1
|
Lin H, Huang Z, Huang D, Zheng D, Lin P, Lin Y, Chen W. Subthreshold micropulse laser therapy for early postoperative macular thickening following surgical removal of epiretinal membrane. BMC Ophthalmol 2024; 24:102. [PMID: 38443874 DOI: 10.1186/s12886-024-03365-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND This study aimed to investigate the functional and anatomical outcomes of subthreshold micropulse laser (SMPL) therapy in eyes with early postoperative macular thickening after idiopathic epiretinal membrane (iERM) removal. METHODS This was a prospective and interventional study. Forty-eight eyes from 48 patients with macular edema at 1 month after iERM removal were randomly divided into two groups. Patients in the SMPL group (n = 24) received SMPL therapy while no special intervention was used for the observation group (n = 24). Baseline demographic data and clinical findings before and at 1 and 3 months after SMPL treatment or observation, including best-corrected visual acuity (BCVA) and the changes in central subfield thickness (CST) and average macular thickness (AMT), were analyzed. RESULTS An improvement in BCVA with a decrease in CST and AMT from baseline to the 3-month follow-ups were observed in both SMPL and observation groups. No significant difference in BCVA was observed between the SMPL group and observation group either in the 1-month (0.26 [0.15, 0.52] vs. 0.26 [0.15, 0.39], P = 0.852) or the 3-month (0.15 [0.10, 0.30] vs. 0.23 [0.15, 0.30], P = 0.329) follow-up. There was a greater reduction in CST in the SMPL group versus observation group between baseline and the 3-month follow-up (-77.8 ± 72.3 μm vs. -45.0 ± 46.9 μm, P = 0.049). The alteration in AMT did not differ between the two groups in either 1-month (-16.5 ± 20.1 μm vs. -19.7 ± 16.3 μm, P = 0.547) or 3-month (-36.9 ± 26.9 μm vs. -34.0 ± 20.1 μm, P = 0.678) follow-up. CONCLUSIONS SMPL therapy led to a significant decrease in CST at the 3-month follow-up while did not significantly improve the visual acuity in patients with postoperative macular thickening following iERM surgery. TRIAL REGISTRATION The study was registered on Aug 27, 2020 (Trial Registration Number: ChiCTR 2000037227).
Collapse
Affiliation(s)
- Hongjie Lin
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, Guangdong, 515041, China
| | - Zijing Huang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, Guangdong, 515041, China
| | - Dingguo Huang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, Guangdong, 515041, China
| | - Dezhi Zheng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, Guangdong, 515041, China
| | - Peimin Lin
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, Guangdong, 515041, China
| | - Yangxuan Lin
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, Guangdong, 515041, China
| | - Weiqi Chen
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, 69 North Dongxia Rd, Shantou, Guangdong, 515041, China.
| |
Collapse
|
2
|
Smeller L, Toth-Molnar E, Sohar N. Optical Coherence Tomography: Focus on the Pathology of Macula in Scleritis Patients. J Clin Med 2023; 12:4825. [PMID: 37510941 PMCID: PMC10381547 DOI: 10.3390/jcm12144825] [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: 06/06/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Optical coherence tomography (OCT) is a non-invasive imaging technique for high-resolution, cross-sectional tissue imaging of the eye. During the past two and a half decades, OCT has become an essential tool in ophthalmology. It is a painless method for examining details of ocular structures in vivo with high resolution that has revolutionized patient care following and treating scleritis patients. METHODS Twenty-four patients diagnosed with scleritis were selected for this study. All of the patients went through basic ophthalmological examinations, such as visual acuity testing (VA), intraocular pressure measurement (IOP), slit lamp examination, ophthalmoscopic examination, and OCT. OCT examinations were taken by SD-OCT Spectralis OCT system (Heidelberg Engineering, Heidelberg, Germany). RESULTS Twenty-seven eyes of 24 patients (7 males and 17 females) were included in this study, who were diagnosed with scleritis. OCT examinations showed epiretinal membrane (ERM) in three patients (12%), cystoid macular edema (CME) (three cases, 12%), diffuse macular edema (DME) (one case, 4%), and serous retinal detachment (SRD) (one case, 4%). CONCLUSIONS OCT proved to be a valuable, non-invasive method for detecting macular pathology in patients with scleritis. Despite the best treatment regimen applied, macular involvement resulting in reduced visual acuity (VA) can develop, which we could detect with OCT since macular edema (ME) is the leading cause of decreased vision due to the damaged outer blood-retina barrier (BRB) in inflammation. OCT investigation is a highly important method for early detection of ocular complications in scleritis in order to prevent blindness.
