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Nicolai M, Franceschi A, De Turris S, Rosati A, Carpenè MJ, Danieli L, Lassandro NV, Pelliccioni P, Lupidi M, Mariotti C. Correlation between retinal sensitivity and retinal vascular perfusion after idiopathic epiretinal membrane peeling. Eur J Ophthalmol 2024; 34:1228-1238. [PMID: 37926976 DOI: 10.1177/11206721231212823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND To evaluate the correlations between anatomical and functional changes after idiopathic epiretinal membrane (iERM) surgery. METHODS In this prospective, observational, single-center study, consecutive patients who underwent iERM peeling were enrolled. Reported data were pre- and postoperative best-corrected visual acuity (BCVA), retinal sensitivity (RS) and fixation stability values on microperimetry, structural macular features on SD-OCT and OCTA. RS of foveal and parafoveal area was analysed and two sub-groups were identified whether RS improved or remained unchanged/worsened after surgery; consequently, vascular perfusion density (VPD) of the same area was studied. RESULTS Twenty-nine eyes of 29 patients were examined. The post-operative improvement in terms of BCVA, RS and fixation within the central 4 degrees was significant (p < 0.001, p < 0.001, p = 0.001), as well as the foveal thickness and macular volume change/reduction (p < 0.001). The pre-operative superficial VPD, choriocapillaris VPD and capillary free zone (CFZ) area were significantly reduced compared to the fellow healthy eye (p = 0.001, p = 0.02, p < 0.001). Choriocapillaris VPD showed a statistically significant increase after surgery (p < 0.02). Superficial, deep and choriocapillaris VPD of the improved RS group showed a significant increase both in foveal (p = 0.03, p = 0.03, p = 0.01) and parafoveal areas (p = 0.01, p = 0.03, p = 0.001). CONCLUSIONS We reported a higher VPD in the retinal area that experienced a retinal sensitivity improvement 6 months after ERM surgery. This result objectifies the tight bond between visual function and retinal perfusion in ERM patients.
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Affiliation(s)
- Michele Nicolai
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Marche, Italy
| | - Alessandro Franceschi
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Marche, Italy
| | - Serena De Turris
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Marche, Italy
| | - Alessandro Rosati
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Marche, Italy
| | - Maria Jolanda Carpenè
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Marche, Italy
| | - Luca Danieli
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Marche, Italy
| | - Nicola Vito Lassandro
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Marche, Italy
| | - Paolo Pelliccioni
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Marche, Italy
| | - Marco Lupidi
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Marche, Italy
| | - Cesare Mariotti
- Eye Clinic, Polytechnic University of Marche, via Conca 61, 60126, Ancona, Marche, Italy
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Ducloyer JB, Eude Y, Volteau C, Lebreton O, Bonissent A, Fossum P, Tadayoni R, Creuzot-Garcher CP, Le Mer Y, Perol J, Fortin J, Jobert A, Billaud F, Ivan C, Poinas A, Weber M. Pros and cons of internal limiting membrane peeling during epiretinal membrane surgery: a randomised clinical trial with microperimetry (PEELING). Br J Ophthalmol 2024:bjo-2023-324990. [PMID: 38901960 DOI: 10.1136/bjo-2023-324990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/02/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND After idiopathic epiretinal membrane (iERM) removal, it is unclear whether the internal limiting membrane (ILM) should be removed. The objective was to assess if active ILM peeling after iERM removal could induce microscotomas. METHODS The PEELING study is a national randomised clinical trial. When no spontaneous ILM peeling occurred, patients were randomised either to the ILM peeling or no ILM peeling group. Groups were compared at the month 1 (M1), M6 and M12 visits in terms of microperimetry, best-corrected visual acuity (BCVA) and optical coherence tomography findings. The primary outcome was the difference in microscotoma number between baseline and M6. RESULTS 213 patients were included, 101 experienced spontaneous ILM peeling and 100 were randomised to the ILM peeling (n=51) or no ILM peeling group (n=49). The difference in microscotoma number between both groups was significant at M1 (3.9 more microscotomas in ILM peeling group, (0.8;7.0) p=0.0155) but not at M6 (2.1 more microscotomas in ILM peeling group (-0.5;4.7) p=0.1155). Only in the no ILM peeling group, the number of microscotomas significantly decreased and the mean retinal sensitivity significantly improved. The ERM recurred in nine patients in the no ILM peeling group (19.6%) versus zero in the ILM peeling group (p=0.0008): two of them underwent revision surgery. There was no difference in mean BCVA and microperimetry between patients experiencing or not a recurrence at M12. CONCLUSION Spontaneous ILM peeling is very common. Active ILM peeling prevents anatomical ERM recurrence but may induce retinal impairments and delay visual recovery. TRIAL REGISTRATION NCT02146144.
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Affiliation(s)
- Jean-Baptiste Ducloyer
- CHU Nantes Department of Ophthalmology, Nantes University, Nantes, France
- Inserm, CIC 1413, CHU Nantes, Nantes, Pays de la Loire, France
| | - Yannick Eude
- CHU Nantes Department of Ophthalmology, Nantes University, Nantes, France
| | - Christelle Volteau
- CHU Nantes, Sponsor Departement, Nantes University, Nantes, Pays de la Loire, France
| | - Olivier Lebreton
- CHU Nantes Department of Ophthalmology, Nantes University, Nantes, France
| | | | - Paul Fossum
- CHU Nantes Department of Ophthalmology, Nantes University, Nantes, France
| | - Ramin Tadayoni
- Ophthalmology department, Hoital Lariboisière, AP-HP, Université paris 7 - Sorbonne Paris Cité, Paris, France
| | | | - Yannick Le Mer
- Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Julien Perol
- Ophthalmology Department, Polyclinique de l'Atlantique, Saint Herblain, France
| | - June Fortin
- CHU Nantes, Sponsor Departement, Nantes University, Nantes, Pays de la Loire, France
| | - Alexandra Jobert
- CHU Nantes, Sponsor Departement, Nantes University, Nantes, Pays de la Loire, France
| | - Fanny Billaud
- CHU Nantes Department of Ophthalmology, Nantes University, Nantes, France
- Inserm, CIC 1413, CHU Nantes, Nantes, Pays de la Loire, France
| | - Catherine Ivan
- CHU Nantes Department of Ophthalmology, Nantes University, Nantes, France
- Inserm, CIC 1413, CHU Nantes, Nantes, Pays de la Loire, France
| | | | - Michel Weber
- CHU Nantes Department of Ophthalmology, Nantes University, Nantes, France
- Inserm, CIC 1413, CHU Nantes, Nantes, Pays de la Loire, France
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Furashova O, Adrianowicz B, Engelmann K. Autologous platelet concentrate in epiretinal membrane surgery: A single-centre prospective comparative non-inferiority study. Acta Ophthalmol 2024. [PMID: 38591236 DOI: 10.1111/aos.16690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 03/29/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE The purpose of the study was to compare the anatomical and functional results including reading ability after epiretinal membrane (ERM) surgery in patients with and without the use of autologous platelet concentrate (APC). METHODS Design: Prospective, comparative non-inferiority series. SETTING Institutional. PATIENTS 51 eyes of 51 patients, who underwent pars-plana vitrectomy (PPV) for ERM surgery. 29 eyes additionally received intraoperative APC, 22 eyes underwent standard procedure without APC use. OBSERVATIONS anatomical and functional outcome parameters (central retinal thickness (CRT), best corrected visual acuity (BCVA) and reading ability (RA)) were compared between the two groups at 6 weeks and 6 months postoperatively. Subjective assessment of visual acuity and reading ability was also analysed. MAIN OUTCOME MEASURES BCVA, RA and CRT. RESULTS Both groups showed significant CRT reduction and RA improvement, while BCVA improvement was significant only in eyes with intraoperative APC use during the follow-up time of 6 months. There was no statistically significant difference between CRT reduction, BCVA and RA improvement between the groups. CONCLUSION Intraoperative APC use for ERM surgery results in similar anatomical and functional outcomes compared with standard ERM surgery without APC use.
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Affiliation(s)
- Olga Furashova
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | | | - Katrin Engelmann
- Department of Ophthalmology, Klinikum Chemnitz gGmbH, Chemnitz, Germany
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4
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Muller YG, Soudier G, Olteanu S, Lenoble P. [Effects of internal limiting membrane peeling in epiretinal membrane surgery on OCT-angiography]. J Fr Ophtalmol 2023; 46:896-907. [PMID: 37625996 DOI: 10.1016/j.jfo.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE To assess macular microvascular parameters using OCT-angiography (OCT-A) in idiopathic epiretinal membrane surgery with or without internal limiting membrane peeling. MATERIALS AND METHODS We retrospectively studied 17 eyes of 17 patients who underwent vitrectomy surgery for idiopathic epiretinal membrane with (n=10) or without (n=7) internal limiting membrane peeling. Patients operated on between July 2020 and June 2022 at the Colmar Hospital (France) by a single surgeon were evaluated before and 1 month after surgery, using OCT-A (Spectralis OCT-A module, Heidelberg Engineering®, Germany). The parameters studied were the area, perimeter and acircularity index of the foveal avascular zone (FAZ), the foveolar (FVD) and parafoveolar (PRVD) perfusion density and the macular vessel density ratio (MVR) in the superficial vascular complex (SVC) and the deep vascular complex (DVC). These parameters were measured using ImageJ software (National Institutes of Health, Bethesda, Maryland, USA). RESULTS We found no statistically significant difference between the two groups postoperatively in either area, perimeter, or acircularity index of the FAZ, FVD, PRVD, or MVR in either the SVC or DVC. CONCLUSION Our results with regard to macular microvasculature demonstrate no difference related to peeling of the internal limiting membrane and thus do not argue against this practice during epiretinal membrane surgery.
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Affiliation(s)
- Y-G Muller
- Université Louis-Pasteur, 67000 Strasbourg, France.
| | - G Soudier
- Centre ophtalmologique Dromson, Sélestat, France
| | - S Olteanu
- Hôpital Pasteur, 68000 Colmar, France
| | - P Lenoble
- Hôpital Pasteur, 68000 Colmar, France
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Muller YG, Lenoble P. [Clinical and pathophysiological contribution of OCT-angiography to epiretinal membranes]. J Fr Ophtalmol 2023; 46:776-790. [PMID: 37164872 DOI: 10.1016/j.jfo.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/30/2023] [Indexed: 05/12/2023]
Abstract
Epiretinal membranes may lead to centripetal contraction forces on the retina and its vessels. OCT-Angiography (OCT-A) is a recent tool which permits a non-invasive understanding of these vascular changes. This review focuses on the OCT-A findings in idiopathic epiretinal membranes, before and after surgery, and the role of internal limiting membrane peeling. It appears that contraction of the epiretinal membrane is associated with both a reduction in the area and perimeter of the foveal avascular zone and alterations in the superficial and deep capillary plexuses. These changes mainly reflect a vascular shift from the perifoveal to the foveal region, increasing with retinal deformation, but also probable dynamic changes in vascular flow. Membrane peeling allows at least partial improvement of these microvascular parameters. Nevertheless, some limitations of OCT-A, such as segmentation errors on a retina with highly modified architecture, can lead to a selection bias in the studies and should call for caution in the interpretation of the results. Finally, internal limiting membrane peeling contributes to changes in the retinal architecture after surgery, in particular by causing a centripetal movement of the macular capillaries and a displacement of the fovea toward the optic nerve head. This role should be clarified in future studies.
