796395 DOI: 10.1186/s12886-022-02273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diffractive intraocular lenses (IOLs) could affect visual acuity in patients with macular pathologies such as epiretinal membrane (ERM) and could influence the results of pars plana vitrectomy (PPV) for ERM removal in pseudophakic eyes with these IOLs. The aim of this study is to evaluate the effect on visual outcomes of a diffractive trifocal IOL in PPV for ERM peeling. METHODS This is a retrospective cohort study on 20 eyes with a single model of trifocal IOL that underwent PPV for removal of ERM between January 2015 and September 2018 in our clinics. Follow up was at least 1 year. Primary outcome measure was mean change in visual acuity. Secondary outcome measures were mean change in central macular thickness (CMT), recovery of the external retinal layers, and change in spherical equivalent (SE). RESULTS Mean corrected distance visual acuity (CDVA) was 0.03 ± 0.03 logMAR after phacoemulsification; this worsened to 0.23 ± 0.10 logMAR with ERM, improving to 0.10 ± 0.04 log MAR 12 months after PPV (p = 0.001). Mean uncorrected near visual acuity (UNVA) was Jaeger 2.62 ± 0.51 after lensectomy. This worsened to Jaeger 5.46 ± 1.67 with ERM and improved to the initial Jaeger 2.69 ± 0.84 after PPV (p = 0.005). CMT decreased significantly, from 380.15 ± 60.50 μm with the ERM to 313.70 ± 36.98 μm after PPV. Mean SE after lensectomy was - 0.18 ± 0.38 D, which minimally changed to - 0.18 ± 0.47 D after PPV (p = 0.99). The only complication recorded after PPV was a case of cystoid macular edema. No difficulties in visualization due to IOL design were reported during PPV. CONCLUSION PPV for ERM in eyes with this trifocal IOL seems to be safe and effective, and allows recovery of the loss of UNVA.
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Affiliation(s)
- Luis Arrevola-Velasco
- Retina-Vitreous Unit, Refractive Surgery Unit, Clinica Baviera (an AIER EYE HOSPITAL GROUP division), Paseo de la Castellana, 20 28046, Madrid, Spain.
| | - Jaime Beltran
- Research and Development Clinica Baviera (an AIER EYE HOSPITAL GROUP division), Valencia, Spain
| | - Maria Jesus Gimeno
- Refractive Surgery Unit, Research and Development, Clinica Baviera (an AIER EYE HOSPITAL GROUP division), Valencia, Spain
| | - Julio Ortega-Usobiaga
- Refractive Surgery Unit, Clinica Baviera (an AIER EYE HOSPITAL GROUP division), Bilbao, Spain
| | - Vasyl Druchkiv
- Research and Development Clinica Baviera (an AIER EYE HOSPITAL GROUP division), Valencia, Spain
| | - Fernando Llovet-Osuna
- Refractive Surgery Unit, Clinica Baviera (an AIER EYE HOSPITAL GROUP division), Madrid, Spain
| | - Julio Baviera-Sabater
- Refractive Surgery Unit, Clinica Baviera (an AIER EYE HOSPITAL GROUP division), Valencia, Spain
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71
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Framme C, Feltgen N, Schumann R, Stichtenoth DO, Hattenbach LO. [Regression of idiopathic epiretinal membrane-Case report and consideration of the possible mechanism]. Ophthalmologe 2022. [PMID: 35076756 DOI: 10.1007/s00347-022-01577-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 11/27/2022]
Abstract
In the presence of a symptomatic epiretinal gliosis, pars plana vitrectomy with membrane peeling to remove the membrane is usually indicated in clinical practice. According to common clinical experience, almost no independent regression of such an epiretinal membrane and thus healing of the pathology alone exists. Therefore, the unusual case of bilateral independent regression of idiopathic epiretinal gliosis and formation of a lamellar macular hole in a 73-year-old male patient is described. Considerations of the possible mechanism are presented based on the existing literature. These include separation of inflammatory versus noninflammatory membranes, possible separation of individual layers depending on the status of the posterior vitreous limiting membrane and also the possible action of proteolytic systems in the posterior vitreous region. Finally, the question arises, whether patients have to be informed about this fact before possible surgery.
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72
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Alshahrani ST, Alshahrani ST, Arevalo JF. Epiretinal membrane after branch retinal vein occlusion: Separation after dexamethasone implant injection. Am J Ophthalmol Case Rep 2022; 25:101252. [PMID: 35036630 PMCID: PMC8743195 DOI: 10.1016/j.ajoc.2021.101252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/06/2021] [Accepted: 12/30/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose The authors report a case of epiretinal membrane after branch retinal vein occlusion with macular wrinkling that was successfully managed without surgical treatment. Observations A patient presented with complaints of a gradual decrease in vision, with metamorphopsia over the previous 2 years in the right eye. The patient was diagnosed with a grade 2 epiretinal membrane (ERM) with macular wrinkling in the right eye that was confirmed with optical coherence tomography (OCT) demonstrating significant macular thickening. The patient refused surgical intervention, and was managed with a dexamethasone implant to decrease macular edema. Six months later, the patient presented with resolution of macular edema, separation of the ERM from the retina as confirmed with OCT, and excellent visual recovery. Conclusions and Importance A dexamethasone implant injection can be an alternative treatment for ERM resulting in excellent visual recovery and possibly, separation of ERM.
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Affiliation(s)
| | | | - J Fernando Arevalo
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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73
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Karasu B, Celebi ARC. Predictive value of ectopic inner foveal layer without internal limiting membrane peeling for idiopathic epiretinal membrane surgery. Int Ophthalmol 2022. [PMID: 34989953 DOI: 10.1007/s10792-021-02186-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the clinical importance of ectopic inner foveal layer (EIFL) grading (mild to severe) in patients diagnosed with idiopathic epiretinal membrane (iERM) and had pars plana vitrectomy (PPV) with solely ERM peeling. MATERIALS AND METHODS Patients diagnosed with iERMs who had undergone PPV including only ERM peeling were enrolled in the study, and follow-up findings were recorded at baseline, and at 3, 6, 12 months and final examinations. EIFL was categorized into four grades, from mild to severe. Pre- and postoperative anatomical changes were measured using spectral domain optical coherence tomography (SD-OCT) imaging. The association between EIFL and other SD-OCT parameters with best-corrected visual acuity (BCVA) was assessed before and after PPV surgery. RESULTS One-hundred thirty-eight eyes of 106 patients with mild to severe EIFL were included in the study. Higher EIFL thickness was significantly correlated with lower baseline (r = 0.575, p = 0.020) and final BCVA (r = 0.748, p = 0.001). Although EIFLs continued in advanced-stage cases (stage 3 and 4) (64 eyes [82%]) at the final visit, it was observed in 8 eyes (23%) in the early stage (stage 2) of iERMs. A strong positive correlation was found between EIFL thickness and recurrence rate of ERM (r = 0.876, p < 0.001). Recurrence of ERM was detected in 27 eyes; 2 (7%) at stage 1, 3 (9%) at stage 2, 10 (23%) in stage 3, and 12 (33%) in stage 4 (p < 0.001). CONCLUSION A negative association was found between the severity of EIFL and postoperative anatomical and visual recovery. In terms of surgical timing, early stages (stages 1 and 2) may be preferred for providing good anatomical and visual recovery and a low recurrence rate following surgery.