Collapse
Affiliation(s)
- Lilla Smeller
- Department of Ophthalmology, University of Szeged, 6720 Szeged, Hungary
| | - Edit Toth-Molnar
- Department of Ophthalmology, University of Szeged, 6720 Szeged, Hungary
| | - Nicolette Sohar
- Department of Ophthalmology, University of Szeged, 6720 Szeged, Hungary
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Variability of Visual Recovery with Time in Epiretinal Membrane Surgery: A Predictive Analysis Based on Retinal Layer OCT Thickness Changes. J Clin Med 2023; 12:jcm12062107. [PMID: 36983110 PMCID: PMC10059266 DOI: 10.3390/jcm12062107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/13/2023] [Accepted: 03/01/2023] [Indexed: 03/10/2023] Open
Abstract
Purpose: To correlate postoperative optical coherence tomography (OCT) thickness changes of each retinal layer with different patterns of visual recovery after idiopathic epiretinal membrane (ERM) surgery in a cohort of patients showing no known risk factors for poor visual recovery at preoperative imaging. Methods: Best corrected visual acuity (BCVA) and OCT images were acquired preoperatively and 1 month, 3 months and 6 months postoperatively. Patients were divided into four groups according to postoperative BCVA improvement: improvement < 15 ETDRS letters (GROUP 1), immediate improvement of BCVA without further improvements at later follow-ups (GROUP 2), immediate improvement of BCVA with further improvements at later follow-ups (GROUP 3) and delayed improvement of BCVA (GROUP 4). Results: Eighty-five patients were included. GROUP1 was the only one characterized by retinal nerve fiber layer (RNFL) thickness increase and ganglion cell layer/central macular thickness (GCL/CMT) ratio decrease at 1 month and outer nuclear layer (ONL) thickness decrease at 3 and 6 months. GROUP 2 was the only one showing a decrease in GCL/inner plexiform layer (GCL/IPL) ratio at 1 month. GROUP 3 and 4 showed higher preoperative RNFL thickness compared to the other, and GROUP 4 manifested a late increase in RNFL thickness at 6 months. Conclusions: Different patterns of VA recovery are associated with specific layer thickness changes. If further confirmed, this would help detect those cases characterized by poor or delayed visual recovery despite the absence of other known imaging risk factors.
Collapse
|
5
|
Li B, Du Y, Gou W, Yan L, You H, Bai M, Xie C, Li H. Effect of Internal Limiting Membrane Peeling or Not on Blood Flow Signal in Macular Area of Diabetic Patients with Preretinal Membrane. Curr Eye Res 2023; 48:584-590. [PMID: 36729584 DOI: 10.1080/02713683.2023.2175367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To study the effect of intraoperative internal limiting membrane (ILM) peeling on the macular vascular structure in patients with diabetic epiretinal membrane (ERM). METHODS Patients with diabetic ERM were divided into an ERM + ILM peeling group (18 eyes) and an ERM peeling group (19 eyes), all of whom underwent standard vitrectomy and were followed up until 6 months postoperatively. Best-corrected visual acuity (BCVA), Central macular thickness (CMT), Vessel density (VD) and vessel length density (VLD) of the superficial as well as deep retinal capillary plexus were compared between the two groups. RESULTS There was no significant difference in BCVA (p = .188, .410, .901, .916) and CMT (p = .164, .128, .110, .105) between the two groups at the week 1, month 1, month 3 and month 6 after operation. In the superficial capillary plexus (SCP), the change in VD (p = .106) and VLD (p = .438) was not affected by ILM peeling, and there was no significant difference in VD (p = .154, .063, .100, .162) and VLD (p = .386, .263, .431, .391) between the two groups during the four follow-up after operation. For the deep capillary plexus (DCP), there was an effect of ILM peeling on the changes in VD (p = .024) and VLD (p = .012), ILM peeling delayed the recovery time of the VD and VLD; The VD (p = .026, .000, .003) and VLD (p = .005, .000, .000) of ERM + ILM peeling group were lower than those of ERM peeling group from the month 1 to the month 6 after operation. CONCLUSION Intraoperative peeling of the ILM in patients with diabetic ERM delayed the improvement of blood flow signal in the DCP but did not affect the recovery of postoperative BCVA and CMT.