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Affiliation(s)
- Y-G Muller
- Université Louis-Pasteur, 67000 Strasbourg, France.
| | - P Lenoble
- Hôpital Pasteur, 68000 Colmar, France
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Sborgia A, Niro A, Pastore V, Albano V, Boscia G, Piepoli M, Di Pardo C, Accurso Tagano L, Zerbinati M, Landini L, Pignataro MG, Petruzzella G, Donghia R, Alqahtani AS, Coassin M, Dell’Omo R, Boscia F, Alessio G, Sborgia G. Biofeedback Training after Successful Inverted Internal Limiting Membrane (ILM)-Flap Technique for High Myopic Macular Hole. J Clin Med 2023; 12:5188. [PMID: 37629230 PMCID: PMC10455115 DOI: 10.3390/jcm12165188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/30/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Microperimetric biofeedback training improved visual acuity and fixation stability in patients who previously underwent macular surgery. We aimed to compare the functional results of biofeedback training with the standard of care in patients who underwent successful inverted Internal Limiting Membrane (ILM)-flap technique for high myopic macular holes (hMMH). METHODS This was a retrospective, comparative, cohort study. Patients with hMMH after surgical hole closure underwent microperimetric biofeedback using structured light stimulus plus acoustic tone (n = 12; Biofeedback) or standard of care with scheduled visits (n = 11; Control). Best-corrected visual acuity, retinal sensitivity at central 12° (RS) and 4° (CRS) with a mean deviation at central 12° (MD), and fixation stability as bivariate contour ellipse area (BCEA 68%, 95%, and 99%) were assessed at baseline and month 1, 3, 6, and 12. The Mann-Whitney test was used to test the difference between the groups. RESULTS Baseline functional parameters were not significantly different among the groups. BCVA significantly improved in each group (Biofeedback, p = 0.002; Control, p ≤ 0.02) at all follow-up visits. CRS significantly improved at 6 (p = 0.03) and 12 (p = 0.01) months in the Biofeedback group and at month 12 (p = 0.01) in the Control group. RS (p = 0.001) and MD (p = 0.005) improved at the last follow-up only in the trained group. After training, BCEA 68% and 95% significantly improved (6 and 12 months, p < 0.05). The Biofeedback group had better results in RS (p ≤ 0.02), CRS (p ≤ 0.02), and BCEA 68%, 95%, and 99% (p ≤ 0.01) compared to the Control at all follow-ups. BCVA and MD were better in the Biofeedback group at month 3 (p = 0.01), and month 3 (p = 0.01) and 12 (p = 0.003), respectively. CONCLUSIONS Microperimetric biofeedback can increase retinal sensitivity and stabilize fixation better than the standard care over months after a successful inverted ILM-flap for hMMH.
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Affiliation(s)
- Alessandra Sborgia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
| | - Alfredo Niro
- Eye Clinic, “SS. Annunziata” Hospital, ASL Taranto, 74100 Taranto, Italy
| | - Valentina Pastore
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
| | - Valeria Albano
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
| | - Giacomo Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
| | - Marina Piepoli
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
| | - Camilla Di Pardo
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
| | - Lorenzo Accurso Tagano
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
| | - Marta Zerbinati
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
| | - Luca Landini
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
| | - Maria Grazia Pignataro
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
| | - Giovanni Petruzzella
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
| | - Rossella Donghia
- National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte, Italy
| | - Abdullah S. Alqahtani
- Department of Surgery, Division of Ophthalmology, National Guard Hospital, Jeddah 31982, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
| | - Marco Coassin
- Ophthalmology, University Campus Bio-Medico, 00128 Rome, Italy
| | - Roberto Dell’Omo
- Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, 86100 Campobasso, Italy
| | - Francesco Boscia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
| | - Giovanni Alessio
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
| | - Giancarlo Sborgia
- Eye Clinic, Department of Medical Science, Neuroscience and Sense Organs, University of Bari, 70124 Bari, Italy
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Nam SW, Byun Z, Ham DI, Kong M. Microperimetric evaluation for different methods of epiretinal membrane surgery. BMC Ophthalmol 2023; 23:295. [PMID: 37386389 DOI: 10.1186/s12886-023-03056-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/22/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE To investigate the anatomic and functional outcomes using microperimetry for the surgical methods for idiopathic epiretinal membranes (ERM). METHODS This retrospective study included 41 eyes from 41 patients. All patients underwent combined epiretinal membrane and cataract surgery. Best-corrected visual acuity (BCVA), optical coherence tomography, and microperimetry were performed before and 6 months and 1 year after surgery. The patients were divided into 3 groups; "ERM removal only without indocyanine green (ICG) staining", "ERM and internal limiting membrane (ILM) removal without ICG staining", and "ERM and ILM removal with ICG staining". RESULTS Preoperatively, the ages, BCVAs, central macular thickness (CMT), and mean retinal sensitivities of central 6° (MRSs) of the groups were not significantly different (p > 0.05). Postoperatively, the MRSs of the "ERM removal only without ICG staining" and "ERM and ILM removal without ICG staining" groups were not significantly different (p > 0.05). The MRSs of the "ERM and ILM removal without ICG staining" and "ERM and ILM removal with ICG staining" groups were not significantly different (p > 0.05). However, the MRSs of the "ERM and ILM removal with ICG staining" group significantly reduced than "ERM removal only without ICG staining" group (p < 0.05). CONCLUSION This retrospective study found reduced retinal sensitivity in ERM and ILM removal with ICG staining group compared to ERM removal only without ICG staining. Further studies with larger sample sizes are required.
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Affiliation(s)
- Seung Wan Nam
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea
- Department of Ophthalmology, College of Medicine, Catholic Kwandong University, Incheon, Korea
| | - Zeeyoon Byun
- Department of Ophthalmology, HanGil Eye Hospital, Incheon, Korea
| | - Don-Il Ham
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mingui Kong
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, Korea.
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Obata S, Sawada O, Kakinoki M, Matsumoto R, Saishin Y, Ohji M. Effects of internal limiting membrane peeling on anatomical and functional outcomes in macula-off rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy: Japan-Retinal Detachment Registry. Jpn J Ophthalmol 2023:10.1007/s10384-023-01000-y. [PMID: 37289298 DOI: 10.1007/s10384-023-01000-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/26/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To investigate the effects of internal limiting membrane (ILM) peeling on retinal attachment after a single surgery, and on postoperative visual acuity (VA) at 6 months, in eyes with macula-off rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR). STUDY DESIGN Nationwide, multicenter retrospective cohort study. METHODS The Japan-RD Registry database was used for analysis of patients who had undergone vitrectomy for macula-off RRD complicated by PVR. Multivariate analysis was performed to detect prognostic factors for retinal attachment after a single surgery and for VA at 6 months postoperatively. Retinal attachment after a single surgery or VA at 6 months postoperatively was the objective variable; ILM peeling, preoperative VA, PVR grade, age, and intraocular pressure were explanatory variables. RESULTS Eighty-nine eyes met the inclusion criteria; ILM peeling was performed in 25 eyes (28%). Preoperative VA was significantly associated with retinal attachment, but ILM peeling did not (odds ratios = 2.1 and 1.3, respectively; p = 0.009 and 0.67, respectively). Poor preoperative VA and younger patient age were significantly associated with poor postoperative VA, but ILM peeling was not (β-values = 0.37, -0.008, and 0.15, respectively; p < 0.001, p = 0.02, and p = 0.15, respectively. CONCLUSIONS Preoperative VA was a risk factor associated with retinal attachment. Preoperative VA and patient age were risk factors associated with postoperative poor VA. In eyes with macula-off RRD complicated by PVR, ILM peeling did not have a clear beneficial effect on anatomical and functional outcomes, suggesting that it may be unnecessary for eyes with this condition.
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Affiliation(s)
- Shumpei Obata
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan.
| | - Osamu Sawada
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan
- Japan-Retinal Detachment Registry Group, Osaka, Japan
| | - Masashi Kakinoki
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan
- Japan-Retinal Detachment Registry Group, Osaka, Japan
| | - Riko Matsumoto
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Yoshitsugu Saishin
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Seta Tsukinowacho, Otsu, Shiga, 520-2192, Japan
- Japan-Retinal Detachment Registry Group, Osaka, Japan
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Kim DJ, Kim DG, Park KH. THREE-DIMENSIONAL HEADS-UP VITRECTOMY VERSUS CONVENTIONAL MICROSCOPIC VITRECTOMY FOR PATIENTS WITH EPIRETINAL MEMBRANE. Retina 2023; 43:1010-1018. [PMID: 36763981 DOI: 10.1097/iae.0000000000003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
PURPOSE To investigate the efficacy and safety of 3D heads-up display (3D-HUD) vitrectomy compared with conventional microscopy (CM) vitrectomy in epiretinal membrane (ERM) surgery. METHODS Epiretinal membrane removal with or without internal limiting membrane (ILM) peeling was performed using a 3D-HUD or CM system. The mean changes in best-corrected visual acuity (BCVA) and in central macular thickness (CMT) and postoperative complications were assessed. RESULTS Baseline demographics were comparable except for the follow-up period. Both BCVA and CMT improved at the final visit (all P < 0.05). The ERM recurrence and dissociated optic nerve fiber layer (DONFL) rates were lower in the 3D group (both P < 0.05). conventional microscopic vitrectomy (odds ratio [OR] = 12.86, P = 0.02) and absence of ILM peeling (OR = 45.25, P < 0.05) were associated with ERM recurrence. In the DONFL, CM vitrectomy (OR = 1.98, <0.05) and combined phacovitrectomy (OR = 2.33, P = 0.03) were analyzed as risk factors for DONFL. CONCLUSION The improvement in BCVA and CMT in ERM surgery using a 3D-HUD is comparable with that of CM vitrectomy, with a significantly low rate of ERM recurrence and DONFL occurrence. Therefore, 3D vitrectomy might have an advantage for ERM surgery.
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Affiliation(s)
- Dong Ju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong Geun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; and
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; and
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Li H, Zhang C, Li H, Yang S, Liu Y, Wang F. Effects of disorganization of retinal inner layers for Idiopathic epiretinal membrane surgery: the surgical status and prognosis. BMC Ophthalmol 2023; 23:108. [PMID: 36932394 PMCID: PMC10022165 DOI: 10.1186/s12886-023-02856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND To compare the surgical status in idiopathic epiretinal membrane (IERM) patients with or without disorganization of retinal inner layers (DRIL) and to correlate with optical coherence tomography angiography (OCTA) and clinical data. METHODS In 74 eyes from 74 patients with IERM treated by surgery with 12-month follow-up. According to the superficial hemorrhage, the patients were divided into group A (no macular bleeding), group B (macular parafoveal bleeding) and group C (macular foveal bleeding). Optical coherence tomography (OCT) were evaluated for presence of DRIL,central retina thickness and integrity of the inner/outer segment layer recorded at baseline and at 1, 3, 6, and 12 months postoperatively and best-corrected visual acuity (BCVA) was recorded simultaneously. OCTA was conducted at 12 months postoperatively. Main outcome measures is correlation between DRIL and superficial hemorrhage in membrane peeling,and BCVA and OCTA outcomes postoperatively. RESULTS The rate of DRIL and BCVA had statistically significant differences between the three groups at the time points(baseline and 1, 3, 6, and 12 months after surgery), respectively (P < 0.001 for all). FD-300 value (P = 0.001)and DCP in all parafoveal regions (superior: P = 0.001; inferior: P = 0.002;Nasal: P = 0.014;Tempo: P = 0.004) in eyes with DRIL were lower than those without DRIL.There was a linear regression relationship between FD-300 and postoperative BCVA (P = 0.011). CONCLUSION IERM Patients with DRIL have more intraoperative adverse events and limited benefits from surgery which should be considered in the decision whether to perform mebrane peeling.OCT-A provides more detailed vascular information that extends our understanding of persistent DRIL.
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Affiliation(s)
- Huanhuan Li
- Department of Ophthalmology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Suzhou University, Chang Zhou, 213003, China
| | - Conghui Zhang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shang Hai, 200072, China
| | - Hui Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shang Hai, 200072, China
| | - Shuai Yang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shang Hai, 200072, China
| | - Yao Liu
- Department of Ophthalmology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Suzhou University, Chang Zhou, 213003, China.
| | - Fang Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shang Hai, 200072, China.
- Purui Eye Group, Shanghai Purui Eye Hospital, Shang Hai, 200336, China.