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74
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da Silva RA, Roda VMDP, Matsuda M, Siqueira PV, Lustoza-Costa GJ, Wu DC, Hamassaki DE. Cellular components of the idiopathic epiretinal membrane. Graefes Arch Clin Exp Ophthalmol 2021; 260:1435-1444. [PMID: 34842983 DOI: 10.1007/s00417-021-05492-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/24/2021] [Accepted: 11/04/2021] [Indexed: 01/19/2023] Open
Abstract
Idiopathic epiretinal membrane (iERM) is a fibrocellular proliferation on the inner surface of the retina, which leads to decreased visual acuity and even central visual loss. As iERM is associated to advanced age and posterior vitreous detachment, a higher prevalence is expected with increasing life expectancy and aging of the global population. Although various cell types of retinal and extra-retinal origin have been described in iERMs (Müller glial cells, astrocytes, hyalocytes, retinal pigment epithelium cells, myofibroblasts, and fibroblasts), myofibroblasts have a central role in collagen production and contractile activity. Thus, myofibroblast differentiation is considered a key event for the iERM formation and progression, and fibroblasts, Müller glial cells, hyalocytes, and retinal pigment epithelium have been identified as myofibroblast precursors. On the other side, the different cell types synthesize growth factors, cytokines, and extracellular matrix, which have a crucial role in ERM pathogenesis. In the present review, the major cellular components and their functions are summarized, and their possible roles in the iERM formation are discussed. By exploring in detail the cellular and molecular aspects of iERM, we seek to contribute for better understanding of this fibrotic disease and the origin of myofibroblasts, which may eventually drive to more targeted therapeutic approaches.
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Affiliation(s)
- Rafael André da Silva
- Department of Cell & Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, 05508-000, Brazil
| | - Vinicius Moraes de Paiva Roda
- Department of Cell & Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, 05508-000, Brazil
| | - Monique Matsuda
- Laboratory of Investigation in Ophthalmology (LIM-33), Division of Ophthalmology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Paula Veloso Siqueira
- Department of Cell & Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, 05508-000, Brazil
| | - Gabriela Jesus Lustoza-Costa
- Department of Cell & Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, 05508-000, Brazil
| | - Davi Chen Wu
- Department of Cell & Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, 05508-000, Brazil.,Department of Ophthalmology, Irmandade de Misericórdia da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Dânia Emi Hamassaki
- Department of Cell & Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, 05508-000, Brazil.
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75
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Pettenkofer M, Chehaibou I, Pole C, Rodriguez M, Rabina G, Kreiger AE, Schwartz SD, Hubschman JP. Epiretinal proliferation after rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol 2021. [PMID: 34821991 DOI: 10.1007/s00417-021-05502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/14/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To determine the characteristics and appearance rate of epiretinal proliferation (ERP) on SD-OCT after surgery for rhegmatogenous retinal detachment (RRD) repair. METHODS One hundred eight eyes of 108 patients who underwent one or more surgeries for RRD were enrolled. The eyes with other maculopathies that were directly related to RRD were excluded. Image acquisition was performed with SD-OCT (Heidelberg Engineering, Germany). Clinical charts were reviewed to assess clinical and surgical findings. Statistical analyses were performed using XLSTAT (Assinsoft, Paris, France). RESULTS ERP was found in 9.3% eyes (n = 10). The mean initial visual acuity (logMAR) was 1.34 ± 0.82 in the ERP group compared to 0.49 ± 0.70 in the non-ERP group. PVR was present in 70.0% and chronic macular edema was found in 80.0% of eyes which developed ERP. The mean number of vitreoretinal surgeries in eyes with ERP was 3.3 ± 1.19 and only 1.44 ± 1.02 in eyes without. Silicone oil was used in 60.0% of eyes which developed ERP compared to 13.9% in the non-ERP group. CONCLUSION ERP is a late-onset postoperative finding in eyes with RRD and can occur in absence of macular holes. Overall, ERP is more frequent in eyes with complicated courses of RRD including multiple operations, PVR, usage of silicone oil, and chronic macular edema.
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76
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Yu SN, Hood DC, Blumberg DM, Chang S, Greenstein VC. Structure-function analysis for macular surgery in patients with coexisting glaucoma. Graefes Arch Clin Exp Ophthalmol 2021; 260:1475-1489. [PMID: 34783892 DOI: 10.1007/s00417-021-05481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/09/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To develop methods to assess the effects of epiretinal membranes (ERM) and macular holes (MH) coexisting with glaucoma on pre-operative retinal structure and function and evaluate post-operative outcomes. METHODS Seven eyes of 7 patients with glaucoma, 6 with ERMs and 1 with MH, were enrolled; 4 underwent vitrectomy for ERM and one for MH. Visual fields (VFs) and optical coherence tomography (OCT) scans were obtained pre- and post-operatively. The 10-2VF deviation map was overlayed on ganglion cell and inner plexiform layer (GCL + IPL) and retinal nerve fiber layer (RNFL) deviation maps derived from OCT macula and disc cube scans. Optic nerve circle scans were obtained to assess RNFL thickness, and OCT b-scans associated with VF defects were compared pre- and post-operatively. RESULTS Examination of pre-operative VFs and OCT scans showed the importance of determining the extent to which glaucomatous damage contributed to VF loss; verifying automated segmentation of the GCL + IPL and RNFL; and assessing foveal anatomy. Evaluation of post-operative structure-function outcomes required correction of magnification changes in OCT scans and repeated follow-up visits to clarify the origin of VF changes. CONCLUSIONS Pre-operative comparisons of VFs and OCT scans may be beneficial in guiding surgical planning, and evaluating outcomes, in eyes with glaucoma undergoing macular surgery.
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Affiliation(s)
- Sarah N Yu
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Donald C Hood
- Department of Ophthalmology, Columbia University, New York, NY, USA
- Department of Psychology, Columbia University, 160 Fort Washington Avenue, Room 508, New York, NY, 10032, USA
| | - Dana M Blumberg
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Stanley Chang
- Department of Ophthalmology, Columbia University, New York, NY, USA
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77
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Far PM, Yeung SC, Ma PE, Hurley B, Kertes P, You Y, Yan P. Effects of Internal Limiting Membrane Peel for Idiopathic Epiretinal Membrane Surgery: A Systematic Review of Randomized Controlled Trials. Am J Ophthalmol 2021; 231:79-87. [PMID: 33989597 DOI: 10.1016/j.ajo.2021.04.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/11/2021] [Accepted: 04/28/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to compare functional and anatomical outcomes after epiretinal membrane (ERM) peeling with internal limiting membrane (ERM/ILM) peeling and without for the treatment of idiopathic ERM. DESIGN Systematic review and meta-analysis. METHODS A comprehensive search of Cochrane CENTRAL, MEDLINE Ovid, and Embase Ovid for randomized controlled trials comparing ERM/ILM with ERM was performed. Two independent reviewers selected papers and extracted data. Methodological quality was assessed using the Cochrane Risk of Bias (RobVis) tool. Data was analyzed using RevMan 5.3. Quality of body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS Seven studies reporting 387 eyes overall were included. A total of 207 eyes (53%) received ERM/ILM. A total of 180 (47%) received ERM. Post-operative visual acuities (logMAR) were not significantly different between ERM/ILM and ERM, with a mean difference (MD) of 0.02 (95% confidence interval [CI]: -0.04 to 0.09; P = .45; I2= 42%; n = 101) at 1 month; 0.03 (95% CI: -0.01 to 0.06; P = .11, I2 = 15%; n = 299; High Certainty of Evidence) at 3 months; 0.01 (95% CI: -0.03 to 0.04; P = .72; I2 = 21%; n = 317; High Certainty of Evidence) at 6 months; and 0.01 (95% CI: -0.02 to 0.04; P = .49; I2 = 39%; n = 234) at 12 months post-operatively. ERM/ILM was significantly associated with lower ERM recurrence at 6-12 months with a relative risk of 0.16 (95% CI: 0.04-0.64; P = .01; I2 = 0%; n = 155; Moderate certainty of evidence) and an increased central macular thickness (micrometers) at 12 months with an MD of 20.53 (95% CI: 4.96-36.09; P = .01; I2 = 12%; n = 234). CONCLUSIONS ERM/ILM and ERM result in similar visual acuity despite subtle differences in anatomical outcomes (central macular thickness). ERM/ILM is associated with a significantly lower rate of ERM recurrence at 6-12 months post-operatively and should be considered where recurrence prevention is the treatment priority.