Collapse
Affiliation(s)
- Bo Li
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
| | - Yanjun Du
- Department of Cardiovascular Medicine, Suining Third People's Hospital, Suining, P.R. China
| | - Wenjun Gou
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
| | - Liying Yan
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
| | - Hui You
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
| | - Mengtian Bai
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
| | - Chen Xie
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
| | - Heng Li
- Department of Ophthalmology, Suining Central Hospital, Suining, P.R. China
| |
Collapse
|
6
|
Wang X, Yang J, Wang C, Li X. Choroidal morphologic and vascular features in patients with unilateral idiopathic epiretinal membranes: An optical coherence tomography analysis integrated with assessment of retinal layers. Front Med (Lausanne) 2023; 9:1083601. [PMID: 36687460 PMCID: PMC9853170 DOI: 10.3389/fmed.2022.1083601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/16/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Integrated analysis of retinal and choroidal morphologic and vascular features is urgently needed to examine whether and how these two elements interact with each other, thus contributing to visual impairment in patients with idiopathic epiretinal membranes (iERMs). Methods An observational retrospective study consisting of 181 patients diagnosed with unilateral iERM between August 2019 and July 2022 was carried out at Peking University Third Hospital. All patients underwent a standardized set of ophthalmologic examinations, including EDI-OCT and OCTA scanning, and were subsequently categorized into four stages according to current classification schemes based on their OCT findings. Altogether, 15 qualitative and quantitative parameters of both the retina (full-layer, inner and outer layers) and choroid were identified. Results The results revealed variations in the choroidal vascularity index (CVI) among different stages of iERMs (p < 0.001) for the first time. Distributions of retinal parameters across four stages of iERMs were validated. Correlation analysis between choroidal and retinal parameters showed that the CVI was associated with both inner and outer retinal morphologic biomarkers. Functional damage to retinal integrity was determined to be a strong contributor to visual acuity reduction in iERMs. Discussion This study complemented our present understanding of posterior segment structural and vascular alterations in iERMs.
Collapse
Affiliation(s)
- Xinglin Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Jiarui Yang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Changguan Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China,Changguan Wang,
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China,*Correspondence: Xuemin Li,
| |
Collapse
|
7
|
Buyukavsar C, Sonmez M, Sagdic SK, Unal MH. Relationship between ganglion cell complex thickness and vision in age-related macular degeneration treated with aflibercept. Eur J Ophthalmol 2022:11206721221149065. [PMID: 36579800 DOI: 10.1177/11206721221149065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE This study aimed to analyze the correlation between ganglion cell complex thickness (GCCT) and vision compared with the choroidal thickness (CT) and central retinal thickness (CRT) in relation to the outcomes of intravitreal aflibercept treatment for choroidal neovascular membranes secondary to age-related macular degeneration (AMD). METHODS This was a prospective, observational study. Forty-three eyes of 38 patients with wet AMD received a monthly loading dose of 2 mg aflibercept by intravitreal injection (IVI) during the first 3 months and were then followed at regular monthly intervals for an average of 10 months by a pro re nata regimen. All patients were examined using spectral domain-optic coherence tomography (OCT) and enhanced depth imaging OCT. According to their response to IVI treatment in the third month, patients were divided into 2 groups, both functionally and anatomically. RESULTS Three-month GCCT and optic disc retinal nerve fiber layer thickness (ODRNFLT) had the most correlation with the 10-month vision (p = 0.002, p = 0.02, respectively). While baseline GCCT was most correlated with the functional response, baseline CRT was most correlated with the anatomical response (p = 0.01, p = 0.004, respectively). CONCLUSIONS The results suggest that a reduction in 3-month GCCT indicates a good long-term vision outcome, while a reduction in 3-month ODRNFLT shows a poor long-term vision outcome. The literature suggests that this study is the first to demonstrate that baseline GCCT is more strongly correlated with the functional response than it is with CT and CRT. Hence, GCCT has a prognostic value for vision impairment.
Collapse
Affiliation(s)
- Cihan Buyukavsar
- Department of Ophthalmology, Aksehir State Hospital; Aksehir, 42560, Konya, Turkey
| | - Murat Sonmez
- Department of Ophthalmology, 506079Sultan Abdulhamid Khan Training and Research Hospital; Uskudar, 34660, Istanbul, Turkey
| | - Sercan Koray Sagdic
- Department of Ophthalmology, 605511Kilis State Hospital; 79000, Kilis, Turkey
| | - Melih Hamdi Unal
- Department of Ophthalmology, 506079Sultan Abdulhamid Khan Training and Research Hospital; Uskudar, 34660, Istanbul, Turkey
| |
Collapse
|
8
|
Wang LC, Lo WJ, Huang YY, Chou YB, Li AF, Chen SJ, Chou TY, Lin TC. Correlations between Clinical and Histopathologic Characteristics in Idiopathic Epiretinal Membrane. Ophthalmology 2022; 129:1421-1428. [PMID: 35817198 DOI: 10.1016/j.ophtha.2022.06.040] [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: 04/10/2022] [Revised: 06/08/2022] [Accepted: 06/29/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To investigate correlations between clinical and histopathologic characteristics of idiopathic epiretinal membrane (ERM). DESIGN Retrospective interventional case series. PARTICIPANTS In total, 87 eyes from 87 patients with idiopathic ERM who underwent pars plana vitrectomy with peeling of the ERM from 2019 to 2020 were included. METHODS The outcomes of clinical ophthalmic examination, including measurement of best-corrected visual acuity (BCVA) and spectral-domain OCT (SD-OCT), before and after surgery were reviewed. Surgical specimens were fixed in formalin and embedded in paraffin for histologic and immunohistochemical analysis. MAIN OUTCOMES MEASURES The association between morphological characteristics revealed on SD-OCT images and the cellular composition of the surgically excised ERM demonstrated with immunohistochemical staining were the main outcome measures. Changes in the BCVA and central macular thickness (CMT) were assessed through a comparison of preoperative and postoperative measurements. RESULTS Based on SD-OCT morphological characteristics in the foveal area, 15 cases were classified into group 1A (mainly outer retinal thickening), 39 into group 1B (more tenting of the outer retina and distorted inner retina), and 33 into group 1C (prominent inner retina thickening). Overall, postoperative final BCVA and CMT at 1 year improved in all groups. Patients who presented with a better initial BCVA exhibited a more favorable final BCVA. Epiretinal membranes in group 1C demonstrated the greatest decrease in CMT compared with those in groups 1B and 1A, but the final CMT did not differ among the groups. A negative correlation between the density of hyalocytes (P = 0.003) and myofibroblasts (P = 0.047) was noted between the 3 groups. Total cell density and glial cell density of the ERMs were strongly associated with poor final BCVA and BCVA improvement. CONCLUSIONS The present study provides new histopathologic information regarding the formation and progression of idiopathic ERM. Glial cell proliferation plays a predominant role in these processes. Epiretinal membranes with high cellularity and glial cell density may cause damage to the retina structure, resulting in poor postoperative visual outcomes. These findings provide additional evidence supporting early surgical intervention in patients with idiopathic ERM reported with visual disturbance.