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11
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Zhang B, Dong X, Sun Y. Effect of internal limiting membrane peeling for idiopathic epiretinal membrane. Heliyon 2023; 9:e14079. [PMID: 36915505 PMCID: PMC10006490 DOI: 10.1016/j.heliyon.2023.e14079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose To further evaluate the necessity of internal limiting membrane (ILM) peeling for patients with idiopathic epiretinal membrane (iERM). Method We searched PubMed, Web of Science, Embase, Cochrane Library, and CNKI from their inception up to August 24, 2021. Eligible meta-analyses comparing iERM removal with and without ILM peeling were included. AMSTAR and GRADE classification was used to assess the methodological quality of each study and the quality for each outcome, respectively. The primary outcomes were best-corrected visual acuity (BCVA), central macular thickness (CMT), and recurrence. Results 10 meta-analyses were included. 75.9% of studies revealed no statistically significant difference in BCVA between the groups, while only 10.3% showed better BCVA favorable to additional ILM peeling. 54.2% reported no significant difference in CMT between the groups, followed by 41.7% showing thicker CMT due to additional ILM peeling. Compared to iERM removal alone, additional ILM peeling provided a lower recurrence rate in 66.7% of studies. Conclusion ILM peeling could significantly reduce recurrence rate, but not significantly improve the recovery of visual outcome or decrease the thickness of central macula.
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Affiliation(s)
- Bowen Zhang
- Surgical Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Xingmei Dong
- Department of Pathology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou 510120, China
| | - Yi Sun
- Department of Ophthalmology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
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12
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Features of a well-timed macular hole closure related retinal regmatogenous detachment complicated by macular hole. OPHTHALMOLOGY JOURNAL 2023. [DOI: 10.17816/ov109976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
The literature review deals with the analysis of the timing and surgical techniques of macular hole closure in patients with retinal detachment complicated by macular hole. Modern concepts of treatment tactics for this disease, its efficacy are analyzed. Benefits and drawbacks of each of the discussed surgical treatment methods are specified.
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13
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Analysis of Retinal Microstructure in Eyes with Dissociated Optic Nerve Fiber Layer (DONFL) Appearance following Idiopathic Macular Hole Surgery: An Optical Coherence Tomography Study. J Pers Med 2023; 13:jpm13020255. [PMID: 36836488 PMCID: PMC9963747 DOI: 10.3390/jpm13020255] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/21/2023] [Accepted: 01/28/2023] [Indexed: 01/31/2023] Open
Abstract
(1) Purpose: This study aimed to evaluate morphological changes of the retina in eyes with dissociated optic nerve fiber layer (DONFL) appearance following internal limiting membrane (ILM) peeling for full-thickness idiopathic macular hole (IMH) on spectral-domain optical coherence tomography (SD-OCT). (2) Methods: We retrospectively analyzed 39 eyes of 39 patients with type 1 macular hole closure after a vitrectomy with ILM peeling procedure at a six-month minimum postoperative follow-up. The retinal thickness maps and cross-sectional OCT images were obtained from a clinical OCT device. The cross-sectional area of the retinal nerve fiber layer (RNFL) on cross-sectional OCT images was manually measured by ImageJ software. (3) Results: The inner retinal layers (IRLs) thickness thinned down much more in the temporal quadrant than in nasal quadrants at 2 and 6 months postoperatively (p < 0.001). However, the cross-sectional area of the RNFL did not change significantly at 2 and 6 months postoperatively (p > 0.05) when compared to preoperative data. In addition, the thinning of the IRL did not correlate with the best-corrected visual acuity (BCVA) at 6 months postoperatively. (4) Conclusions: The thickness of the IRL decreased in eyes with a DONFL appearance after ILM peeling for IMH. The thickness of the IRL decreased more in the temporal retina than in the nasal retina, but the change did not affect BCVA during the 6 months after surgery.
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14
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Serjanov D, Hyde DR. Extracellular Matrix: The Unexplored Aspects of Retinal Pathologies and Regeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1415:309-317. [PMID: 37440050 DOI: 10.1007/978-3-031-27681-1_45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Nearly a billion people worldwide are affected by vision-impairing conditions, with retinal degenerative diseases being a major cause of blindness. Unfortunately, such diseases are often permanent and progressive, resulting in further degeneration and loss of sight, due to the human retina possessing little, if any, regenerative capacity. Despite numerous efforts and great progress being made to understand the molecular mechanisms of these diseases and possible therapies, the majority of investigations focused on cell-intrinsic factors. However, the microenvironment surrounding retinal cells throughout these processes also plays an important role, though our current understanding of its involvement remains limited. Here we present a brief overview of the current state of the field of extracellular matrix studies within the retina and its potential roles in retinal diseases and potential therapeutic approaches.
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Affiliation(s)
- Dmitri Serjanov
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA
| | - David R Hyde
- Department of Biological Sciences, University of Notre Dame, Notre Dame, IN, USA.
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15
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A randomised controlled trial evaluating internal limiting membrane peeling forceps in macular hole surgery. Graefes Arch Clin Exp Ophthalmol 2022; 261:1553-1562. [DOI: 10.1007/s00417-022-05932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/18/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Purpose
To assess study design and a range of anatomical and functional changes after internal limiting membrane (ILM) peeling using forceps developed for atraumatic ILM pick-up compared to standard forceps.
Methods
We conducted a masked proof-of concept randomised controlled trial (RCT) on 65 patients who underwent ILM peeling for idiopathic full-thickness macular hole (FTMH) using etched-tip forceps (etched-tip group, 33 eyes) compared to standard ILM forceps (smooth-tip group, 32 eyes). Patients were assessed preoperatively, 3 weeks, 3 and 6 months postoperatively.
Results
The primary closure rate was 95.4%. There was no statistically significant difference between the groups in terms of final visual acuity (66.9 vs 70.9 ETDRS letters, p = 0.13), difference of visual field mean deviation (1.32 vs 1.14 decibels), and number of eyes with pick-up-related retinal haemorrhages (16% vs 16%, p = 0.96), swelling of arcuate nerve fibre layer lesions (63% vs 55%, p = 0.54), number of dissociated optic nerve fibre layer lesions (31.4 vs 41.0, p = 0.16), nor inner retina defects (37% vs 22%, p = 0.17). Similar changes in inner retinal volumes were detected in all 9 sectors of an ETDRS grid except for a trend (p = 0.06) towards a lower reduction in the inferior inner sector in the etched-tip group.
Conclusions
The study was successfully completed with masking maintained and a low risk of bias. Multiple endpoints relating to ILM peeling were assessed, and estimates were provided that can be used for future studies. Although the study was not powered to assess any specific endpoint, the anatomical and functional outcomes assessed did not significantly differ.
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16
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Retinal and Corneal Changes Associated with Intraocular Silicone Oil Tamponade. J Clin Med 2022; 11:jcm11175234. [PMID: 36079165 PMCID: PMC9457190 DOI: 10.3390/jcm11175234] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/13/2022] [Accepted: 09/01/2022] [Indexed: 12/22/2022] Open
Abstract
Silicone oils (SO) are used as long-term intraocular tamponades and have an irreplaceable role in vitreoretinal surgery. They can, however, be associated with multiple and potentially severe complications, involving different ocular tissues, in particular retina and cornea. Recent advances in ophthalmic imaging have allowed the precise characterization of retinal and corneal microstructural changes, at a subclinical level. This detailed analysis of SO-related retinal and corneal changes has improved our understanding of their pathogenesis and offer the potential for optimized monitoring and management of patients with SO-filled eyes. This review aims to provide clinicians and ophthalmic scientists with an updated and comprehensive overview of the corneal and retinal changes associated with SO tamponade.
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17
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Mao ZQ, Wu HX, Fan HM, Li G, You ZP, Tan YY. Intraoperative Optical Coherence Tomography in Idiopathic Macular Epiretinal Membrane Surgery. Int J Gen Med 2022; 15:6499-6505. [PMID: 35966505 PMCID: PMC9374091 DOI: 10.2147/ijgm.s374630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the feasibility and practicability of intraoperative optical coherence tomography (IOCT) in the surgery of idiopathic macular epiretinal membrane (IMM) without internal limiting membrane staining in all patients. Methods Patients were selected from July 2018 to June 2020, and 32 patients (32 eyes) with IMM were operated with the use of IOCT. All patients underwent standard 23g vitrectomy. The internal limiting membrane was peeled off if there were obvious retinal folds. Intraoperative and postoperative complications, macular microstructural changes, and integrity of the detached membranes were recorded. The preoperative and postoperative best corrected visual acuity were compared. Results The macular epiretinal membrane was completely removed in 75% (24 eyes) patients without internal limiting membrane staining, and in 15.6% (5 eyes) patients with combined internal limiting membrane stripping. The "starting point" of macular epiretinal membrane stripping was found in 75% (24 eyes), and the time required to find the best starting point ranged from 28s to 140s (mean 66 ± 15s). At 3 months after operation, 96.8% of the patients had stable or improved BCVA (p < 0.05). The central macular thickness of the affected eyes decreased significantly at 1 and 3 months after operation (p < 0.05). Conclusion IOCT can significantly reduce the use of internal limiting membrane staining in idiopathic macular epiretinal membrane surgery, and it is safe, feasible and practical in idiopathic macular epiretinal membrane surgery without internal limiting membrane staining in all patients.
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Affiliation(s)
- Zi-Qing Mao
- Department of Ophthalmology, Affiliated Eye Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Hong-Xi Wu
- Department of Ophthalmology, Affiliated Eye Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Hui-Min Fan
- Department of Ophthalmology, Affiliated Eye Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Gen Li
- Department of Ophthalmology, Zhangshu People's Hospital, Zhangshu, 331299, People's Republic of China
| | - Zhi-Peng You
- Department of Ophthalmology, Affiliated Eye Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Yun-Yu Tan
- Department of Ophthalmology, Affiliated Eye Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
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18
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Removing the Retained Subfoveal Perfluorocarbon Liquid With Peeled Internal Limiting Membrane Reposition and Flute Aspiration. Retina 2022; 42:1612-1615. [PMID: 30893273 DOI: 10.1097/iae.0000000000002515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Hwang YH, Byun ZY, Hwang DDJ. Changes in circumpapillary retinal nerve fiber layer thickness after vitrectomy for rhegmatogenous retinal detachment. Sci Rep 2022; 12:9630. [PMID: 35688835 PMCID: PMC9187641 DOI: 10.1038/s41598-022-13070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/12/2022] [Indexed: 11/30/2022] Open
Abstract
The study aimed to evaluate the long-term changes in circumpapillary retinal nerve fiber layer (RNFL) thickness after vitrectomy for rhegmatogenous retinal detachment (RRD) repair. A total of 33 eyes of 33 patients were enrolled. By using optical coherence tomography, the circumpapillary RNFL thickness was measured before surgery and 1, 3, 6 months and 1, 2, 3 years after surgery and compared with the preoperative value. The effect of duration, location, and extent of RRD on RNFL thickness change was evaluated. There was a significant increase of circumpapillary RNFL thickness at the 1-month, 3-month [except in the nasal superior sector (P = 0.627)], and only in the nasal inferior sector at 6-month (P = 0.010) follow-up compared with the baseline value (all Ps < 0.05). No significant differences were observed 1, 2, and 3 years after the surgery (P > 0.05). The duration, location, and extent of detachment did not reveal significant correlations with RNFL parameters (P > 0.05). Circumpapillary RNFL thickness in eyes with RRD after vitrectomy demonstrated a transient increase during the early postoperative period. This increase was not associated with duration, location, and extent of RRD. At 3 years following surgery, no RNFL thinning or thickening was observed.
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Affiliation(s)
- Young Hoon Hwang
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Zee Yoon Byun
- Department of Ophthalmology, Hangil Eye Hospital, #35 Bupyeong-daero, Bupyeong-gu, Incheon, 21388, Republic of Korea
| | - Daniel Duck-Jin Hwang
- Department of Ophthalmology, Hangil Eye Hospital, #35 Bupyeong-daero, Bupyeong-gu, Incheon, 21388, Republic of Korea. .,Department of Ophthalmology, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea.