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78
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Preti RC, Zacharias LC, Cunha LP, Monteiro MLR, Sarraf D. Spontaneous closure of degenerative lamellar macular hole with epiretinal membrane proliferation. Int J Retina Vitreous 2021; 7:64. [PMID: 34702375 PMCID: PMC8549372 DOI: 10.1186/s40942-021-00339-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background To describe the spontaneous closure of a degenerative lamellar macular hole with epiretinal proliferation (LHEP) as documented with tracked spectral domain optical coherence tomography (SD-OCT). Case presentation A 54-years-old diabetic female patient presented with progressive vision loss in the left eye. SD-OCT illustrated LHEP associated with cystic fluid in the outer nuclear layer. Sequentially tracked SD-OCT showed progressive closure of the degenerative lamellar macular hole and resolution of the CME over almost 4 years, in the absence of any surgical intervention. Discussion/conclusion LHEP may represent a specialized form of degenerative epiretinal membrane associated with Muller cell activation. Spontaneous degenerative LMH closure may rarely occur with these lesion types, in the absence of surgical intervention, possibly due to Muller cell proliferation preceded by PVD.
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Affiliation(s)
- Rony C Preti
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, SP, Brazil.
| | - Leandro C Zacharias
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Leonardo P Cunha
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, SP, Brazil.,Department of Ophtalmology, School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Mario L R Monteiro
- Division of Ophthalmology, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - David Sarraf
- David Geffen School of Medicine at UCLA, Stein Eye Institute, Los Angeles, CA, USA.,Greater Los Angeles Veterans Affairs Healthcare Center, Los Angeles, CA, USA
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79
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Fleissig E, Sigford DK, Sandhu HS, Barr CC. Long-Term Follow-Up of Outer Retinal Layers in Patients with Epiretinal Membranes. Ophthalmologica 2021; 245:117-123. [PMID: 34634784 DOI: 10.1159/000519938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/24/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE This study aimed to investigate the long-term effect of observed epiretinal membranes on the outer retinal layers and visual acuity. METHODS It is a retrospective observational study. Subjects with an epiretinal membrane and consecutive optical coherence tomography scans were followed for changes in visual acuity, central macular thickness, ellipsoid zone loss, and outer foveal thickness (OFT). RESULTS The study consisted of 24 eyes of 22 patients, with a mean follow-up of 5 ± 1.6 years. The mean visual acuity was slightly worse at the last follow-up (0.22 ± 0.36 LogMAR [20/33] vs. 0.27 ± 0.36 LogMAR [20/36], p = 0.05). Ellipsoid zone loss was found in 37.5% of eyes. Vision loss was associated with initial size of ellipsoid disruption (p = 0.048) and age (p = 0.027). A decrease in OFT was associated with an initially larger zone of ellipsoid disruption (p = 0.006) and an initially thicker OFT (p = 0.011). An epiretinal membrane associated with vitreomacular adhesion within 1,000 μm of the foveal center at baseline was associated with ellipsoid zone loss (p = 0.012) but not with a change in visual acuity. CONCLUSIONS Ellipsoid zone changes were common in this study and tended to enlarge over time. Epiretinal membranes associated with vitreomacular adhesion within 1,000 μm of the foveal center may be a risk factor for ellipsoid zone loss.
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Affiliation(s)
- Efrat Fleissig
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA, .,Department of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel,
| | - Douglas Kenneth Sigford
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Harpal Singh Sandhu
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Charles C Barr
- Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Louisville, Kentucky, USA
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80
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Ivastinovic D, Haas A, Weger M, Seidel G, Mayer-Xanthaki C, Lindner E, Guttmann A, Wedrich A. Vitrectomy for diabetic macular edema and the relevance of external limiting membrane. BMC Ophthalmol 2021; 21:334. [PMID: 34525998 PMCID: PMC8444500 DOI: 10.1186/s12886-021-02095-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the relevance of external limiting membrane (ELM) on the visual and morphological results in eyes with diabetic macular edema (DME) that underwent pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling. METHODS Medical records of patients with DME who underwent PPV at our unit between January 2017 and December 2019 were reviewed. We assessed preoperative and postoperative best-corrected visual acuity (BCVA), central macular thickness (CMT) using spectral domain OCT (optical coherence tomography). Exclusion criteria were previous PPV; incomplete data; concomitant diseases including retinal vein occlusion, age-related macular degeneration, uveitis; and a follow-up of less than 12 months. The surgeries were performed using 23- or 27-gauge vitrectomy. The ELM was graded depending on its configuration (grade 0 = intact, grade 1 to 3: disruption of varying extent). RESULTS Ninety-nine eyes were enrolled. The postoperative follow up averaged 23.7 months. The preoperative and final BCVA averaged 0.71 ± 0.28 and 0.52 ± 0.3 logMAR, respectively (p = 0.002). The CMT averaged 515.2 ± 209.1 μm preoperatively and 327 ± 66.1 μm postoperatively (p = 0.001). Eyes with intact ELM (n = 8) had a significantly better BCVA compared to those with ELM disruption (0.28 ± 0.14 vs. 0.7 ± 0.25 logMAR, p = 0.01). The final CMT was similar among the groups (intact ELM: 317 ± 54.6 μm; ELM disruption: 334 ± 75.2, p = 0.31). CONCLUSIONS PPV with ERM and ILM peeling is an effective treatment of DME. Eyes with intact ELM preoperatively had a significantly better final visual outcome. To maximize the benefit for patients with DME we recommend early PPV as long as ELM is intact.
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Affiliation(s)
- Domagoj Ivastinovic
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria.
| | - Anton Haas
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Martin Weger
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Gerald Seidel
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | | | - Ewald Lindner
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Andreas Guttmann
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
| | - Andreas Wedrich
- Department of Ophthalmology, Medical University Graz, Auenbruggerplatz 4, 8036, Graz, Austria
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81
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Wang Y, Chen Z, Yu W, Chen Y. Activation of quiescent polypoidal choroidal vasculopathy after membrane peeling vitrectomy for epiretinal membrane: a case report. BMC Ophthalmol 2021; 21:321. [PMID: 34488669 DOI: 10.1186/s12886-021-02080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/24/2021] [Indexed: 11/20/2022] Open
Abstract
Background Regular membrane peeling vitrectomy for epiretinal membrane (ERM) patients seldom causes large pigment epithelial detachment (PED). We presented an unusual case of the activation of quiescent polypoidal choroidal vasculopathy (PCV) after membrane peeling vitrectomy for ERM, with an uneven therapeutic process. Case presentation A 75-year-old female patient complained of metamorphopsia in her left eye for 2 years. Her best-corrected visual acuity was 20/160 with a moderate nuclear cataract. An irregular ERM and slight PED were shown in optical coherence tomography (OCT). No obvious orange-red lesion was detected. The patient underwent vitrectomy + ERM peeling + cataract surgery. After the operation, large PED emerged, and indocyanine green angiography (ICGA) confirmed PCV. Four monthly injections of intravitreal ranibizumab were administered, but PED persisted. After focal laser therapy targeted to the polyps combined with ranibizumab treatment, PED was absorbed. Conclusions Careful evaluation for PCV before membrane peeling vitrectomy for ERM is important, as indolent PCV may be activated postoperatively. Anti-VEGF therapy accompanied by laser photocoagulation may be more effective for PCV polyps located away from the fovea. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02080-5.