Collapse
Affiliation(s)
- Lei-Chi Wang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Jung Lo
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Yun Huang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Education and Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - An-Fei Li
- Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Teh-Ying Chou
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tai-Chi Lin
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Ophthalmology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| |
Collapse
|
9
|
Wang X, Yang J, Li Z, Hou Q, Wang C, Li X. Insights into the underlying choroid in different stages of idiopathic epiretinal membranes after Viteromacular surgery. Acta Ophthalmol 2022; 101:403-412. [PMID: 36408816 DOI: 10.1111/aos.15295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/22/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of the study was to longitudinally investigate the correlation between choroidal morphologic and vascular parameters and postoperative visual outcome in different stages of idiopathic epiretinal membranes (iERMs). METHODS A prospective, observational, institutional case series of 102 consecutive patients diagnosed with unilateral iERMs were recruited at Peking University Third Hospital and were followed up for 12 months after surgical treatment with vitrectomy. Participants were classified into four stages according to current staging scheme. All eligible subjects underwent standardized imaging evaluation of choroidal parameters including subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI), and choroidal capillary perfusion (CCP) at baseline and each follow-up by enhanced depth optical coherence tomography (EDI-OCT) and OCT angiography (OCTA). Longitudinal follow-up of choroidal parameters over 12 months was analysed, and their correlations with best-corrected visual acuity (BCVA) were also assessed for predictive prognostic value. RESULTS CVI and CCP were significantly correlated with BCVA at each follow-up examination (all p < 0.05). However, SFCT exhibited no variation among different stages of iERMs at baseline (p = 0.981) or during follow-up (p = 0.520). The preoperative CVI correlated with 12-month postoperative BCVA (p < 0.001) and its predictive prognostic effect on BCVA was validated in multiple regression analysis (p = 0.006). CONCLUSION CVI varied among different stages of iERM and was significantly correlated with visual outcomes after the surgery. CVI could serve as a predictive prognostic marker in iERMs, which further indicates the underlying choroid should be taken into consideration in clinical evaluation of iERMs.
Collapse
Affiliation(s)
- Xinglin Wang
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Jiarui Yang
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Zihan Li
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Qingyi Hou
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Changguan Wang
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| | - Xuemin Li
- Department of Ophthalmology Peking University Third Hospital Beijing China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Beijing China
| |
Collapse
|
10
|
Lin W, Ren W, Chen H, Wei Y. Impacts of Surgeons' Experience on Patients with Epiretinal Membrane: A Retrospective Study from 2015 to 2020 in Wenzhou Eye Hospital. Ther Clin Risk Manag 2022; 18:835-841. [PMID: 36034091 PMCID: PMC9400678 DOI: 10.2147/tcrm.s377501] [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: 06/06/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background To explore the impacts of surgeons’ experience in patients with epiretinal membrane (ERM). Methods Patients with idiopathic ERM (334 eyes) who underwent PPV and membrane peeling were included in this study. The surgeries were performed by 9 surgeons. Patients were categorized into the experienced group (surgeons who had performed more than 5000 cases of PPV) and the regular group (surgeons who had performed less than 1000 cases of PPV). The patients were also categorized into five groups according to different preoperative best corrected visual acuity (BCVA): 20/100 or worse, 20/70-20/50, 20/40-20/30, 20/25 and 20/20. Impacts of preoperative BCVA, surgeons’ experience, lens status, and internal limiting membrane (ILM) peeling on postoperative BCVA were analyzed. Results The postoperative BCVA was significantly better at 1 week and 1 month in the experienced group compared to the regular group (p = 0.022 and 0.045, respectively). There were no significant differences in postoperative BCVA at 3 months and 6 months between the two groups (p = 0.268 and 0.233, respectively). Postoperative BCVA at 6 months was similar in the 20/25 group and 20/20 group (p = 0.063); both groups had better BCVA compared to the other three groups. The 20/100 or worse group had the greatest visual improvement among the 5 groups at 6 months. Conclusion This study suggested that although the experience of surgeons had no significant impact on the final BCVA following PPV and ERM removal, the BCVA during the early postoperative phase appeared to be better in the experienced group.