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20
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Pradhan D, Agarwal L, Joshi I, Kushwaha A, Aditya K, Kumari A. Internal limiting membrane peeling in macular hole surgery. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2022; 20:Doc07. [PMID: 35813123 PMCID: PMC9204259 DOI: 10.3205/000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/23/2021] [Indexed: 11/18/2022]
Abstract
Since the era when macular hole was considered untreatable, macular hole surgery has come a long way to being one of the most successful surgeries. Internal limiting membrane (ILM) peeling has been an essential step of macular hole surgery since the establishment of the role of ILM in the aetiopathogenesis and progression of macular hole. However, the novel technique was not all virtuous. It had some vices which were not evident immediately. With the advent of spectral domain optical coherence tomography, short- and long-term effects of ILM peeling on macular structures were known; and with microperimetry, its effect on the function of macula could be evaluated. The technique has evolved with time from total peeling to inverted flap to just temporal peeling and temporal flap in an attempt to mitigate its adverse effects and to improve its surgical outcome. ILM abrasion technique and Ocriplasmin may eliminate the need of ILM peeling in selected cases, but they have their own limitations. We here discuss the role of ILM in the pathogenesis of macular hole, the benefits and adverse effects of ILM peeling, and the various modifications of the procedure, to then explore the alternatives.
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Affiliation(s)
- Deepti Pradhan
- Kirtipur Eye Hospital, Department of Vitreoretinal Services, Kirtipur, Nepal,*To whom correspondence should be addressed: Deepti Pradhan, Kirtipur Eye Hospital, Department of Vitreoretinal Services, Tahalcha, Tinkune, 44618 Kirtipur-10, Nepal, Phone: +977 9808119112, E-mail:
| | - Lalit Agarwal
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
| | - Ichhya Joshi
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
| | - Anamika Kushwaha
- Biratnagar Eye Hospital, Department of Vitreoretinal Services, Biratnagar, Nepal
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21
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Alberti M, Jacobsen MF, Hermann MN, Konge L, Christensen UC, Thomsen ASS, Cour M. Quantifying surgical skill in macular surgery. Acta Ophthalmol 2022; 100:440-446. [PMID: 34549889 DOI: 10.1111/aos.15023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/15/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the relationship between patient outcome and surgical experience by developing an objective quality measure of macular hole surgery based on forceps damage to the inner retina. METHODS We retrospectively examined 3 macular hole case series >1 year after pars plana vitrectomy, internal limiting membrane peeling and gas tamponade. The patients were operated by (1) a novice surgeon (<20 cases), (2) an intermediate (150+ cases) and (3) an experienced surgeon (2000+ cases). Primary outcome was inner retinal volume defect as segmented from optical coherence tomography (GCL++: thickness from internal limiting membrane to inner plexiform layer). Secondary outcome was retinal function measured by confocal microperimetry using a custom scanning protocol. RESULTS Thirty-two patients were examined: 11, 10 and 11 patients in the novice, intermediate and experienced surgeon group, respectively. Median GCL++ volume defect was 23.68 × 106 μm3 (IQR: 22.77 × 106 -44.81 × 106 μm3 ), 8.42 × 106 μm3 (IQR: 4.86 × 106 -10.03 × 106 μm3 ) and 3.55 × 106 μm3 (IQR: 1.44 × 103 -7.94 × 106 μm3 ) in the novice, intermediate and experienced surgeon group, respectively (p = 0.0004). The novice surgeon volume defect differed significantly from the intermediate and experienced surgeon (p = 0.016 and p = 0.0002, respectively). A subset of 12 patients underwent microperimetry measurements demonstrating correlation between inner retinal volume defect and reduced retinal sensitivity (p = 0.02). CONCLUSIONS Forceps induced inner retinal damage commonly occurs during initiation of internal limiting membrane peeling in macular hole surgery. Damage to the structure and function of the inner retina seems to correlate to surgical experience.
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Affiliation(s)
- Mark Alberti
- Department of Ophthalmology Rigshospitalet – Glostrup Glostrup Denmark
| | - Mads Forslund Jacobsen
- Department of Ophthalmology Rigshospitalet – Glostrup Glostrup Denmark
- Copenhagen Academy for Medical Education and Simulation Centre for HR & Education Copenhagen Denmark
| | | | - Lars Konge
- Department of Ophthalmology Rigshospitalet – Glostrup Glostrup Denmark
- Copenhagen Academy for Medical Education and Simulation Centre for HR & Education Copenhagen Denmark
| | | | - Ann Sofia Skou Thomsen
- Department of Ophthalmology Rigshospitalet – Glostrup Glostrup Denmark
- Copenhagen Academy for Medical Education and Simulation Centre for HR & Education Copenhagen Denmark
| | - Morten Cour
- Department of Ophthalmology Rigshospitalet – Glostrup Glostrup Denmark
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22
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Kunavisarut P, Supawongwattana M, Patikulsila D, Choovuthayakorn J, Watanachai N, Chaikitmongkol V, Pathanapitoon K, Rothova A. Idiopathic Epiretinal Membranes: Visual Outcomes and Prognostic Factors. Turk J Ophthalmol 2022; 52:109-118. [PMID: 35481732 PMCID: PMC9069092 DOI: 10.4274/tjo.galenos.2021.09258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/18/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives To evaluate the associations between anatomical changes and visual outcomes in patients with idiopathic epiretinal membrane (ERM). Materials and Methods We performed a prospective study of 130 consecutive idiopathic ERM patients and report their visual outcomes and the factors associated with visual outcome and anatomical changes. Results Of 130 eyes of 130 patients, 87 eyes underwent surgery, while the remaining 43 eyes were observed. At 6-month follow-up, the best-corrected visual acuity (BCVA) increased in the whole population. Mean Early Treatment Diabetic Retinopathy Study letter score changed from 51 to 65 in the surgical group and from 67 to 68 in the non-surgical group. The surgical group had improvement in BCVA at all ERM stages and grades of disorganization of the retinal inner layers (DRIL) (p<0.01). In multivariable analysis of the surgical group, factors associated with BCVA of ETDRS 60 letters or more were no or mild DRIL and the absence of ellipsoid zone disruption at baseline (p=0.002 and p=0.034, respectively) and this statistically significant positive correlation was still maintained at 12-month follow-up. Conclusion Baseline DRIL grade and presence of ellipsoid zone disruption were the most informative prognostic factors in patients with idiopathic ERMs. Patients with severe DRIL and/or advanced ERMs had improved vision after ERM removal.
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Affiliation(s)
- Paradee Kunavisarut
- Chiang Mai University Faculty of Medicine, Department of Ophthalmology, Chiang Mai, Thailand
| | - Montana Supawongwattana
- Chiang Mai University Faculty of Medicine, Department of Ophthalmology, Chiang Mai, Thailand
| | - Direk Patikulsila
- Chiang Mai University Faculty of Medicine, Department of Ophthalmology, Chiang Mai, Thailand
| | - Janejit Choovuthayakorn
- Chiang Mai University Faculty of Medicine, Department of Ophthalmology, Chiang Mai, Thailand
| | - Nawat Watanachai
- Chiang Mai University Faculty of Medicine, Department of Ophthalmology, Chiang Mai, Thailand
| | - Voraporn Chaikitmongkol
- Chiang Mai University Faculty of Medicine, Department of Ophthalmology, Chiang Mai, Thailand
| | - Kessara Pathanapitoon
- Chiang Mai University Faculty of Medicine, Department of Ophthalmology, Chiang Mai, Thailand
| | - Aniki Rothova
- Erasmus Medical Center, Department of Ophthalmology, Rotterdam, The Netherlands
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23
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Chua PY, Sandinha MT, Steel DH. Idiopathic epiretinal membrane: progression and timing of surgery. Eye (Lond) 2022; 36:495-503. [PMID: 34290446 PMCID: PMC9074182 DOI: 10.1038/s41433-021-01681-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 06/22/2021] [Accepted: 06/29/2021] [Indexed: 02/01/2023] Open
Abstract
Primary idiopathic epiretinal membrane (iERM) is a common finding, particularly so in the era of high street spectral-domain optical coherence tomography. Clinicians often face the dilemma of early versus delayed surgical intervention in the management of iERM with macular pucker, especially in those patients with good vision. The aim of this review is to assist clinicians in their understanding of the natural history of iERM to enable decision-making and optimally advising patients. We systematically searched the Medline and EMBASE databases for relevant publications from 2001 onwards using defined search terms with pre-planned inclusion and exclusion criteria. In this article, we review the epidemiology of iERM, classifications, their effect on visual function, the natural history and factors predicting progression and finally, factors which might predict the visual outcome with surgery.
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Affiliation(s)
- Paul Y. Chua
- grid.415970.e0000 0004 0417 2395St. Paul’s Eye Unit, The Royal Liverpool University Hospital, Liverpool, UK
| | - Maria T. Sandinha
- grid.415970.e0000 0004 0417 2395St. Paul’s Eye Unit, The Royal Liverpool University Hospital, Liverpool, UK ,grid.10025.360000 0004 1936 8470Department of Eye and Vision Science, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK
| | - David H. Steel
- grid.10025.360000 0004 1936 8470Department of Eye and Vision Science, Institute of Ageing & Chronic Disease, University of Liverpool, Liverpool, UK ,grid.419700.b0000 0004 0399 9171Sunderland Eye Infirmary, Sunderland, Sunderland, UK ,grid.1006.70000 0001 0462 7212Bioscience Institute, Newcastle University, Newcastle upon Tyne, UK
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24
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Mandelcorn ED, Al‐Falah M, Zhao LD, Kertes P, Devenyi R, Lam W. A prospective randomized clinical trial comparing nepafenac, intravitreal triamcinolone and no adjuvant therapy for epiretinal membrane. Acta Ophthalmol 2022; 100:e297-e303. [PMID: 33847066 DOI: 10.1111/aos.14873] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the efficacy of topical nepafenac 0.1% versus intravitreal triamcinolone acetonide (IVTA) at the conclusion of vitrectomy surgery versus no adjuvant therapy (NAT) in improving macular morphology post-operatively in patients undergoing vitrectomy for epiretinal membrane (ERM), as measured by optical coherence tomography (OCT) imaging and best-corrected visual acuity (BCVA). METHODS Design: Prospective randomized clinical trial Setting: Multi-centre 80 patients scheduled to undergo vitrectomy surgery for idiopathic ERM were randomized to receive either IVTA (4 mg/0.1 cc) at the end of surgery, topical nepafenac sodium 0.1% TID for 1 month post-operation or no adjuvant treatment (NAT). Optical coherence tomography (OCT) imaging, best-corrected visual acuity and intraocular pressure (IOP) were measured before surgery, and 1 and 2 months post-operation. RESULTS Although all three groups showed reduction in macular thickness post-operation, the NAT group showed the most improvement, with a reduction of 136.18 ± 29.84 μm at two months. There was no statistically significant difference in macular thickness between the groups at each time point, p = 0.158. The NAT group also had the best recovery in BCVA with an improvement of 0.207 logMAR (10.35 letters) at two months post-operation. There was no statistically significant difference in BCVA between the groups, p = 0.606. There was statistically significant difference in the IOP between the three groups, p = 0.04 only at 1-month visit. The IVTA group had the highest rise in average IOP at both 1 and 2 months post-operation (2.72 and 1.58 mmHg, respectively). CONCLUSION Our study data suggest there was no advantage in the use of topical nepafenac or IVTA for post-vitrectomy ERM surgery.