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82
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Zobor G, Sacu S, Hollaus M, Aliyeva L, Schmalek AS, Schmidt-Erfurth U, Georgopoulos M. The Postoperative Course of Choroidal and Central Retinal Thickness in Epiretinal Membranes with Respect to Membrane Severity. Ophthalmic Res 2021; 64:1020-1028. [PMID: 34469892 DOI: 10.1159/000519272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/07/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the relation between choroidal thickness (CT), central retinal thickness (CRT) and best-corrected visual acuity (BCVA) after surgery for idiopathic epiretinal membrane (iERM). METHODS Patients with 4 severity stages of iERM, who underwent vitrectomy with membrane- and internal limiting membrane peeling, were included in this prospective study. CRT, CT, and BCVA were assessed at baseline (BSL), 1 week, 1 and 3 months postoperatively. RESULTS Twenty-one eyes were phakic, 11 eyes pseudophakic at BSL, in 14 cases combined cataract surgery was performed. BCVA was highest in stage 1 and 2, lowest in stage 4 iERM (p < 0.001) and correlated with CRT. After surgery, CRT decreased and BCVA increased significantly (p < 0.05). CT did not show significant differences among stages (p = 0.23). BSL CRT did not differ between phakic and pseudophakic eyes, the least reduction after surgery was detected in patients who underwent combined cataract surgery and vitrectomy. BSL CT was greater in phakic than in pseudophakic eyes (p = 0.033). Postoperative CT decreased in pseudophakic and phakic eyes, but remained higher after combined surgery (p = 0.0048). CONCLUSION CT is not related to the severity of iERM. Choroidal changes did not influence the BCVA. Additional cataract surgery seems to cause longer recovery in CT and CRT.
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Affiliation(s)
- Gergely Zobor
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Marlene Hollaus
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Leyla Aliyeva
- Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Alexandra-Stephanie Schmalek
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria.,Vienna Clinical Trial Center, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Michael Georgopoulos
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
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Meyer PS, Kammann MT, Meyer CH. Vitrectomy in full thickness macular holes on top of a pigment epithelial detachment in age-related macular degeneration (AMD). Surgical consideration and review of the literature. Am J Ophthalmol Case Rep 2021; 23:101154. [PMID: 34286160 PMCID: PMC8280528 DOI: 10.1016/j.ajoc.2021.101154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To present the surgical treatment of a full thickness macular hole (MH) caused by a vitreomacular traction (VMT) on top of an adjacent subfoveal pigment epithelial detachment (PED) in age-related macular degeneration (AMD). OBSERVATION A 77-year-old female with a subfoveal PED receiving consecutive intravitreal injections noticed a sudden decreased visual acuity (VA) due to the development an occult MH in her right eye after 19 repeated intravitreal anti vascular endothelial growth factor (VEGF)-injections. Her initial VA declined from 20/50 to 20/400. The firm VMT induced a rupture of the multi-layered retina and may progress to an RPE-tear or possible to a subretinal haemorrhage. We discussed with the patient the risks of the natural progression and explained possible treatment options: We continued her anti-VEGF combined with air bubble injections to induce a posterior vitreous detachment, to stabilise the retinal architecture, reduce the subretinal fluid and avoid possible intraoperative bleeding. As injections did release the VMT, vitrectomy released the posterior vitreous from the optic nerve and trimmed it towards the central retina. Peeling with brilliant blue removed the internal limiting membrane without any signs of bleeding, rupture of the PED or enlargement of the MH, prior to the installation of 10% SF6 gas. The postoperative optical coherence tomography (OCT) on day 5 confirmed a closed MH, while the size, shape and pattern of the PED remained unchanged. Her VA increased from 20/400 to 20/50 (equal to her previous VA prior to the MH-formation). To avoid a potential progression of the PED, we maintained her retreatment intervals at 5 weeks for the next 6 months. A literature review presents similar intraoperative approaches and postoperative outcomes in 8 out of the 9 published cases. CONCLUSIONS AND IMPORTANCE VMT can induce an occult MH on top of a PED, causing a significant loss of vision. When gas injections are not successful, surgery may release the traction, restore the retinal architecture, and significantly improve and maintain the VA over a documented long-term observation. The epiretinal procedure should be assisted under regular anti-VEGF injections to maintain the subretinal architecture.
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84
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Oshiro A, Imanaga N, Koizumi H. Rapid formation of macular pucker following intravitreal ranibizumab injection for branch retinal vein occlusion. Am J Ophthalmol Case Rep 2021; 23:101192. [PMID: 34430758 PMCID: PMC8365331 DOI: 10.1016/j.ajoc.2021.101192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/27/2021] [Accepted: 08/09/2021] [Indexed: 10/28/2022] Open
Abstract
Purpose To report a case of branch retinal vein occlusion (BRVO) in which rapid formation of macular pucker was observed after an intravitreal ranibizumab (IVR) injection. Observations A 66-year-old patient was referred to our department for the treatment of macular edema (ME) secondary to BRVO in the left eye. On the initial visit, widespread retinal hemorrhage was observed around the superior temporal vascular arcade, and the decimal best-corrected visual acuity (BCVA) was 0.7 (Snellen equivalent 20/29) in the left eye. Optical coherence tomography demonstrated a thin epiretinal membrane (ERM) accompanied by diffuse retinal thickening. A 0.5 mg IVR injection was administered for the treatment of ME and prompt resolution of retinal hemorrhage. Fourteen days after IVR administration, the ERM had progressed remarkably into a macular pucker and had spread from the superior macula to the equator, accompanied by partial tractional retinal detachment. We performed pars plana vitrectomy combined with encircling scleral buckling. Three months after the surgery, the decimal BCVA was 0.4 (Snellen equivalent 20/50), the retina was attached, and no recurrence of ME or proliferation was observed. Conclusions and Importance IVR for BRVO may cause rapid formation of macular pucker in the eye, especially in the presence of pre-existing ERM. Careful observation of patients with BRVO is essential after administration of anti-VEGF agents, especially in eyes with pre-existing ERM.
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Affiliation(s)
- Ayano Oshiro
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Naoya Imanaga
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hideki Koizumi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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85
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Xue-Qing B, Li L, Yan-Hui C, Ning-Dong L. Recurrent and Spontaneous Release of Epiretinal Membrane in a Toddler. Case Rep Ophthalmol 2021; 12:670-674. [PMID: 34413760 PMCID: PMC8339516 DOI: 10.1159/000510388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/22/2020] [Indexed: 11/19/2022] Open
Abstract
We report a case of an epiretinal membrane (ERM) in a 3-year-old girl, which was accidently discovered after a strabismus surgery. The ERM occurred twice in 2 years and spontaneously released within 3 months, which has not been previously reported.