Collapse
Affiliation(s)
- Wei Lin
- School of Ophthalmology and Optometry, Eye Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Wenjun Ren
- School of Ophthalmology and Optometry, Eye Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Hao Chen
- School of Ophthalmology and Optometry, Eye Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Yong Wei
- School of Ophthalmology and Optometry, Eye Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.,State Key Laboratory of Optometry, Ophthalmology, and Vision Science, Affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, People's Republic of China
| |
Collapse
|
11
|
Prevalence and predictive factors for posterior vitreous attachment in eyes undergoing epiretinal membrane surgery. Eye (Lond) 2022; 36:1302-1307. [PMID: 34155364 PMCID: PMC9151910 DOI: 10.1038/s41433-021-01636-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/24/2021] [Accepted: 06/10/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To report the prevalence of posterior vitreous attachment (PVA) in patients with idiopathic epiretinal membrane (iERM) and to determine associated preoperative predictive factors. METHODS Retrospective observational case series of 408 eyes who underwent surgery for iERM without vitreomacular traction. The status of the posterior hyaloid was assessed intraoperatively. Predictive factors were analysed using univariate and multivariate logistic regression. We also evaluated the effect of PVA on the anatomical and functional outcomes of surgery. RESULTS Eighty-two (20.1%) eyes were found to have an undetached posterior hyaloid during vitrectomy. In multivariate analysis, axial length (AL) and lens status were strongly associated with the posterior vitreous status (p = 0.031 and p = 0.048). The odds of having a PVA decreased by a factor 0.81 per mm of AL (95% CI, 0.66-1.00). Phakic eyes had a 2.88-fold increased risk of exhibiting PVA compared to those with previous cataract extraction (95% CI, 1.10-7.52). The presence of PVA did not have any effect on postoperative anatomical and functional outcomes. In contrast, we found that eyes with shorter axial length, low preoperative visual acuity and disruption of the ellipsoid zone exhibited worse visual recovery (p = 0.006, p < 0.001 and p = 0.037). CONCLUSION PVA was observed in 20.1% of eyes undergoing vitrectomy for iERM. Shorter AL and phakic status were strong predictive factors of PVA in those eyes. However, the morphological features and the surgical prognosis of iERMs with PVA did not differ from those with posterior vitreous detachment.
Collapse
|
12
|
Incidence and risk factors of progressive nasal inner nuclear layer thickening after surgical peeling of epiretinal membrane. Sci Rep 2022; 12:7643. [PMID: 35538094 PMCID: PMC9090843 DOI: 10.1038/s41598-022-11609-7] [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: 11/08/2021] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
To assess incidence and risk factors of postoperative progressive nasal inner nuclear layer (INL) thickening after epiretinal membrane (ERM) surgery. Progressive nasal INL thickening was defined as 1.5-fold increase in thickness of nasal INL after ERM surgery compared to preoperative examination. Kaplan–Meier survival analysis was done to compare the cumulative risk ratio between groups stratified by presence of progressive nasal INL thickening. Logistic regression was performed to identify possible risk factors. Progressive nasal INL thickening occurred in 13.0% of ERM removal patients. Patients without progressive nasal INL thickening showed better visual acuity recovery compared to patients with nasal INL thickening (p = 0.029). Presence of cystoid space in inner retinal layer before surgery (odds ratio [OR] = 0.143, 95% confidence interval [CI] 0.028–0.736; p = 0.020), older age (OR = 0.896, 95% CI 0.817–0.982, p = 0.020), and thicker preoperative central macular thickness (OR = 0.994, 95% CI 0.988–1.000, p = 0.039) were correlated inversely with thickening of nasal INL. Correlation between nasal INL thickness and postoperative visual outcome was significant. Absence of cystoid space before ERM surgery, younger age, and thinner central macular thickness were risk factors for progressive postoperative nasal INL thickening. Progressive nasal INL thickening may serve as a new biomarker for worsened visual symptom after ERM surgery.
Collapse
|
13
|
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: 16] [Impact Index Per Article: 8.0] [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.