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Affiliation(s)
- Efrem D. Mandelcorn
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
| | - Mohammed Al‐Falah
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
- College of Medicine King Faisal University Al‐Ahsa Saudi Arabia
| | - Lei Di Zhao
- Division of Ophthalmology McMaster University Hamilton ON Canada
| | - Peter Kertes
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
- The John and Liz Tory Eye Centre Sunnybrook Health Sciences Centre Toronto ON Canada
| | - Robert Devenyi
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
| | - Wai‐Ching Lam
- Department of Ophthalmology and Vision Sciences University of Toronto Toronto ON Canada
- Department of Ophthalmology University of Hong Kong Hong Kong Hong Kong
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Macular edema after surgical treatment of rhegmatogenous retinal detachment – the possibilities of its prediction. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.6-1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim: to develop a mathematical model for predicting macular edema based on the informativeness of clinical and instrumental predictors of its occurrence.Materials and methods. To determine the risk factors for macular edema 64 patients (64 eyes) with macula-off rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy (grade Cp 1–2) were selected. A retrospective analysis of the surgical treatment results was carried out. The age of the patients ranged from 30 to 81 years (28 women and 36 men).Results. Using regression analysis, two signifi cant factors were identifi ed: the sum of 8 meridians of the visual fi eld before surgery (p = 0.015) and the number of detached quadrants (p = 0.021). Based on the identifi ed factors, a model was obtained for predicting the occurrence of macular edema in the postoperative period for the patients with rhegmatogenous retinal detachment. Conclusion. Based on the analysis of clinical and instrumental indicators in patients with rhegmatogenous retinal detachment, a mathematical model has been developed that allows predicting the occurrence of macular edema in the postoperative period.The application of the proposed prediction model makes it possible to determine the tactics of treatment (peeling of internal limiting membrane) and predict the appearance of macular edema at the preoperative stage.
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Abdul-Kadir MA, Lim LT. Update on surgical management of complex macular holes: a review. Int J Retina Vitreous 2021; 7:75. [PMID: 34930488 PMCID: PMC8686572 DOI: 10.1186/s40942-021-00350-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/05/2021] [Indexed: 11/18/2022] Open
Abstract
Modern surgical interventions effectively treat macular holes (MHs) more than 90%. Current surgical treatment for MHs is pars plana vitrectomy with epiretinal membrane, internal limiting membrane (ILM) peeling, gas endotamponade, and prone posturing postoperatively. However, a small subset of MHs imposes challenges to surgeons and frustrations on patients. A narrative review was performed on the surgical treatment of challenging MHs including large and extra-large MHs, myopic MHs with or without retinal detachment, and chronic and refractory MHs. There are robust data supporting inverted ILM flap as the first-line treatment for large idiopathic MHs and certain secondary MHs including myopic MHs. In addition, several studies had shown that ILM flap manipulations in combination with surgical adjuncts increase surgical success, especially in difficult MHs. Even in eyes with limited ILM, surgical options included autologous retinal graft, human amniotic membrane, and creation of a distal ILM flap that can assist in MH closure even though the functional outcome may be affected by the MH chronicity. Despite relative success anatomically and visually after each technique, most techniques require a long-term study to analyze their safety profile and to establish any morphological changes of the MH plug in the closed MHs.
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Affiliation(s)
| | - Lik Thai Lim
- Department of Ophthalmology, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Malaysia
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Lee JY, Joo K, Park SJ, Woo SJ, Park KH. EPIRETINAL MEMBRANE SURGERY IN PATIENTS WITH MULTIFOCAL VERSUS MONOFOCAL INTRAOCULAR LENSES. Retina 2021; 41:2491-2498. [PMID: 34267117 DOI: 10.1097/iae.0000000000003255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the visual/anatomical outcomes and feasibility of epiretinal membrane surgery between patients with multifocal or monofocal intraocular lenses (IOLs). METHODS We reviewed the medical records of 46 patients who underwent epiretinal membrane surgery under multifocal or monofocal IOL pseudophakia. The operation time, mean changes in best-corrected visual acuity, and central macular thickness, and complications were compared between the groups. RESULTS Macular surgery was performed in 22 and 24 eyes with multifocal and monofocal IOLs, respectively. The total operation time and the total membrane peeling time were similar in both groups (P = 0.125, P = 0.462, respectively). The mean time to create a membrane edge or flap with retinal microforceps was longer for multifocal than for monofocal IOLs (P = 0.013). The mean changes in best-corrected visual acuity and central macular thickness were similar in both groups (P = 0.682, P = 0.741, respectively). Complications were similar between groups. CONCLUSION With multifocal IOLs, vision outside the central surgical field was blurred, requiring more time to create the membrane flap. Retinal surgeons should anticipate the difficulty in precise focusing when creating a membrane flap in macular surgery in patients with multifocal IOLs and should pay more attention to the macular surgery.
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Affiliation(s)
- Jong Young Lee
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; and
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kwangsic Joo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; and
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; and
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; and
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; and
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Macular edema risk factors after vitrectomy for rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy. OPHTHALMOLOGY JOURNAL 2021. [DOI: 10.17816/ov64272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: Despite significant advances in the technology of surgical treatment of regmatogenous retinal detachment, a certain proportion of patients with emerging macular edema against the background of silicone oil tamponade remains.
AIM: To evaluate the risk factors of macular edema development and to work out a mathematical model for its prediction based on a retrospective analysis of clinical data of patients with rhegmatogenous retinal detachment complicated by proliferative vitreoretinopathy.
MATERIALS AND METHODS: A retrospective case series of 64 patients (64 eyes) with regmatogenous retinal detachment complicated by grade CP proliferative vitreoretinopathy who underwent primary retinal detachment repair. Patients were divided into two groups: with the presence of macular edema in the postoperative period and without it (32 patients in each group). In all cases, at the initial examination, retinal detachment involved the macular area.
RESULTS: Using regression analysis, two significant factors were identified: the sum of the 8 meridians of the visual field before surgery (p=0.015) and the number of detached quadrants (p=0.021). Based on the identified factors, a model for predicting macular edema occurrence in the postoperative period in the surgical treatment of regmatogenous retinal detachment was obtained.
CONCLUSIONS: The investigation results allowed establishing that the retinal detachment area and the sum of the 8 meridians of the visual field are significant pre-operative factors for macular edema development in retinal detachments with proliferative vitreoretinopathy of CP 1-2 degree. The developed mathematical model based on these indicators is characterized by significant information content and allows predicting macular edema occurrence in the postoperative period. The use of the proposed prognostic model determines a differentiated approach to surgical prevention of macular edema and allows making a decision on the removal of internal limiting membrane at the preoperative stage.
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INVERTED INTERNAL LIMITING MEMBRANE-FLAP TECHNIQUE FOR OPTIC DISK PIT MACULOPATHY: MORPHOLOGIC AND FUNCTIONAL ANALYSIS. Retin Cases Brief Rep 2021; 15:31-37. [PMID: 29474223 DOI: 10.1097/icb.0000000000000731] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze morphologic and functional changes after inverted internal limiting membrane-flap technique for optic disk pit maculopathy using optical coherence tomography, multifocal electroretinography, and microperimetry. METHODS One case report. RESULTS A 30-year-old woman presented us with decreased visual acuity (20/63) in the left eye because of retinoschisis and serous macular detachment associated with optic disk pit. Optical coherence tomography did not localize the source of intraretinal and subretinal fluid. A partial flattening of serous detachment after vitrectomy with internal limiting membrane peeling, inverted internal limiting membrane-flap technique, and gas tamponade was reported. Visual acuity and multifocal electroretinography improved while retinal sensitivity decreased at microperimetry during 3 months of follow-up. CONCLUSION Optical coherence tomography is helpful to assess the effectiveness of surgical maneuvers to treat optic disk pit maculopathy. Multifocal electroretinography and microperimetry might offer additional tools for follow-up analysis of retinal function after surgery.
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Obata S, Kakinoki M, Sawada O, Saishin Y, Ichiyama Y, Ohji M. Effect of internal limiting membrane peeling on postoperative visual acuity in macula-off rhegmatogenous retinal detachment. PLoS One 2021; 16:e0255827. [PMID: 34352010 PMCID: PMC8341536 DOI: 10.1371/journal.pone.0255827] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/23/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the effects of internal limiting membrane (ILM) peeling on visual acuity (VA) after rhegmatogenous retinal detachment (RRD) surgery. METHODS This retrospective analysis examined the medical records of patients with RRD who underwent vitrectomy at 26 institutions. To detect prognostic factors of VA at 6 months postoperatively (post-VA), multivariate linear regression was performed with post-VA as the objective variable; ILM peeling, sex, age, preoperative VA (pre-VA), intraocular pressure, axial length, duration of RRD, and cataract surgery served as explanatory variables. Recurrence of RRD and epiretinal membrane formation within 6 months postoperatively were compared between groups of patients with and without ILM peeling, among patients with macula-on and macula-off RRD. RESULTS The inclusion criteria were met by 523 eyes with a macula-on RRD and 364 eyes with a macula-off RRD. ILM peeling was performed in 85 eyes with a macula-on RRD and 57 eyes with a macula-off RRD. In eyes with a macula-on RRD, ILM peeling did not affect post-VA (p = 0.72). Vitrectomy without cataract surgery and poor pre-VA were significantly associated with poor post-VA (p = 0.01 and p < 0.001, respectively). In eyes with a macula-off RRD, ILM peeling, long duration of RRD, and poor pre-VA were significantly associated with poor post-VA (p = 0.037, p = 0.007, and p < 0.001, respectively). Recurrence of RRD and epiretinal membrane formation were similar between groups of patients with and without ILM peeling, among patients with macula-on and macula-off RRD. Retina sensitivity was not evaluated by microperimetry. CONCLUSION ILM peeling did not affect post-VA in eyes with a macula-on RRD, whereas post-VA was worse in eyes with ILM peeling than in eyes without peeling, among eyes with a macula-off RRD.
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Affiliation(s)
- Shumpei Obata
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
| | - Masashi Kakinoki
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
| | - Osamu Sawada
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
| | - Yoshitsugu Saishin
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
| | - Yusuke Ichiyama
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
| | - Masahito Ohji
- Department of Ophthalmology, Shiga University of Medical Science, Shiga, Japan
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31
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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 JOURNAL OF OPHTHALMOLOGY 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] [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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[Long-term functional and anatomical effects after macular hole surgery with internal limiting membrane peeling]. J Fr Ophtalmol 2021; 44:523-530. [PMID: 33622547 DOI: 10.1016/j.jfo.2020.06.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION To study the functional and anatomical effects of internal limiting membrane (ILM) peeling in macular hole surgery with a minimum follow-up of 10 years. METHODS Retrospective study of patients who underwent successful macular hole surgery prior to 2010. All patients underwent vitrectomy and ILM peeling after staining. Functional assessment included measurement of visual acuity and retinal sensitivity using microperimetry (NIDEK MP-3) as well as a subjective visual function questionnaire. Anatomical assessment was based on evaluation of the macular region and optic nerve using spectral domain optical coherence tomography (SD-OCT) with comparison to the fellow eye. RESULTS Fourteen women and five men were included. Visual acuity of operated eyes (0.07±0.08logMar) was not significantly different from that of fellow eyes (0.04±0.08logMar) (P=0.10). The mean retinal sensitivity of the operated eyes was 25.1±1.9dB with no difference from the fellow eyes 25.2±1.6dB (P=0.82). However, 2 patients exhibited 2 relative scotomas >10dB. On questioning, 3/19 patients (16%) described a disturbing scotoma in monocular vision, while 11/19 (58%) described metamorphopsia, and 3 subjectively assessed their visual loss at more than 60%. The external limiting membrane was present and intact in all patients, and the ellipsoid zone was restored in 16/19 patients (84%). The cone interdigitation zone was intact in 9 patients, altered in one patient and not interpretable in 9 patients. Retinal optic nerve fiber layer thickness showed a moderate loss of fibers in the operated group 95.9±9.5 versus 101.5±10.9 (P=0.001) in the fellow eyes. The ganglionic complex thickness in the operated eyes (90.1±8.3) was not significantly different from that of fellow eyes (91.9±8.8) (P=0.37). CONCLUSION ILM peeling in macular hole surgery induces anatomical changes in the inner layers of the retina, still visible on SD-OCT 10 years after the procedure. However, this remodeling of the inner layers does not appear to have significant deleterious effects on patients' retinal sensitivity or vision.