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Affiliation(s)
- Bai Xue-Qing
- Department of Ophthalmology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Li Li
- Department of Ophthalmology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Cui Yan-Hui
- Department of Ophthalmology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Li Ning-Dong
- Department of Ophthalmology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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86
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Adıyeke SK, Kutlu N, Özen K, Doran MA, Demirbaş K, Ture G, Talay E. Is pseudoexfoliation syndrome associated with vitreoretinal interface abnormalities? Graefes Arch Clin Exp Ophthalmol 2021; 260:431-437. [PMID: 34406503 DOI: 10.1007/s00417-021-05373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/31/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND To evaluate vitreoretinal interface abnormalities in patients with pseudoexfoliation (PEX) syndrome. METHODS This case-control study was performed in 136 patients diagnosed with unilateral PEX (PEX group) and 139 age- and sex-matched healthy volunteers (Control group). Both the affected and contralateral eyes were evaluated in the PEX group and the right eye was evaluated in the Control group. Vitreoretinal interface abnormalities and posterior vitreous detachment (PVD) were evaluated on optical coherence tomography (OCT) examination. RESULTS The incidences of incomplete and complete PVD were significantly higher in the affected than contralateral eye in the PEX group and in the right eye in the Control group (P = 0.009, P = 0.012 and P = 0.004, P = 0.017, respectively). The rates of 'no PVD' were significantly higher in the contralateral eye in the PEX group and the Control group compared to the affected eye in the PEX group (P = 0.003 and P = 0.001, respectively). The odds ratio for incomplete PVD was 3.1 in PEX eyes compared to the contralateral eye in the PEX group and 3.9 compared to the Control group. The rate of epiretinal membranes (ERMs) in the affected eye was significantly different from the contralateral eye in the PEX and Control groups (P < 0.001 and P < 0.001, respectively). The odds ratio for ERM in PEX eyes was 3.51 compared to the contralateral eye in the PEX group and 4.23 compared to the Control group. In the presence of incomplete PVD, the odds ratio for ERM development was 3.81 in PEX eyes. CONCLUSIONS We detected high rates of ERMs and incomplete PVD in patients with PEX. It is important to evaluate and follow up PEX cases in terms of vitreoretinal interface abnormalities.
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Affiliation(s)
- Seda Karaca Adıyeke
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey.
| | - Neslisah Kutlu
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey
| | - Kıvanç Özen
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey
| | - Mehmet Ali Doran
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey
| | - Kemal Demirbaş
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey
| | - Gamze Ture
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey
| | - Ekrem Talay
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey
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Giachos I, Chalkiadaki E, Andreanos K, Symeonidis C, Charonis A, Georgalas I, Rotsos T. Epiretinal membrane-induced intraretinal neovascularization. Am J Ophthalmol Case Rep 2021; 23:101180. [PMID: 34381926 PMCID: PMC8332659 DOI: 10.1016/j.ajoc.2021.101180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 11/01/2022] Open
Abstract
Purpose To report a 71-year-old male patient diagnosed with epiretinal membrane-induced intraretinal neovascularization. Observations The presence of an epiretinal membrane (ERM) was confirmed by Optical Coherence Tomography (OCT), fluorescein and indocyanine angiography. Optical coherence tomography angiography (OCT-A) revealed a neovascular membrane within the ERM. Intravitreal ranibizumab injections were administered three times at four-week intervals. Imaging revealed a stable membrane with no leakage. Five months after the third injection, OCT revealed intraretinal fluid. OCT-A showed a new branch of the neo-vascular membrane at the superficial capillary plexus. Following an additional ranibizumab injection, the membrane stabilized. Conclusions and importance It is conceivable that neovascularization developed due to, or in close conjunction with an epiretinal membranes already in place.
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Affiliation(s)
- Ioannis Giachos
- 1st Department of Ophthalmology, University of Athens, G. Gennimatas General Hospital, 154, Mesogion Av., 115 27 Athens, Greece
| | - Evangelia Chalkiadaki
- 1st Department of Ophthalmology, University of Athens, G. Gennimatas General Hospital, 154, Mesogion Av., 115 27 Athens, Greece
| | - Konstantinos Andreanos
- 1st Department of Ophthalmology, University of Athens, G. Gennimatas General Hospital, 154, Mesogion Av., 115 27 Athens, Greece
| | - Chrysanthos Symeonidis
- 1st Department of Ophthalmology, University of Athens, G. Gennimatas General Hospital, 154, Mesogion Av., 115 27 Athens, Greece
| | - Alexandros Charonis
- Athens Vision Eye Institute, 328-330, A. Syngros Av., 176 73, Athens, Greece
| | - Ilias Georgalas
- 1st Department of Ophthalmology, University of Athens, G. Gennimatas General Hospital, 154, Mesogion Av., 115 27 Athens, Greece
| | - Tryfon Rotsos
- 1st Department of Ophthalmology, University of Athens, G. Gennimatas General Hospital, 154, Mesogion Av., 115 27 Athens, Greece
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Iuliano L, Cisa di Gresy G, Fogliato G, Corbelli E, Bandello F, Codenotti M. Increased risk of postsurgical macular edema in high stage idiopathic epiretinal membranes. Eye Vis (Lond) 2021; 8:29. [PMID: 34348801 PMCID: PMC8335864 DOI: 10.1186/s40662-021-00252-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/18/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the rate of occurrence and the risk factors of postsurgical macular edema (PSME) in eyes with idiopathic epiretinal membrane (iERM) or full-thickness macular hole (FTMH). METHODS Retrospective longitudinal analysis of all subjects scheduled for vitrectomy with or without combined cataract surgery over a 6-month period. Electronic medical charts and imaging data were analyzed preoperatively and at 1, 3 and 6 months after surgery. RESULTS From 101 patients diagnosed with iERM or FTMH, 71 patients were eligible for the study. Forty-nine eyes with iERM (69.0%) and 22 eyes with FTMH (31.0%) underwent vitrectomy either isolated (31.0%) or combined with cataract extraction (69.0%). The overall rate of PSME was 26.7%, without differences between the two groups (P = 0.9479). Combined cataract extraction did not affect the overall occurrence of PSME rate in both groups (P = 0.9255 in FTMH and P = 0.8658 in iERM). If grouped by stage, eyes with stage 4 iERM though disclosed an increased rate of PSME (57.1%) compared to lower (1 to 3) stages (14.3%, P = 0.0021), particularly when combined with cataract surgery (71.4% vs. 15.4% in stages ≤ 3, P = 0.0021). The PSME odds ratio for a stage 4 iERM is 8 (95% CI: 1.933-33.1; P = 0.0041) compared to stages 3 and below. CONCLUSIONS PSME remains a clinically relevant and frequent event after surgery for iERM and FTMH. Patients with stage 4 iERM have an 8-fold higher likelihood of developing PSME in a 6-month postsurgical period compared to iERM in 1-3 stages, especially when combined with cataract extraction.