Collapse
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
| |
Collapse
|
14
|
Venkatesh R, Gupta A, Yadav N, Chhablani J. Presumed Combined Brilliant Blue G and Endolight-Induced Macular Damage following Epiretinal Membrane Removal Surgery. J Curr Ophthalmol 2022; 34:267-270. [PMID: 36147266 PMCID: PMC9487014 DOI: 10.4103/joco.joco_46_22] [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: 02/08/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose: To report a rare case of macular outer retinal and retinal pigment epithelium (RPE) damage following brilliant blue G (BBG)-assisted epiretinal membrane (ERM) removal surgery. Methods: Retrospective, observational case report. Results: An 85-year-old lady presented with decreased vision in the left eye and a best-corrected visual acuity of 20/400. The right eye examination was within normal limits. The left eye had a significant cataract, and the fundus examination through the cataractous haze showed an ERM with macular pucker, which was confirmed on an optical coherence tomography (OCT) scan. A combined cataract surgery with intraocular lens implantation and BBG-assisted ERM removal and internal limiting membrane peeling surgery was performed. Over the subsequent visits, a well-defined area of outer retinal and RPE alteration was identified on OCT and fundus autofluorescence without significant improvement in visual acuity. At the last follow-up visit, the visual acuity minimally improved to 20/200. Conclusions: Macular toxicity due to repeated usage of BBG dye and high intensity focal endo-illumination may lead to poor visual outcome following ERM removal or similar macular surgeries. Adequate precautions need to be taken to prevent vision loss.
Collapse
|
15
|
Xu M, Zhou M, Sun X, Shi X. Geographic variations in idiopathic epiretinal membranes in China. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:938. [PMID: 34350253 PMCID: PMC8263892 DOI: 10.21037/atm-21-2722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/09/2021] [Indexed: 11/07/2022]
Abstract
Background Idiopathic epiretinal membranes (ERMs) often cause metamorphopsia and the progressive loss of central visual function, which seriously affect quality of life. We aimed to map the distribution pattern of idiopathic ERMs in China and to examine the factors affecting the surgical choices of multicenter surgeons. Methods A national ophthalmologist-oriented questionnaire was administered, applied with a multistage probability sampling method. Data of essential characteristics, including age, professional title, residence, and perioperative and postoperative care, were gathered. All the data are expressed as odds ratios (ORs) and 95% confidence intervals (CIs). The histogram and choropleth map were generated by Excel 2016. Results In total, 1,137 (85.2%) valid responses were returned with maximized response and completion rates. The study showed that monthly admission numbers, and preoperative and postoperative care varied significantly across different regions in China. Generally, the monthly patient admission numbers were lower in the Western region than the Eastern region. However, patients in the Eastern region had longer preoperative waiting periods and shorter hospital stays. Conclusions The epidemiology of idiopathic ERMs varied significantly across different regions in China. The distribution pattern of ERM in China and the overview of the factors affecting the surgery approaches of multicenter surgeons were shown. The findings of this study will contribute to the formulation of medical policies, and provide insights into the healthcare environments across China.
Collapse
Affiliation(s)
- Mengqiao Xu
- Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Fundus Disease, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minwen Zhou
- Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Fundus Disease, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, National Clinical Research Center for Eye Diseases, Shanghai Key Laboratory of Fundus Disease, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Shi
- Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong, China
| |
Collapse
|
16
|
Chatzistergiou V, Papasavvas I, Ambresin A, Pournaras JAC. Prediction of Post-operative Visual Outcome in Patients with Idiopathic Epiretinal Membrane. Ophthalmologica 2021; 244:535-542. [PMID: 34062549 DOI: 10.1159/000517193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/30/2021] [Indexed: 11/19/2022]
Affiliation(s)
| | - Ioannis Papasavvas
- RétinElysée, Lausanne, Switzerland
- Clinique de Montchoisi Centre C, Lausanne, Switzerland
| | - Aude Ambresin
- RétinElysée, Lausanne, Switzerland
- Clinique de Montchoisi Centre C, Lausanne, Switzerland
- University of Lausanne (UNIL), Faculty of Biology and Medicine, Lausanne, Switzerland
| | | |
Collapse
|
17
|
Fung AT, Galvin J, Tran T. Epiretinal membrane: A review. Clin Exp Ophthalmol 2021; 49:289-308. [PMID: 33656784 DOI: 10.1111/ceo.13914] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 02/07/2023]
Abstract
The prevalence of epiretinal membrane (ERM) is 7% to 11.8%, with increasing age being the most important risk factor. Although most ERM is idiopathic, common secondary causes include cataract surgery, retinal vascular disease, uveitis and retinal tears. The myofibroblastic pre-retinal cells are thought to transdifferentiate from glial and retinal pigment epithelial cells that reach the retinal surface via defects in the internal limiting membrane (ILM) or from the vitreous cavity. Grading schemes have evolved from clinical signs to ocular coherence tomography (OCT) based classification with associated features such as the cotton ball sign. Features predictive of better prognosis include absence of ectopic inner foveal layers, cystoid macular oedema, acquired vitelliform lesions and ellipsoid and cone outer segment termination defects. OCT-angiography shows reduced size of the foveal avascular zone. Vitrectomy with membrane peeling remains the mainstay of treatment for symptomatic ERMs. Additional ILM peeling reduces recurrence but is associated with anatomical changes including inner retinal dimpling.