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Vingopoulos F, Koulouri I, Miller JB, Vavvas DG. Anatomical and Functional Recovery Kinetics After Epiretinal Membrane Removal. Clin Ophthalmol 2021; 15:175-181. [PMID: 33488066 PMCID: PMC7815987 DOI: 10.2147/opth.s264948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/14/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the nature of anatomical and functional recovery kinetics after epiretinal membrane (ERM) removal. Methods The records of 42 patients (45 eyes) with idiopathic ERM treated with pars plana vitrectomy and surgical peeling of the ERM performed by a single surgeon at Massachusetts Eye and Ear between 2012 and 2017 were retrospectively reviewed. Outcome measures included spectral domain optical coherence tomography-measured central macular thickness (CMT) pre-operatively and at post-operative day 1, week 1, months 1, 3, 6, 12 and 24 as well as best-corrected visual acuity (BCVA). Correlations between baseline or early values and final anatomical and functional outcomes were investigated. Results Improvement in CMT was statistically significant after 1 week, 1, 3, 6, 12 and 24 months (p < 0.01). BCVA improvement was statistically significant after 1, 6, 12 and 24 months follow-up (p<0.01). The improvement of BCVA and CMT with time was found to be logarithmic (R2 =0.96, R2 =0.84) suggesting that early (<30 days) post-operative functional and anatomical changes may be predictive of long-term outcomes. Preoperative BCVA and CMT revealed a weak positive correlation with the respective BCVA and CMT at 24 months (R2=0.13 and R2=0.16). When plotted as a percentage of the fellow normal eye CMT, first week proportional improvement in CMT from pre-operative baseline was found to be correlated with final CMT proportional decrease (R2=0.72) suggesting that first week postoperative CMT could be predictive of final CMT. Conclusion There is a logarithmic improvement in CMT and BCVA after ERM peel with BCVA improvement following the CMT improvement. Early (less than 30 days) post-operative anatomical changes can be predictive of long-term anatomical outcomes.
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Affiliation(s)
- Filippos Vingopoulos
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Ismini Koulouri
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - John B Miller
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Demetrios G Vavvas
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Effects of different tamponade materials on macular segmentation after retinal detachment repair. Jpn J Ophthalmol 2021; 65:227-236. [PMID: 33420541 DOI: 10.1007/s10384-020-00800-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/25/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study used spectral domain-optical coherence tomography (SD-OCT) to evaluate individual retinal layer thickness in eyes with macula-off rhegmatogenous retinal detachment (RRD) treated with silicone oil (SiO) or gas endotamponades. STUDY DESIGN This was a retrospective, interventional, comparative study. METHODS The study included 86 eyes of 43 patients who were divided into 3 groups according to endotamponades: SiO, perfluoropropane (C3F8), and sulfur hexafluoride (SF6). The affected eyes were compared with the fellow eyes of the same patient via SD-OCT automated segmentation analysis. Patients with a follow-up of at least 6 months were included in the final analysis. Macular segmentation including the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE), inner retinal layers (IRLs), and outer retinal layers (ORLs) was analyzed. RESULTS In the SiO group, the mean thickness of each retinal layer including the RNFL, GCL, IPL, ONL, and IRLs within a 1-mm ETDRS subfield of the affected eyes was significantly lower than that of the fellow eyes (P = 0.036, P = 0.028, P = 0.003, P < 0.001, P = 0.013, respectively). There was no significant difference in the C3F8 and SF6 groups (all P > 0.05). The difference between the ONL and IRLs in the SiO-treated eyes differed significantly from that of the gas groups (P = 0.001 and P = 0.045, respectively) The difference in the GCL thickness of the affected eyes and healthy eyes showed a significant correlation with postoperative BCVA changes in the SiO, C3F8, and SF6 groups (P = 0.041, P = 0.048, and P = 0.045, respectively). CONCLUSION The findings of our study show that endotamponades used in RRD surgery may have different effects on retinal layers. In addition, SiO may cause undesirable effects on the retinal layers.
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Guo J, Bi X, Chen SN, Chen S, He GH, Wu B, Zhang W, Wang J. Efficacy of internal limiting membrane peeling for diabetic macular edema after preoperative anti-vascular endothelial growth factor injection. Int J Ophthalmol 2020; 13:1758-1764. [PMID: 33215007 DOI: 10.18240/ijo.2020.11.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To explore the efficacy of minimally invasive vitrectomy (MIV) with or without internal limiting membrane (ILM) peeling on the treatment of diabetic macular edema (DME) in proliferative diabetic retinopathy (PDR) combining with preoperative anti-vascular endothelial growth factor (anti-VEGF) injection. METHODS Totally 132 eyes (132 patients) diagnosed PDR with DME were included between June 2015 and June 2018 in Tianjin Eye Hospital. The single MIV treatment group included 68 eyes and the MIV combined with ILM peeling group included 64 eyes. Anti-VEGF drugs were injected intravitreally 1wk before the operation and the period of follow-up was 1 to 3y. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), total macular volume (TMV), macular edema (ME) severity, intraocular pressure (IOP), and complications were recorded. Prognostic factors of visual acuity following ILM peeling were analyzed. RESULTS The BCVA was higher than preoperative values at 1, 3, 6, and 12mo after surgery in both groups (all P<0.05). At 6 and 12mo, the BCVA of the combined group was significantly higher than that of the MIV only group (0.52±0.23 vs 0.64±0.29 logMAR, P=0.011 in 6mo; 0.41±0.25 vs 0.52±0.25 logMAR, P=0.008 in 12mo). Mean CRT values postoperative were significantly lower than preoperative values in both groups from the 1st month (1mo 397.65±106.18 vs 451.94±118.88 µm in MIV only group; 388.88±108.68 vs 464.36±111.53 µm in combined group; both P<0.05) and decreased gradually. The differences between the two groups were statistically significant at 3, 6, and 12mo (P=0.004, 0.003, 0.00 respectively). The TMV was decreased from the 3rd month in the single treatment group (3mo 11.14±1.66 vs 12.20±2.09 mm3, P<0.05). At 12mo, the proportion of eyes with edema that had CRT more than 350 µm was significantly lower than before surgery (13.24% vs 77.94% in MIV only group; 1.56% vs 81.25% in combined group; both P<0.05). There was no significant difference in the recurrence incidence of macular epiretinal membrane, ME, transient IOP increase, vitreous rebleeding, or traction retinal detachment between the two groups. BCVA after ILM excision was positively correlated with the CRT and ME degree before and after surgery (r=0.430, 0.485, respectively; P<0.05). CONCLUSION MIV combined with ILM peeling accelerates the absorption of ME, improves vision, reduces the postoperative CRT and TMV, and reduces the recurrence rate of postoperative ME.
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Affiliation(s)
- Jing Guo
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China.,Department of Ophthalmology, Guangdong Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong Province, China
| | - Xue Bi
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Shan-Na Chen
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China.,Xiamen Kehong Eye Hospital, Xiamen 361000, Fujian Province, China
| | - Song Chen
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Guang-Hui He
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Bin Wu
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Wei Zhang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China
| | - Jian Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin 300070, China.,Tianjin Eye Hospital, Tianjin Eye Institute, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin 300020, China
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EPIRETINAL MEMBRANE REMOVAL WITH FOVEAL-SPARING INTERNAL LIMITING MEMBRANE PEELING: A Pilot Study. Retina 2020; 39:2116-2124. [PMID: 30063558 DOI: 10.1097/iae.0000000000002274] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the retinal sensitivity after complete internal limiting membrane (ILM) peeling with that after foveal-sparing ILM peeling during vitrectomy for Type I epiretinal membrane. METHODS This was a prospective, randomized, comparative study. Thirty-eight eyes were randomized to undergo complete peeling of the ILM (CP group) or peeling with foveal sparing (FS group). The main outcome measures were foveal and perifoveal retinal sensitivity, visual acuity, and central retinal thickness. RESULTS Foveal retinal sensitivity showed a significant improvement in the FS group (2.82 ± 0.85 dB, P = 0.037) versus a slight drop in the CP group (-0.66 ± 0.48 dB, P = 1). Perifoveal retinal sensitivity slightly improved in both groups (0.47 ± 0.37 dB, P = 1 in the CP group and 0.79 ± 0.42 dB, P = 0.77 in the FS group), showing a similar trend without significant differences. Significant improvements were observed in both visual acuity and central retinal thickness in both groups. However, three cases in the FS group showed epiretinal membrane recurrence and required revision surgery with complete ILM removal. CONCLUSION Internal limiting membrane peeling may reduce retinal sensitivity and significantly increase the incidence of microscotomas. However, the higher epiretinal membrane recurrence rate after the foveal-sparing technique limits the effectiveness of this procedure. Further studies must be conducted to determine if it is safe to leave a portion of the ILM in front of the fovea.
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Outer Plexiform Layer Angle: A Prognostic Factor for Idiopathic Macular Pucker Surgery. J Ophthalmol 2020. [DOI: 10.1155/2020/8879212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose. To investigate the efficacy of idiopathic macular pucker (epimacular membrane) surgery and to identify the possible prognostic factor. Methods. This was a retrospective study which enrolled 38 patients with idiopathic macular pucker who underwent 23-gauge pars plana vitrectomy (PPV) with indocyanine green-assisted peeling of epiretinal membrane (ERM) and internal limiting membrane (ILM). Visual outcomes were assessed at the baseline and during the follow-up including best-corrected visual acuity (BCVA) and metamorphopsia score, as well as outer plexiform layer (OPL) angle and central retinal thickness (CRT) using spectral-domain optical coherence tomography (SD-OCT). A comparison was made between patients with the prepeeling CRTs ≥500 μm and those <500 μm. A comparison was also made between patients with the prepeeling OPL angles ≥130° and those <130°. Based on the prepeeling parameters, the correlations between various prepeeling and postpeeling visual functions were analyzed. Results. Mean follow-up was 36.07 ± 4.62 months (range 1.30–96.70 months). BCVA was significantly improved from 0.26 ± 0.03 to 0.67 ± 0.04
; metamorphopsia score was significantly reduced from 1.42 ± 0.16 to 0.61 ± 0.08
; CRT was significantly decreased from 519.62 ± 13.41 μm to 385.37 ± 8.97 μm
. Greater prepeeling OPL angle (≥130°) was associated with significantly greater BCVA improvement (Snellen E/LogMAR:
) and greater metamorphopsia reduction
, as compared to smaller OPL angle (<130°) with less BCVA improvement and less metamorphopsia reduction. However, the final BCVA improvement and metamorphopsia reduction relevant to the prepeeling smaller CRT (<500 μm) did not significantly differ from that relevant to the prepeeling greater CRT (≥500 μm;
). Endophthalmitis, retinal tear, or retinal detachment was not observed after peeling. Conclusion. Indocyanine green-assisted ERM/ILM peeling combined with small gauge vitrectomy is associated with significant visual acuity improvement and metamorphopsia reduction in patients with idiopathic macular pucker. Greater prepeeling OPL angle rather than CRT might act as a useful prognostic factor in predicting better final visual functional outcomes.