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Affiliation(s)
- Lorenzo Iuliano
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Gloria Cisa di Gresy
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giovanni Fogliato
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Eleonora Corbelli
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Codenotti
- Department of Ophthalmology, Vita-Salute University, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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89
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Kim JH, Kim JW, Kim CG. Characteristics of spontaneous reattachment of rhegmatogenous retinal detachment: optical coherence tomography features and follow-up outcomes. Graefes Arch Clin Exp Ophthalmol 2021. [PMID: 34244825 DOI: 10.1007/s00417-021-05304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/06/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To investigate the clinical features of spontaneous reattachment of rhegmatogenous retinal detachment (SRRRD) with diffuse retinal pigmentary changes. METHODS This retrospective study included patients diagnosed with SRRRD. The diagnosis of SRRRD was made based on characteristic fundus findings, such as diffuse retinal pigmentary clumpings, retinal pigmentary atrophy, and convex lesion margins. The clinical features of SRRRD were also evaluated. In addition, optical coherence tomography (OCT) images and follow-up data were analyzed. RESULTS Twenty patients were included in the study. All the patients showed unilateral involvement. SRRRD predominantly involved the inferior or temporal retina (90.0%). On OCT, severe disruption of the outer retinal layers was noted in the region of SRRRD. A subretinal gliosis band was noted in 11 patients (55.0%), and an epiretinal membrane (ERM) was noted in nine patients (45.0%). In 18 patients, a mean follow-up of 24.9 ± 29.2 months was performed. During the follow-up period, no definite retinal changes were noted on fundus examination or OCT. CONCLUSIONS SRRRD usually involves the inferior or temporal retina. Although severe disruption of the retinal microstructure is noted in the involved region, the condition is likely to be stable. However, long-term follow-up is required to identify progression of the ERM.
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90
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Mustafi D, Do BK, Rodger DC, Rao NA. Relationship of Epiretinal Membrane Formation and Macular Edema Development in a Large Cohort of Uveitic Eyes. Ocul Immunol Inflamm 2021; 29:915-921. [PMID: 31961201 DOI: 10.1080/09273948.2019.1704026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To identify the temporal relationship and clinical characteristics of epiretinal membrane (ERM) and macular edema (ME) formation in uveitic eyes.Methods: A total of 269 subjects (444 uveitic eyes) met study inclusion criteria. Comprehensive ophthalmic examination, spectral domain-optical coherence tomography (SD-OCT), and clinical testing were carried out.Results: Of the 444 uveitic eyes, 229 eyes (51.6%) developed an ERM, whereas 87 eyes (19.1%) developed ME. The odds ratios (ORs) of systemic disease causing uveitis and resulting in ERM and ME were significantly higher in posterior uveitis (OR 6.56, 95% CI 2.98-14.46; p < .0001) and panuveitis (OR 10.09, 95% CI 4.05-25.15; p < .0001). Temporal analysis revealed that an ERM was noted concurrently or prior to ME development in 93.8% of eyes.Conclusions: ERM and ME are primarily observed in posterior uveitis and panuveitis associated with systemic diseases. The temporal relationship highlights the importance of characterization of ERM as it relates to the development of uveitic ME.
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Affiliation(s)
- Debarshi Mustafi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Brian K Do
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Damien C Rodger
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Narsing A Rao
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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91
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Han GH, Han DJ, Lee JH, Byeon SH, Shin JY. Tomographic Structural Changes of the Inner Retina after Internal Limiting Membrane Peeling for Idiopathic Epiretinal Membrane. Korean J Ophthalmol 2021; 34:235-241. [PMID: 32495532 PMCID: PMC7269741 DOI: 10.3341/kjo.2019.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/10/2020] [Accepted: 03/11/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the tomographic structural changes in the retinal layers after internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (ERM). Methods Sixty-nine eyes treated with vitrectomy and ILM peeling for idiopathic ERM were analyzed. Parafoveal retinal thickness was measured at baseline and 6 months after surgery. Results Total retinal thickness decreased significantly in the nasal and temporal subfields after surgery (p < 0.001), whereas the inner nuclear layer and outer nuclear layer showed nasal thickening (all, p < 0.001). The postoperative temporal/nasal subfield thickness ratio of each layer was significantly lower than that of fellow eyes. Eyes with larger ILM peeling showed a significantly lower temporal/nasal subfield thickness ratio (p = 0.033) than those with smaller sizes. Conclusions The retinal thickness of each layer showed anatomical changes from ILM peeling and ERM removal. Nasal parafoveal thickening and temporal thinning occurred in the inner retinal architecture, which might be affected by ILM peeling size.
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Affiliation(s)
- Ga Hee Han
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Dong Jin Han
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jong Hyun Lee
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Suk Ho Byeon
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Youn Shin
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.,Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea.
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92
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Takeyama A, Imamura Y, Shibata M, Komiya Y, Ishida M. Inner retinal structure and visual function after idiopathic epiretinal membrane surgery with and without brilliant blue G. Jpn J Ophthalmol 2021; 65:689-697. [PMID: 34196835 DOI: 10.1007/s10384-021-00851-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Vital dyes are frequently used to visualize the internal limiting membrane (ILM) of the neuroretina. This study evaluated and compared the microstructure of the inner retina and visual function with and without brilliant blue G (BBG) staining for ILM peeling during idiopathic epiretinal membrane (ERM) surgery. STUDY DESIGN Retrospective, consecutive, interventional case series. METHODS Fifty-five patients (55 eyes) with ERM underwent ILM peeling without dyes (non-dye group) and 55 patients (55 eyes) underwent ILM peeling with BBG staining (BBG group). The logMAR visual acuity (VA) and ganglion cell complex (GCC) thickness were measured using optical coherence tomography at baseline and 12 months after surgery. RESULTS LogMAR VA improved significantly in both groups at 12 months and the BBG group tended to be better than the non-dye group but with no significant difference between the groups (unpaired t-test, P = 0.490). The average GCC thickness significantly decreased in both groups; however, there was no difference in the rates of change in GCC thickness between the groups. The ratio of GCC thickness to total retinal thickness (%) was significantly higher in the BBG group in the superior quadrant at 12 months postoperatively (P = 0.010). CONCLUSION BBG-assisted ERM surgery resulted in better visual improvement and fewer structural changes in the inner retinal layers. BBG-assisted ILM peeling is safe both functionally and anatomically.
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Affiliation(s)
- Asuka Takeyama
- Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, 5-1-1Takatsu-ku, FutagoKawasaki, Kanagawa, 213-8507, Japan. .,Department of Ophthalmology, Toho University Ohashi Medical Center, Tokyo, Japan.
| | - Yutaka Imamura
- Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, 5-1-1Takatsu-ku, FutagoKawasaki, Kanagawa, 213-8507, Japan
| | - Masaki Shibata
- Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, 5-1-1Takatsu-ku, FutagoKawasaki, Kanagawa, 213-8507, Japan
| | - Yuko Komiya
- Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, 5-1-1Takatsu-ku, FutagoKawasaki, Kanagawa, 213-8507, Japan
| | - Masahiro Ishida
- Department of Ophthalmology, Teikyo University School of Medicine, University Hospital Mizonokuchi, 5-1-1Takatsu-ku, FutagoKawasaki, Kanagawa, 213-8507, Japan.,Department of Ophthalmology, Toho University Ohashi Medical Center, Tokyo, Japan
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93
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Terashima H, Okamoto F, Hasebe H, Matsuoka N, Ueda E, Yoshida H, Togano T, Fukuchi T. Evaluation of postoperative visual function based on the preoperative inner layer structure in the epiretinal membrane. Graefes Arch Clin Exp Ophthalmol 2021. [PMID: 34097112 DOI: 10.1007/s00417-021-05248-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the postoperative visual function using a preoperative epiretinal membrane (ERM) classification based on the status of the inner layer structure. METHODS We assessed 62 eyes, one from each patient undergoing vitrectomy with internal limiting membrane (ILM) peeling for unilateral ERM. The inclusion criteria were as follows: (1) the presence of idiopathic ERM based on optical coherence tomography and a healthy contralateral eye, (2) successful surgery after 25- or 27-gauge transconjunctival 3-port pars plana vitrectomy with ILM peeling, and (3) a minimum follow-up period of 12 months. We included patients with preoperative ERM morphology with no disruption of the inner retinal layer in group A (37 eyes) and those with disruption in group B (25 eyes) and compared the visual acuity, central visual-field sensitivity (CVFS) measured using the Humphrey field analyzer 10-2 program, and detection rate of micro-scotoma (< 10 dB) at baseline and 12 months postoperatively between the groups. RESULTS Visual acuity at 12 months showed greater improvement in group A than in group B (P = .03). There was no significant difference in CVFS at baseline; however, that of the nasal area was substantially lower after surgery in group B than in group A (P = .02). The 12-month postoperative detection rate of micro-scotoma was significantly higher in group B than in group A (P = .002). CONCLUSION ERM that has preoperatively disrupted the inner layer poses the risks of CVFS reduction and micro-scotoma formation after vitrectomy. Evaluating the inner layer could be an important prognostic factor in determining retinal function in ERM.