Collapse
Affiliation(s)
- Adrian T Fung
- Westmead Clinical School, Discipline of Ophthalmology and Eye Health, The University of Sydney, Sydney, New South Wales, Australia.,Save Sight Institute, Central Clinical School, Discipline of Ophthalmology and Eye Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Justin Galvin
- St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Tuan Tran
- Save Sight Institute, Central Clinical School, Discipline of Ophthalmology and Eye Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
18
|
The visual outcomes of idiopathic epiretinal membrane removal in eyes with ectopic inner foveal layers and preserved macular segmentation. Graefes Arch Clin Exp Ophthalmol 2021; 259:2193-2201. [PMID: 33528646 DOI: 10.1007/s00417-021-05102-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To analyze the functional impact of ectopic inner foveal layers (EIFL), along with other clinical and optical coherence tomography biomarkers, on patients with epiretinal membrane (ERM) and preserved foveal layers' segmentation undergoing ERM removal. METHODS Retrospective review of consecutive patients with ERM who underwent pars plana vitrectomy with ERM peeling from December 2018 to December 2019. Baseline factors including age, gender, lens status, phacoemulsification at the time of surgery, tamponade agent, dye used for ERM and internal limiting membrane (ILM) enhancement, ILM peeling, best-corrected visual acuity (BCVA) and central macular thickness (CMT), presence and thickness of EIFL, thickness of outer nuclear layer (ONL), presence of a cotton ball, subfoveal state of photoreceptors, and presence of cystoid macular edema were included in a multivariable model having the BCVA at 12 months as the main outcome. The changes in EIFL and ONL thickness over time were also analyzed. RESULTS Fifty-one patients (58 eyes, 23 eyes in the no EIFL group, and 35 eyes in the EIFL group) were enrolled. The BCVA significantly improved over 12 months after surgery, regardless of the presence of EIFL (p < 0.001). Eyes with no EIFL had better BCVA at month 3 (p = 0.04), but this difference was no longer detectable at 6 and 12 months. The presence of EIFL was not associated with the final BCVA (p = 0.9), while the CMT at 12 months correlated with EIFL thickness (r = 0.8, p = 0.008). CONCLUSION Patients with EIFL could reach optimal visual acuity in the absence of disorganization of the inner retinal layers but should be warned of potentially longer healing times. None of the morphologic signs included in this study precluded good visual recovery on long-term follow-up.
Collapse
|
19
|
Poornachandra B, James E, Aseem A, Jayadev C, Sanjay S, Ashwini KT, Gadde SGK, Yadav NK. Multimodal imaging of an idiopathic florid vascularised epiretinal membrane: Course, treatment, and outcome. Indian J Ophthalmol 2020; 68:2302-2304. [PMID: 32971702 PMCID: PMC7727958 DOI: 10.4103/ijo.ijo_2363_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Idiopathic vascular epiretinal membrane is an extremely rare entity and the pathogenesis and clinical course is not clearly understood. A 53-year-old hypertensive female patient presented with complaints of altered vision in the right eye. On examination, her vision was 20/30 and fundoscopy showed a vascularized epiretinal membrane (ERM), which was confirmed on spectral-domain optical coherence tomography. No primary cause was found after investigations. The symptoms and ERM showed slow progression over the next three years with a visual acuity of 20/60. She underwent surgery for removal of the ERM, which was subjected to histopathological evaluation. This is a unique case of a florid proliferative vascularisation of an ERM in the absence of any identifiable cause, which had a good visual outcome following surgery.
Collapse
Affiliation(s)
- B Poornachandra
- Department of Vitreo- Retina, Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
| | - Edwin James
- Department of Vitreo- Retina, Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
| | - Aditya Aseem
- Department of Vitreo- Retina, Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
| | - Chaitra Jayadev
- Department of Vitreo- Retina, Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
| | - Srinivasan Sanjay
- Department of Vitreo- Retina, Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
| | - K T Ashwini
- Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Santosh G K Gadde
- Department of Vitreo- Retina, Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
| | - Naresh K Yadav
- Department of Vitreo- Retina, Narayana Nethralaya Eye Institute, Bengaluru, Karnataka, India
| |
Collapse
|
20
|
Lin GC, Lin HS, Horng YH, Chu HC, Sheu SJ. Intraocular pressure might play a role in the surgical management of patients with epiretinal membrane. Graefes Arch Clin Exp Ophthalmol 2020; 258:2691-2699. [PMID: 32734468 DOI: 10.1007/s00417-020-04870-x] [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: 04/21/2020] [Revised: 07/02/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To investigate the prognostic factors and visual outcomes for patients with epiretinal membrane after pars plana vitrectomy and possible interactions between multiple factors. METHODS A retrospective chart review of adult patients with epiretinal membrane treated with pars plana vitrectomy performed by a single surgeon between February 1, 2015, and January 31, 2017 was conducted. The surgical procedures included standard 25-gauge vitrectomy with peeling of the epiretinal membrane and internal limiting membrane (ILM). Factors including age, sex, vision, intraocular pressure (IOP), lens status, and baseline optical coherence tomography angiography were analyzed to determine any association with visual outcomes. IOP and lens status were evaluated at every visit point and were used for analysis. RESULTS Visual changes after pars plana vitrectomy in patients with epiretinal membrane were significantly associated with time, lens status, baseline ellipsoid zone integrity, baseline vision, baseline parafoveal vessel density of superficial capillary plexus (SPVD), and IOP. Further investigation using Johnson-Neyman analysis revealed that vision improved over time, especially in pseudophakic eyes. High IOP at baseline or during follow-up was identified as a significant factor associated with limited visual improvement. CONCLUSION Our study showed that vision improved over time after vitrectomy for patients with epiretinal membrane. The surgical outcomes are more stable in pseudophakic eyes, and vision improved after cataract extraction in phakic eyes. IOP should be managed and monitored closely to optimize surgical and visual outcomes in patients.