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Sinawat S, Srihatrai P, Sutra P, Yospaiboon Y, Sinawat S. Comparative study of 1 DD and 2 DD radius conventional internal limiting membrane peeling in large idiopathic full-thickness macular holes: a randomized controlled trial. Eye (Lond) 2020; 35:2506-2513. [PMID: 33159177 DOI: 10.1038/s41433-020-01259-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To compare the surgical outcomes of 1-disc diameter (DD) and 2-DD conventional internal limiting membrane peeling (C-ILMP) in large full-thickness macular holes (FTMHs). MATERIALS AND METHODS A prospective randomized controlled trial. One hundred patients with large idiopathic full-thickness macular hole (FTMH) were randomized into C-ILMP and extended C-ILMP (EC-ILMP) groups. The primary outcome was closure rate at 6 months after surgery. Secondary outcomes were visual acuity (VA), closure type, consequence of ILMP and complications. RESULTS The mean symptom duration was 12.19 ± 9.64 months. Mean preoperative VA was 1.25 ± 0.37 logMAR. The average minimum linear diameter was 633.05 ± 129.82 µm and basal linear dimension was 1158.49 ± 249.07 µm. The two groups did not differ in term of demographic data. Closure rate was significantly higher in the EC-ILMP group (76.47% vs. 51.02%, 95% CI 7.24-43.66; p = 0.008). There were also no significant differences in closure type, central foveal thickness, dissociated optic nerve fibre layer detection, or change in fovea-to-disc distance. There were also no significant differences in postoperative VA (p = 0.069) or visual improvement (mean 0.39 ± 0.43 logMAR; p = 0.286). According to subgroup analysis, EC-ILMP resulted in a higher closure rate in patients with chronic FTMH for >6 months, (p = 0.008). Furthermore, EC-ILMP resulted in better anatomical closure and visual result in patients with FTMH with macular hole closure index ≤0.5, p = 0.003 and p = 0.010, respectively. CONCLUSION Extended C-ILMP yielded a significantly higher closure rate in large FTMHs, but visual outcome did not differ significantly. According to subgroup analysis, extended C-ILMP was more effective in chronic large FTMH with MHCI ≤ 0.5.
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Affiliation(s)
- Suthasinee Sinawat
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Parinya Srihatrai
- Department of Ophthalmology, Suddhavej Hospital, Mahasarakham University, Mahasarakham, Thailand
| | - Plern Sutra
- Department of Ophthalmology, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Yosanan Yospaiboon
- KKU Eye Center, Department of Ophthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Supat Sinawat
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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El Baha SM, Elbaha O, Abouhussein MA. The Pigtail Sign: A New Spectral Domain Optical Coherence Tomography Finding After Inverted ILM Flap Surgery for Idiopathic Macular Hole. Clin Ophthalmol 2020; 14:2577-2581. [PMID: 32943839 PMCID: PMC7481299 DOI: 10.2147/opth.s271703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/07/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose To report a new spectral domain optical coherence tomography (OCT) finding called the pigtail sign. It was found during follow-up of idiopathic macular hole cases after inverted internal limiting membrane (ILM) flap surgery. Methods This is a retrospective case series of 12 eyes (12 patients) who underwent inverted ILM flap technique for idiopathic macular hole closure. Spectral domain optical coherence tomography images were analyzed for the presence of this new finding. Results A new spectral domain OCT finding of a curved coiled line hanging above the surface of the retinal layers was seen in all patients. The mean preoperative best corrected visual acuity (BCVA) logMAR value was 1.25 ± 0.11. At the 6-month follow-up visit, the mean LogMAR BCVA was 0.35 ± 0.18. All the cases showed macular hole closure after surgery. Conclusion This new spectral domain OCT sign can be seen in some OCT scans during follow-up of idiopathic macular hole cases after inverted ILM flap surgery.
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Affiliation(s)
| | - Omar Elbaha
- Ophthalmology, Alexandria University, Alexandria, Egypt
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40
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Christodoulou E, Batsos G, Galanis P, Kalogeropoulos C, Katsanos A, Alamanos Y, Stefaniotou M. Vitrectomy for the removal of idiopathic epiretinal membrane with or without internal limiting membrane peeling: a meta-analysis. Ther Adv Ophthalmol 2020; 12:2515841420927133. [PMID: 32923936 PMCID: PMC7446271 DOI: 10.1177/2515841420927133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 04/24/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose: The aim of this study is to analyze the effect of internal limiting membrane peeling in removal of idiopathic epiretinal membranes through meta-analysis. Methods: We searched PubMed for studies published until 30 April 2018. Inclusion criteria included cases of idiopathic epiretinal membranes, treated with vitrectomy with or without internal limiting membrane peeling. Exclusion criteria consisted of coexisting retinal pathologies and use of indocyanine green to stain the internal limiting membrane. Sixteen studies were included in our meta-analysis. We compared the results of surgical removal of epiretinal membrane, with or without internal limiting membrane peeling, in terms of best-corrected visual acuity and anatomical restoration of the macula (central foveal thickness). Studies or subgroups of patients who had indocyanine green used as an internal limiting membrane stain were excluded from the study, due to evidence of its toxicity to the retina. Results: Regarding best-corrected visual acuity levels, the overall mean difference was –0.29 (95% confidence interval: –0.319 to –0.261), while for patients with internal limiting membrane peeling was –0.289 (95% confidence interval: –0.334 to –0.244) and for patients without internal limiting membrane peeling was –0.282 (95% confidence interval: –0.34 to –0.225). Regarding central foveal thickness levels, the overall mean difference was –117.22 (95% confidence interval: –136.70 to –97.74), while for patients with internal limiting membrane peeling was –121.08 (95% confidence interval: –151.12 to –91.03) and for patients without internal limiting membrane peeling was –105.34 (95% confidence interval: –119.47 to –96.21). Conclusion: Vitrectomy for the removal of epiretinal membrane combined with internal limiting membrane peeling is an effective method for the treatment of patients with idiopathic epiretinal membrane.
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Affiliation(s)
| | - Georgios Batsos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Andreas Katsanos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | - Yannis Alamanos
- Institute of Epidemiology, Preventive Medicine and Public Health, Corfu, Greece
| | - Maria Stefaniotou
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
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41
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Vishwakarma S, Gupta RK, Jakati S, Tyagi M, Pappuru RR, Reddig K, Hendricks G, Volkert MR, Khanna H, Chhablani J, Kaur I. Molecular Assessment of Epiretinal Membrane: Activated Microglia, Oxidative Stress and Inflammation. Antioxidants (Basel) 2020; 9:E654. [PMID: 32717933 PMCID: PMC7465764 DOI: 10.3390/antiox9080654] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/21/2022] Open
Abstract
Fibrocellular membrane or epiretinal membrane (ERM) forms on the surface of the inner limiting membrane (ILM) in the inner retina and alters the structure and function of the retina. ERM formation is frequently observed in ocular inflammatory conditions, such as proliferative diabetic retinopathy (PDR) and retinal detachment (RD). Although peeling of the ERM is used as a surgical intervention, it can inadvertently distort the retina. Our goal is to design alternative strategies to tackle ERMs. As a first step, we sought to determine the composition of the ERMs by identifying the constituent cell-types and gene expression signature in patient samples. Using ultrastructural microscopy and immunofluorescence analyses, we found activated microglia, astrocytes, and Müller glia in the ERMs from PDR and RD patients. Moreover, oxidative stress and inflammation associated gene expression was significantly higher in the RD and PDR membranes as compared to the macular hole samples, which are not associated with inflammation. We specifically detected differential expression of hypoxia inducible factor 1-α (HIF1-α), proinflammatory cytokines, and Notch, Wnt, and ERK signaling pathway-associated genes in the RD and PDR samples. Taken together, our results provide new information to potentially develop methods to tackle ERM formation.
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Affiliation(s)
- Sushma Vishwakarma
- Prof Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad 500034, India; (S.V.); (R.K.G.)
- Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
| | - Rishikesh Kumar Gupta
- Prof Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad 500034, India; (S.V.); (R.K.G.)
| | - Saumya Jakati
- Ophthalmic Pathology Laboratory, L.V. Prasad Eye Institute, Hyderabad 500034, India;
| | - Mudit Tyagi
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Hyderabad 500034, India; (M.T.); (R.R.P.)
| | - Rajeev Reddy Pappuru
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Hyderabad 500034, India; (M.T.); (R.R.P.)
| | - Keith Reddig
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA 01655, USA; (K.R.); (G.H.)
| | - Gregory Hendricks
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA 01655, USA; (K.R.); (G.H.)
| | - Michael R. Volkert
- Department of Microbiology & Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01655, USA;
| | - Hemant Khanna
- Department of Ophthalmology & Visual Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA;
| | - Jay Chhablani
- Smt. Kanuri Santhamma Retina Vitreous Centre, L.V. Prasad Eye Institute, Hyderabad 500034, India; (M.T.); (R.R.P.)
| | - Inderjeet Kaur
- Prof Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad 500034, India; (S.V.); (R.K.G.)
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42
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EN FACE IMAGE–BASED ANALYSIS OF RETINAL TRACTION CAUSED BY EPIRETINAL MEMBRANE AND ITS RELATIONSHIP WITH VISUAL FUNCTIONS. Retina 2020; 40:1262-1271. [DOI: 10.1097/iae.0000000000002569] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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43
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RETINAL SENSITIVITY AND VESSEL DENSITY AFTER MACULAR HOLE SURGERY WITH THE SUPERIOR INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE. Retina 2020; 41:45-53. [DOI: 10.1097/iae.0000000000002839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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Ducloyer JB, Ivan J, Poinas A, Lebreton O, Bonissent A, Fossum P, Volteau C, Tadayoni R, Creuzot-Garchet C, Le Mer Y, Perol J, Fortin J, Chiffoleau A, Billaud F, Ivan C, Weber M. Does internal limiting membrane peeling during epiretinal membrane surgery induce microscotomas on microperimetry? Study protocol for PEELING, a randomized controlled clinical trial. Trials 2020; 21:500. [PMID: 32513229 PMCID: PMC7278143 DOI: 10.1186/s13063-020-04433-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background The epiretinal membrane (ERM) is a degenerative condition associated with age, which can cause loss of vision and/or metamorphopsia. The treatment of symptomatic ERM involves surgical removal including a vitrectomy followed by peeling of the ERM using a microforceps. As the internal limiting membrane (ILM) is adherent to the ERM, it is sometimes removed with it (spontaneous peeling). If ILM remains in place, it can be removed to reduce ERM recurrence. However, it is important to clarify the safety of ILM peeling, while it increases surgical risks and cause histological disorganization of the retina that can lead to microscotomas, may be responsible for definitive visual discomfort. Methods PEELING is a prospective, randomized, controlled, single-blind, and multicentered trial with two parallel arms. This study investigates the benefit/risk ratio of active ILM peeling among individuals undergoing ERM surgery without spontaneous ILM peeling. Randomization is done in the operating room after ERM removal if ILM remains in place. After randomization, the two groups—“active peeling of the ILM” and “no peeling of the ILM”—are compared during a total of three follow-up visits scheduled at month 1, month 6, and month 12. Primary endpoint is the difference in microscotomas before surgery and 6 months after surgery. Patients with spontaneous peeling are not randomized and are included in the ancillary study with the same follow-up visits and the same examinations as the principal study. Relevant inclusion criteria involve individuals aged > 18 years living with idiopathic symptomatic ERM, including pseudophakic patients with transparent posterior capsule or open capsule or lensed patients with age-related cataracts. The calculated sample size corresponds to 53 randomized eyes (one eye/patient) per arm that means 106 randomized eyes (106 randomized patients) in total and a maximum of 222 included patients (116 spontaneous peeling). Discussion ILM peeling is often practiced in ERM surgery to reduce ERM recurrence. It does not impair postoperative visual acuity, but it increases the surgical risks and causes anatomical damages. If active ILM peeling is significantly associated with more microscotomas, it may contraindicate the ILM peeling during primitive idiopathic ERM surgery. Trial registration ClinicalTrials.gov, NCT02146144. Registered on 22 May 2014. Recruitment is still ongoing.