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94
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Bringmann A, Unterlauft JD, Barth T, Wiedemann R, Rehak M, Wiedemann P. Müller cells and astrocytes in tractional macular disorders. Prog Retin Eye Res 2021; 86:100977. [PMID: 34102317 DOI: 10.1016/j.preteyeres.2021.100977] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 02/04/2023]
Abstract
Tractional deformations of the fovea mainly arise from an anomalous posterior vitreous detachment and contraction of epiretinal membranes, and also occur in eyes with cystoid macular edema or high myopia. Traction to the fovea may cause partial- and full-thickness macular defects. Partial-thickness defects are foveal pseudocysts, macular pseudoholes, and tractional, degenerative, and outer lamellar holes. The morphology of the foveal defects can be partly explained by the shape of Müller cells and the location of tissue layer interfaces of low mechanical stability. Because Müller cells and astrocytes provide the structural scaffold of the fovea, they are active players in mediating tractional alterations of the fovea, in protecting the fovea from such alterations, and in the regeneration of the foveal structure. Tractional and degenerative lamellar holes are characterized by a disruption of the Müller cell cone in the foveola. After detachment or disruption of the cone, Müller cells of the foveal walls support the structural stability of the foveal center. After tractional elevation of the inner layers of the foveal walls, possibly resulting in foveoschisis, Müller cells transmit tractional forces from the inner to the outer retina leading to central photoreceptor layer defects and a detachment of the neuroretina from the retinal pigment epithelium. This mechanism plays a role in the widening of outer lameller and full-thickness macular holes, and contributes to visual impairment in eyes with macular disorders caused by conractile epiretinal membranes. Müller cells of the foveal walls may seal holes in the outer fovea and mediate the regeneration of the fovea after closure of full-thickness holes. The latter is mediated by the formation of temporary glial scars whereas persistent glial scars impede regular foveal regeneration. Further research is required to improve our understanding of the roles of glial cells in the pathogenesis and healing of tractional macular disorders.
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Affiliation(s)
- Andreas Bringmann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany.
| | - Jan Darius Unterlauft
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Thomas Barth
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Renate Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Matus Rehak
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
| | - Peter Wiedemann
- Department of Ophthalmology and Eye Hospital, University of Leipzig, 04103, Leipzig, Germany
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Krishna Chandran AM, Coltrini D, Belleri M, Rezzola S, Gambicorti E, Romano D, Morescalchi F, Calza S, Semeraro F, Presta M. Vitreous from idiopathic epiretinal membrane patients induces glial-to-mesenchymal transition in Müller cells. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166181. [PMID: 34082068 DOI: 10.1016/j.bbadis.2021.166181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/10/2021] [Accepted: 05/24/2021] [Indexed: 12/22/2022]
Abstract
Idiopathic epiretinal membranes (ERMs) are fibrocellular membranes containing extracellular matrix proteins and epiretinal cells of retinal and extraretinal origin. iERMs lead to decreased visual acuity and their pathogenesis has not been completely defined. Macroglial Müller cells appear to play a pivotal role in the pathogenesis of iERM where they may undergo glial-to-mesenchymal transition (GMT), a transdifferentiation process characterized by the downregulation of Müller cell markers, paralleled by the upregulation of pro-fibrotic myofibroblast markers. Previous observations from our laboratory allowed the molecular identification of two major clusters of iERM patients (named iERM-A and iERM-B), iERM-A patients being characterized by less severe clinical features and a more "quiescent" iERM gene expression profile when compared to iERM-B patients. In the present work, Müller MIO-M1 cells were exposed to vitreous samples obtained before membrane peeling from the same cohort of iERM-A and iERM-B patients. The results demonstrate that iERM vitreous induces proliferation, migration, and GMT in MIO-M1 cells, a phenotype consistent with Müller cell behavior during iERM progression. However, even though the vitreous samples obtained from iERM-A patients were able to induce a complete GMT in MIO-M1 cells, iERM-B samples caused only a partial GMT, characterized by the downregulation of Müller cell markers in the absence of upregulation of pro-fibrotic myofibroblast markers. Together, the results indicate that a relationship may exist among the ability of iERM vitreous to modulate GMT in Müller cells, the molecular profile of the corresponding iERMs, and the clinical features of iERM patients.
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96
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Khateb S, Aweidah H, Halpert M, Jaouni T. Postoperative Macular Proliferative Vitreoretinopathy: A Case Series and Literature Review. Case Rep Ophthalmol 2021; 12:464-472. [PMID: 34177543 PMCID: PMC8215993 DOI: 10.1159/000512285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/10/2020] [Indexed: 12/02/2022] Open
Abstract
Premacular membranes developing following pars plana vitrectomy (PPV) can cause significant anatomical and functional deficits to the macula. Recent reports showed that postoperative premacular membranes are a localized presentation of macular proliferative vitreoretinopathy (mPVR). Here, we report retrospectively a case series of 5 patients with severe mPVR which developed following uneventful PPV and were followed up to 32 months in the Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, between October 2016 and February 2020. All patients underwent primary repair of rhegmatogenous retinal detachment (RRD) before mPVR developed. Mean best-corrected visual acuity (BCVA) at presentation was 20/76 Snellen (0.58 LogMAR). Median duration of the retinal detachment time until surgery was 1.5 days (range 1–21 days). Mean interval time from last normal follow-up exam to diagnosis of mPVR was 19 days (range 10–28). BCVA dropped from a mean of 20/38 Snellen (0.28 LogMAR) prior to mPVR development to 20/166 Snellen (0.92 LogMAR) following its development, recovering to 20/57 Snellen (0.45 LogMAR) after peeling of membranes. Mean central macular thickness measured by optical coherence tomography decreased from 711 to 354 μm postsurgery. In conclusion, short-term mPVR is a different entity from macular pucker in terms of rapid development, structural distortion, and visual compromise. Surgical treatment significantly restores macular function and anatomy.
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Affiliation(s)
- Samer Khateb
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Hamzah Aweidah
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michael Halpert
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tareq Jaouni
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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97
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Coassin M, Mori T, Mastrofilippo V, Sborgia G, De Maria M, Carlà MM, Di Zazzo A, Fontana L, Cimino L. Surgical management of post-uveitic epiretinal membranes. Eur J Ophthalmol 2021; 32:11206721211017750. [PMID: 34011201 DOI: 10.1177/11206721211017750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE Previous reports described unfavorable visual outcomes after surgery for uveitic macular pucker. Our goal was to demonstrate that patients with history of uveitis may benefit from vitrectomy for epiretinal membrane if executed under appropriate circumstances. METHODS We performed pars plana vitrectomy with ERM and ILM peeling in patients with post-uveitic macular pucker who did not show signs of ocular inflammation for at least 3 months after the suspension of immunosuppressive therapy. Visual acuity, central macular thickness at OCT, ocular inflammation, and complications were recorded. RESULTS Twenty-six eyes were operated. Mean duration of follow-up was 67 months. Visual acuity significantly improved from 20/80 to 20/40 after surgery. Vision increased in 20 (77%), remained stable in 4 (15%), and decreased in 2 (8%) eyes. Best-corrected visual acuity ameliorated by at least 2 ETDRS lines in 14 eyes (54%). Contingency analysis did not show any statistical difference among the different types of uveitis (p = 0.46). Mean central foveal thickness improved postoperatively (428 ± 104 vs 328 ± 130 microns; p = 0.017). CONCLUSION Patients with uveitic epiretinal membrane benefit from vitrectomy with membranectomy if operated when intraocular inflammation had subsided.