Collapse
Affiliation(s)
- Guan-Chyun Lin
- Department of Information Technology and Management, Fooyin University, Kaohsiung, Taiwan
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, Kaohsiung, Taiwan
| | - Yu-Harn Horng
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hui-Chen Chu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Sanmin District, Kaohsiung City, 80756, Taiwan
| | - Shwu-Jiuan Sheu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, No.100, Tzyou 1st Rd., Sanmin District, Kaohsiung City, 80756, Taiwan. .,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
21
|
Zou J, Tan W, Huang W, Liu K, Li F, Xu H. Association between individual retinal layer thickness and visual acuity in patients with epiretinal membrane: a pilot study. PeerJ 2020; 8:e9481. [PMID: 32728494 PMCID: PMC7357566 DOI: 10.7717/peerj.9481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/14/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose We investigated the correlation between visual acuity (VA) and individual retinal layer thickness in the foveal, parafoveal, and perifoveal regions of patients with an idiopathic epiretinal membrane (ERM). Methods One hundred and five subjects presenting with unilateral idiopathic ERM were included in this study. We segmented each patient’s optical coherence tomography (OCT) image into seven layers and calculated the mean layer thickness in the foveal, parafoveal, and perifoveal regions using the Iowa Reference Algorithm. In 105 patients with ERM, we detected correlations between their macular regions’ individual retinal layer thickness and their best corrected VA. Thirty-one of the 105 patients with ERM underwent vitrectomy and completed six months of follow-up. We then compared the 31 surgical patients’ preoperative and postoperative individual retinal layer thickness in each macular region. Additionally, the association between preoperative individual retinal layer thickness in each macular region and VA six months post-surgery in patients with ≥ two Snellen lines of visual improvement was determined. Results Multiple linear regression analysis showed that the inner nuclear layer (INL) thickness in the foveal, parafoveal, and perifoveal region were all associated with VA in the 105 patients (R2 = 0.344, P < 0.001; R2 = 0.427, P < 0.001; and R2 = 0.340, P < 0.001, respectively). Thirty-one surgical patients 6 months post-surgery showed significantly decreased thicknesses (P ≤ 0.012) of the foveal INL, inner plexiform layer (IPL), and outer nuclear layer (ONL); the parafoveal retina nerve fiber layer (RNFL), IPL, INL, and ONL; and the perifoveal RNFL, IPL, INL, ganglion cell layer (GCL), outer plexiform layer (OPL), and photoreceptor layer (PRL). We found a weak correlation between postoperative VA and preoperative foveal and perifoveal RNFL thickness (r = 0.404 and r = 0.359, respectively), and a moderate correlation between postoperative VA and preoperative foveal and parafoveal INL thickness (r = 0.529 and r = 0.583, respectively) in the 31 surgical patients (P ≤ 0.047). The preoperative INL thickness in the foveal, parafoveal, and perifoveal regions showed a moderate to strong correlation (r = 0.507, 0.644, and 0.548, respectively), with postoperative VA in patients with ≥ 2 lines of visual improvement (P ≤ 0.038). Conclusion We detected a correlation between retinal damage and VA in the parafoveal, perifoveal, and foveal regions. Our results suggest that INL thickness in all macular regions may be a prognostic factor for postoperative VA in ERM patients.
Collapse
Affiliation(s)
- Jing Zou
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Ophthalmology, Changsha, Hunan Province, China
| | - Wei Tan
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Ophthalmology, Changsha, Hunan Province, China
| | - Wenlong Huang
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Ophthalmology, Changsha, Hunan Province, China
| | - Kangcheng Liu
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Ophthalmology, Changsha, Hunan Province, China
| | - Fangling Li
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Ophthalmology, Changsha, Hunan Province, China
| | - Huizhuo Xu
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan Province, China.,Hunan Key Laboratory of Ophthalmology, Changsha, Hunan Province, China
| |
Collapse
|