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Affiliation(s)
- Jean-Baptiste Ducloyer
- Department of Ophthalmology, CHU Nantes, Nantes, France.,Clinical Investigation Centre CIC1413, INSERM and CHU Nantes, Nantes, France
| | - Juliette Ivan
- Clinical Investigation Centre CIC1413, INSERM and CHU Nantes, Nantes, France
| | - Alexandra Poinas
- Clinical Investigation Centre CIC1413, INSERM and CHU Nantes, Nantes, France.
| | | | | | - Paul Fossum
- Department of Ophthalmology, CHU Nantes, Nantes, France
| | | | - Ramin Tadayoni
- Ophthalmology Department, Hôpital Lariboisière, AP-HP, Université Paris 7 - Sorbonne Paris Cité, Paris, France
| | | | - Yannick Le Mer
- Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Julien Perol
- Ophthalmology Department, Polyclinique de l'Atlantique, Saint-Herblain, France
| | - June Fortin
- Sponsor Department, CHU Nantes, Nantes, France
| | | | - Fanny Billaud
- Department of Ophthalmology, CHU Nantes, Nantes, France.,Clinical Investigation Centre CIC1413, INSERM and CHU Nantes, Nantes, France
| | - Catherine Ivan
- Department of Ophthalmology, CHU Nantes, Nantes, France.,Clinical Investigation Centre CIC1413, INSERM and CHU Nantes, Nantes, France
| | - Michel Weber
- Department of Ophthalmology, CHU Nantes, Nantes, France.,Clinical Investigation Centre CIC1413, INSERM and CHU Nantes, Nantes, France
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Association of retinal vessel density with retinal sensitivity in surgery for idiopathic epiretinal membrane. Graefes Arch Clin Exp Ophthalmol 2020; 258:1911-1920. [PMID: 32494873 DOI: 10.1007/s00417-020-04754-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The success of surgical treatment for idiopathic epiretinal membrane (ERM) is measured by postoperative best-corrected visual acuity (BCVA), metamorphopsia, and foveal retinal sensitivity (RS).This study searched for predictive biomarkers of surgical success by determining the association between foveal RS and various aspects of vessel density (VD) in the fovea of patients with ERM. METHODS The study examined 25 eyes of 25 patients with ERM who underwent 27-gauge microincision vitrectomy surgery (MIVS). RS was measured with microperimetry (MP-3; NIDEK) at four central points in the fovea with an interpoint distance of 2°. VD was measured with SD-OCT (RS 3000; NIDEK) within the 1-mm2 square defined by the 4 RS points at various depths, including the superficial and deep retinal capillary plexus (SCP and DCP, respectively). RESULTS Though VD did not change throughout the follow-up period, BCVA and RS significantly improved 1 and 3 months after surgery, respectively (both P < 0.0017). Postoperative RS at 6 months was positively correlated with postoperative DCP VD at 1, 3, and 6 months (r = 0.62, P = 0.001; r = 0.40, P = 0.049; r = 0.53, P = 0.007, respectively), but not with SCP VD at any time point. Multiple regression analysis confirmed that postoperative RS at 6 months was associated with postoperative DCP VD at 1 month (P = 0.03). CONCLUSION Higher postoperative DCP VD at 1 month contributed to better postoperative foveal RS at 6 months. Early postoperative VD in the fovea might be a useful predictive biomarker of late postoperative RS in the fovea in ERM patients.
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Pichi F, Hay S, Abboud EB. Inner retinal toxicity due to silicone oil: a case series and review of the literature. Int Ophthalmol 2020; 40:2413-2422. [DOI: 10.1007/s10792-020-01418-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/05/2020] [Indexed: 10/24/2022]
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47
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Mao J, Lao J, Liu C, Zhang C, Chen Y, Tao J, Shen L. A study analyzing macular microvasculature features after vitrectomy using OCT angiography in patients with idiopathic macular epiretinal membrane. BMC Ophthalmol 2020; 20:165. [PMID: 32321458 PMCID: PMC7178723 DOI: 10.1186/s12886-020-01429-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 04/13/2020] [Indexed: 12/22/2022] Open
Abstract
Background To evaluate postoperative changes in retinal capillary plexus and to assess contributing factors in postoperative visual improvement using optical coherence tomography angiography (OCT-A) in patients with idiopathic epiretinal membrane (iERM) post membrane removal. Methods Patients scheduled for vitrectomy and membrane peel for iERM were enrolled. 35 subjects were included for this study. OCT-A was used to measure the FAZ related parameters and the superficial and deep capillary plexus layers using 3 mm × 3 mm scans. Measurements were taken before surgery and at every post-surgical follow-up. The unaffected fellow eyes were used as controls. Evaluated factors included: BCVA, vessel density (VD) and retinal thickness (RT) in five regions, FAZ area, FAZ perimeter (PERIM), acircularity index (AI) and foveal vessel density (FD). Results Compared with the control group, the foveal vessel density (FVD) in superficial capillary plexus (SCP) was greater in the epi-retinal membrane group (P < 0.0001), whereas both groups had comparable parafoveal vessel density (PRVD) in SCP (p > 0.05). After surgery there was a reduction in the PRVD in SCP. The FVD in DCP increased and the PRVD in DCP decreased at baseline (p < 0.001). After surgery there was an increase in PRVD in DCP. By 6 months post-op, the PRVD had no statistically significant difference compared with the control group (p > 0.05). D-value of LogMAR BCVA was positively correlated with pre-op LogMAR BCVA (p < 0.0001), FVD in SCP (p < 0.001). It was negatively correlated with FAZ area (P < 0.001) and PERIM (P < 0.05). Conclusions Vitrectomy and membrane removal led to the decrease of VD in SCP and the increase of PRVD in DCP. Patients with a more severe iERM may receive greater visual improvement with surgery. Trial registration Trial registration number (TRN) and date of registration. ChiCTR2000031289, retrospectively registered, 2020.03.26.
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Affiliation(s)
- Jianbo Mao
- Eye Hospital of Wenzhou medical university, Zhejiang, China
| | - Jimeng Lao
- Eye Hospital of Wenzhou medical university, Zhejiang, China
| | - Chenyi Liu
- Chicago College of Optometry, Midwestern University, Downers Grove, IL, USA
| | - Caiyun Zhang
- Eye Hospital of Wenzhou medical university, Zhejiang, China
| | - Yiqi Chen
- Eye Hospital of Wenzhou medical university, Zhejiang, China
| | - Jiwei Tao
- Eye Hospital of Wenzhou medical university, Zhejiang, China
| | - Lijun Shen
- Eye Hospital of Wenzhou medical university, Zhejiang, China.
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48
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EN FACE OPTICAL COHERENCE TOMOGRAPHY AND OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF INNER RETINAL DIMPLES AFTER INTERNAL LIMITING MEMBRANE PEELING FOR FULL-THICKNESS MACULAR HOLES. Retina 2020; 40:557-566. [DOI: 10.1097/iae.0000000000002432] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Sborgia G, Niro A, Tritto T, Albano V, Sborgia L, Sborgia A, Donghia R, Giancipoli E, Coassin M, Pastore V, Giuliani G, Lorenzi U, Romano MR, Boscia F, Alessio G. Microperimetric Biofeedback Training after Successful Inverted Flap Technique for Large Macular Hole. J Clin Med 2020; 9:jcm9020556. [PMID: 32085592 PMCID: PMC7074367 DOI: 10.3390/jcm9020556] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Despite the high closure rate of large macular hole (LMH) after surgery, visual recovery is often worse than expected. Microperimetric biofeedback can improve visual function in macular pathologies. We evaluated the efficacy of biofeedback on macular function after successful inverted flap technique for LMH. Methods: In this prospective comparative study, 26 patients after LMH surgical closure were enrolled. The whole sample was equally divided into two groups. In Group 1 (trained), patients underwent a double cycle of microperimetric biofeedback, using structured light stimulus plus acoustic tone; in Group 2 (control), patients underwent scheduled visits. We analyzed visual acuity, retinal sensitivity at central 12° (macular sensitivity, MS) and 4° (central macular sensitivity, CMS), and fixation stability over twelve months. Results: Visual acuity improved mainly in the trained group, without any significant differences between the groups (p > 0.05). Only after training did MS significantly improve (p = 0.01). CMS more significantly improved in the trained (p < 0.001) than the control group (p < 0.01) (Group 1 vs. 2, p = 0.004). Only in the trained group did fixation significantly improve (3 months, p ≤ 0.03; 12 months, p ≤ 0.01). An equality test on matched data confirmed a greater significant improvement of CMS (p ≤ 0.02) at all follow-up and fixation (p ≤ 0.02) at last follow-up after training. Conclusions: Microperimetric biofeedback consolidates and increases the improvement of retinal sensitivity and fixation gained after successful inverted flap technique.
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Affiliation(s)
- Giancarlo Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Alfredo Niro
- Eye Clinic, Hospital “S. G. MOSCATI”, A.S.L. Taranto, 74010 Statte, Taranto, Italy;
- Correspondence: ; Tel.: +39-0994585017; Fax: +39-0994585742
| | - Tiziana Tritto
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Valeria Albano
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Luigi Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Alessandra Sborgia
- Eye Clinic, Hospital “S. G. MOSCATI”, A.S.L. Taranto, 74010 Statte, Taranto, Italy;
| | - Rossella Donghia
- National Institute of Gastroenterology “S. de Bellis” Research Hospital, 70013 Castellana Grotte, Bari, Italy;
| | | | - Marco Coassin
- Ophthalmology, University Campus Bio Medico of Rome, 00128 Roma, Italy;
| | - Valentina Pastore
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Gianluigi Giuliani
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Umberto Lorenzi
- Department of Ophthalmology, University Hospital of Rouen, 76000 Rouen, France;
| | - Mario R. Romano
- Department of Ophthalmology, Humanitas University, 20090 Pieve Emanuele, Milan, Italy;
| | - Francesco Boscia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
| | - Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124 Bari, Italy; (G.S.); (T.T.); (V.A.); (L.S.); (V.P.); (G.G.); (F.B.); (G.A.)
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Ghassemi F, Khojasteh H, Khodabande A, Dalvin LA, Mazloumi M, Riazi-Esfahani H, Mirghorbani M. Comparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole. Clin Ophthalmol 2019; 13:2599-2606. [PMID: 31920283 PMCID: PMC6938193 DOI: 10.2147/opth.s236169] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/17/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate and compare three different techniques of inverted internal limiting membrane (ILM) flap in the treatment of large idiopathic full-thickness macular hole. Methods In a comparative interventional case series, 72 eyes from 72 patients with large (> 400 µm) full-thickness macular hole were randomly enrolled into three different groups: group A – hemicircular ILM peel with temporally hinged inverted flap; group B – circular ILM peel with temporally hinged inverted flap; and group C – circular ILM peel with superior inverted flap. Best-corrected visual acuity (BCVA), anatomical closure rate, and ellipsoid zone (EZ) or external limiting membrane (ELM) defects were evaluated preoperatively, at week 1, and months 1, 3 and 6 after surgery. Results There were 24 eyes in group A, 23 in group B, and 25 in group C. In all three groups, larger diameter macular hole was associated with worse preoperative visual acuity (r=0.625, P<0.001). Mean BCVA improved significantly in all three groups 6 months after surgery (0.91vs 0.55, p<0.001). 6 months after surgery, mean BCVA improved from 0.91 logMAR to 0.52±0.06 in group A, 0.90 to 0.53±0.06 in group B, and 0.91 to 0.55±0.11 in group C. In group A vs. B vs. C, improvement of BCVA was 0.380±0.04 vs. 0.383±0.04 vs. 0.368±0.11 logMAR, with no statistically significant difference between groups (P=0.660). The rate of successful hole closure was 87.5% vs. 91.3% vs. 100%. Although the closure rate was 100% in Group C (circular ILM peel with superiorly hinged inverted flap), this difference was not statistically significant (P=0.115). Conclusion ILM peel with an inverted flap is a highly effective procedure for the treatment of large, full-thickness macular hole. Different flap techniques have comparable results, indicating that the technique can be chosen based on surgeon preference.
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Affiliation(s)
- Fariba Ghassemi
- Eye Research Center (ERC), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Khojasteh
- Eye Research Center (ERC), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khodabande
- Eye Research Center (ERC), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Mehdi Mazloumi
- Eye Research Center (ERC), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Hamid Riazi-Esfahani
- Eye Research Center (ERC), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mirghorbani
- Eye Research Center (ERC), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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