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Affiliation(s)
- Marco Coassin
- Ophthalmology, University Campus Bio-Medico of Rome, Roma, Italy
| | - Tommaso Mori
- Ophthalmology, University Campus Bio-Medico of Rome, Roma, Italy
| | - Valentina Mastrofilippo
- Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giancarlo Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy
| | - Michele De Maria
- Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
- University of Modena and Reggio Emilia, Modena, Italy
| | | | - Antonio Di Zazzo
- Ophthalmology, University Campus Bio-Medico of Rome, Roma, Italy
| | - Luigi Fontana
- Ophthalmology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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98
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Zhang S, Xue CY, Liu YJ, Zhang WW, Xie ZG. Macular pucker, an atypical clinical presentation of ocular toxoplasmosis: a case report. BMC Ophthalmol 2021; 21:222. [PMID: 34001069 PMCID: PMC8130357 DOI: 10.1186/s12886-021-01983-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ocular toxoplasmosis caused by Toxoplasma gondii is an infectious disease which is widely distributed around the world and can present with various clinic manifestations. We are here reporting an unusual case presented with epiretinal membrane (ERM), i.e., macular pucker. CASE PRESENTATION A 16-year old male patient visited our outpatient clinic complaining of decreased vision for about 8 years in his left eye. The best-corrected visual acuity (BCVA) was 20/20 OD and 20/400 OS. There was sensory exotropia in his left eye. No inflammatory cells or flare were found in his anterior chamber or vitreous cavity OU. An ERM involving his left macular area was found on his dilated fundus exam, which was confirmed by Optical Coherence Tomography (OCT). The ERM was found to involve his left macular area with his foveal ellipsoid zone absent. The right eye was found to be within normal limit. After a thorough discussion with the patient and his parents about treatment options and surgical benefits, risks and alternatives, we performed vitrectomy, peeled off the ERM and collected the vitreous sample for parasite testing during the procedure. Patient's blood also was drawn for serological testing. Vitreous sample analysis and serological tests confirmed ocular toxoplasmosis OS as his final diagnosis. Unfortunately, the BCVA of this patient was not improved after the surgery, but the exotropia disappeared. CONCLUSION ERM is an unusual clinical presentation of ocular toxoplasmosis. We may add Toxoplasma gondii infection as a differential diagnosis when encountering ERM cases.
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Affiliation(s)
- Si Zhang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu Province, China
| | - Chun-Yan Xue
- Department of Ophthalmology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210008, Jiangsu Province, China
| | - Ya-Jun Liu
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu Province, China
| | - Wen-Wen Zhang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu Province, China
| | - Zheng-Gao Xie
- Department of Ophthalmology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, Jiangsu Province, China.
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99
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Ikegami Y, Numaga J, Ue S, Sano T. Morphological alternation and influence of aqueous flare in idiopathic epiretinal membrane. Int J Retina Vitreous 2021; 7:40. [PMID: 34001276 PMCID: PMC8127242 DOI: 10.1186/s40942-021-00294-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 03/09/2021] [Indexed: 11/12/2022] Open
Abstract
Background Idiopathic epiretinal membrane (iERM) is a common retinal disease in the elderly population. The exact pathogenesis of iERM is unknown. The present study aimed to evaluate the relationship between aqueous flare and morphology of iERM using swept-source optical coherence tomography (OCT). Methods A consecutive series of 36 eyes of 33 patients with iERM and 109 control eyes of 109 patients were retrospectively examined. Aqueous flare measurements and OCT images were obtained on the same day. The average total retinal, inner retinal, outer retinal, and choroidal thicknesses were calculated using the thickness map mode with an Early Treatment Diabetic Retinopathy Study nine-zone grid that was divided into three zones. The maximum depth of the retinal folds in iERMs was manually measured. The correlation among flare value, maximum depth of folds, and retinal and choroidal thicknesses was evaluated. The morphological changes between the control eyes and the eyes with iERM in different stages were examined. Results The result demonstrated a significant positive correlation between the aqueous flare value and total and inner retinal thicknesses in the early stage of iERM. There was a significant positive correlation between the maximum depth of folds and total and inner retinal thicknesses in the early stage of iERM, and the maximum depth of folds significantly increased in the advanced stage. The total and inner retinal thicknesses and proportion of inner retinal thickness significantly increased as the stage of iERM progressed. Conclusions The aqueous flare value was associated with retinal thickness in the early stage of iERM, which supports the idea that inflammation or breakdown of blood–ocular barrier is involved in the process of iERM formation. The maximum retinal folds increased as the stage of iERM progressed and retinal thickness increased, which indicates that the tangential force increases as the iERM stage progresses.
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Affiliation(s)
- Yasuko Ikegami
- Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo, 173-0015, Japan. .,Department of Ophthalmology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Jiro Numaga
- Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo, 173-0015, Japan
| | - Saori Ue
- Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo, 173-0015, Japan
| | - Tomohiro Sano
- Department of Ophthalmology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae-cho, Itabashi district, Tokyo, 173-0015, Japan
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Kim B, Kwon S, Choi A, Jeon S. Influence of mild non-foveal involving epiretinal membrane on visual quality in eyes with multifocal intraocular lens implantation. Graefes Arch Clin Exp Ophthalmol 2021; 259:2723-30. [PMID: 33963918 DOI: 10.1007/s00417-021-05225-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To determine the influence of mild non-foveal involving epiretinal membrane (ERM) on visual outcome in eyes with multifocal intraocular lens (MIOL) implantation. METHODS Patients with history of MIOL implantation were screened for the presence of ERM using spectral-domain optical coherence tomography (SD-OCT) at postoperative 6 months. Ninety-one eyes with mild non-foveal involving ERM and history of MIOL implantation were compared with 83 age-matched controls without ERM and history of MIOL implantation. The visual acuity (corrected and uncorrected) and visual quality (contrast sensitivity, Strehl ratio, area ratio, and higher-order aberrations; HOAs) of the eyes with mild non-foveal involving ERM were compared with the data of the age-matched control group. RESULTS There was no difference in visual acuity between the groups at baseline and postoperative 6 months. The mild non-foveal involving ERM group showed significantly low contrast sensitivity at a visual angle of 4.0°, 2.5°, 1.0°, and 0.64° under scotopic conditions (P = .048, P = .025, P = .003, and P = .02, respectively) and 4.0°, 1.0°, and 0.64° under photopic conditions (P = .028, P = .002, and P = .001, respectively). The mean area ratio of the mild non-foveal involving ERM group was 45.13 ± 10.93, which was significantly lower than that of the control group, which measured 50.34 ± 12.66 (P = .044). CONCLUSION A mild non-foveal involving ERM has no effect on visual acuity, but it reduces visual quality in eyes with MIOL implantation. A thorough screening using SD-OCT is warranted for this condition when considering MIOL implantation.
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