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AIM: To observe the effect on visual quality by traditional Chinese medicine (TCM) warm-reinforcing method for early idiopathic macular epiretinal membrane(IMEM).METHODS: Totally 21 patients (21 eyes) diagnosed as early IMEM with spleen-kidney yang deficiency were treated by Gubenmingmu powder for 2mo.The best corrected visual acuity(BCVA), the contrast sensitivity and the modified vision quality of questionnaire score were detected to compare the life influence of pretherapy with posttherapy in visual changes.RESULTS: The BCVA were separately 0.24±0.07、0.22±0.06、0.27±0.08 in the treating time of 1, 2 and 5mo.Contrast sensitivity function in special frequencies of 6,12 and 18c/d increased than pretherapy (P0.05).Scales of night fixation difficulty, guidepost difficulty, TV font difficulty, satisfaction, annoyance, understanding, newspaper easiness had significant differences(P0.05).CONCLUSION: The TCM warm-reinforcing method could improve the visual function of IMEM patients and improve patients` quality of life.
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AIM: To do the assesement of the effects of repeated parabulbar application of triamcinolone acetonide ( TA ) on uveitic macular edema ( ME ) with and without epiretinal membranes ( ERM) obtained via high resolution optical coherence tomography( OCT) parameters ( central and average macular thicknesses, and volume) and their correlation with visual efficiency. ● METHODS: This study depicts treatment results obtained for 140 eyes in patients with uveitic macular edema divided into two groups based on absence or presence of epiretinal membranes. Three repeated doses of triamcinolone acetonide ( 40 mg each ) were parabulbarlly applied every 3-4wk, and besides which all patients also received local treatment of nonsteroidal anti-inflammatory drugs. Patients′ visual efficiency, intraocular pressure, and high resolution spectral domain optical coherence tomography ( SD-OCT ) examination was performed. ●RESULTS: Best results were achieved in patients with macular edema without epiretinal membranes where average values for average thickness, volume, and central field thickness were statistically significantly lower than the same values at the beginning of treatment. Following treatment of eyes with macular edema in a group with ERM, besides decreased values of volume and average thickness, there was also increased central field thickness. Overall, from initial examination to treatment completion, there was no statistically significant change of intraocular pressure and central field thickness, but there was statistically significant decrease in average thickness, volume, while visual efficiency statistically increased. ln both groups visual efficiency highly correlated with central field thickness. ● CONCLUSION: Repeated parabulbar application of triamcinolone acetonide had better outcome on uveitic macular edema without epiretinal membranes being present.
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PURPOSE: To evaluate the accuracy of postoperative refractive outcomes of combined phacovitrectomy for epiretinal membrane (ERM) in comparison to cataract surgery alone. MATERIALS AND METHODS: Thirty-nine eyes that underwent combined phacovitrectomy with intraocular lens (IOL) implantation for cataract and ERM (combined surgery group) and 39 eyes that received phacoemulsification for cataract (control group) were analyzed, retrospectively. The predicted preoperative refractive aim was compared with the results of postoperative refraction. RESULTS: In the combined surgery group, refractive prediction error by A-scan and IOLMaster were -0.305+/-0.717 diopters (D) and -0.356+/-0.639 D, respectively, compared to 0.215+/-0.541 and 0.077+/-0.529 in the control group, showing significantly more myopic change compared to the control group (p=0.001 and p=0.002, respectively). Within each group, there was no statistically significant difference in refractive prediction error between A-scan and IOLMaster (all p>0.05). IOL power calculation using adjusted A-scan measurement of axial length based on the macular thickness of the normal contralateral eye still resulted in significant postoperative refractive error (all p<0.05). Postoperative refraction calculated with adjusted axial length based on actual postoperative central foveal thickness change showed the closest value to the actual postoperative achieved refraction (p=0.599). CONCLUSION: Combined phacovitrectomy for ERM resulted in significantly more myopic shift of postoperative refraction, compared to the cataract surgery alone, for both A-scan and IOLMaster. To improve the accuracy of IOL power estimation in eyes with cataract and ERM, sequential surgery for ERM and cataract may need to be considered.
Subject(s)
Aged , Female , Humans , Male , Biometry/methods , Case-Control Studies , Cataract Extraction , Epiretinal Membrane/surgery , Eye , Lens Implantation, Intraocular , Lenses, Intraocular , Optics and Photonics , Phacoemulsification/methods , Postoperative Period , Refraction, Ocular/physiology , Retrospective Studies , Treatment Outcome , Vision Tests , Visual Acuity , Vitrectomy/methodsABSTRACT
Background Idiopathic macular epiretinal membrane (IMEM) shows a high incidence and affects visual function of patients.The primary management of IMEM is vitrectomy,but the study on prediction of visual acuity after operation by optical coherence tomography (OCT) is seldom.Objective This study was to evaluate the predicting ability of OCT for preoperative visual outcome for IMEM patients who received vitrectomy.Methods The clinical data of IMEM patients with vitrectomy from March 2009 to May 2013 were retrospectively analyzed in People's Hospital Peking University.Forty-nine eyes of 48 cases were divided into continuous group (19 eyes of 18 cases) and discontinuous group (31 eyes of 31 cases) based on whether the extraretinal layers were intact on OCT,including retinal pigment epithelium (RPE),inner and outer segment of photoreceptors (IS/OS) and external limiting membrane (ELM).Central foveal thickness (CFT) by high-resolution spectral-domain OCT and best corrected visual acuity (BCVA) (LogMAR) before surgery and 12 weeks after surgery were recorded and compared between the two groups,and the correlations of shift of CFT with the shift of LogMAR vision was analyzed by unitary linear regression to evaluate the value of OCT in predicting postoperative vision.Writen informed consent was obtained from each patient prior to any medical operation.Written informed consent was obtained from each patient before surgery.Results In 12 weeks after operation,reflective strips of RPE layer,IS/OS and ELM layer were intact in 18 eyes of the continuous group after vitrectomy.The number of eyes with discontinuous strip in RPE layer decreased to 1 eye after operation from 6 eyes before operation,and the number of eyes with IS/OS reflective strip discontinue decreased to 19 eyes after operation from 29 eyes before operation,and that with ELM layer discontinue decreased to 15 eyes after operation from before operation in the discontinuous group.The improvement of LogMAR BCVA was increased with the decline of CFT values with a negative correlation between them (R2 =0.298,B =0.001,P =0.000),and postoperative LogMAR visual acuity improved 1 line whenever CFT reduced by 100 μm.LogMAR BCVA was 0.4±0.19 before surgery and 0.36±0.21after surgery in the continuous group,showing a insignificant difference between them (t =0.876,P=0.393).In the discontinuous group,the postoperative IogMAR BCVA was significantly higher after operation (0.46±0.26) than 0.82 ±0.41 after operation (t =6.206,P =0.000).The increase value of LogMAR after vitrectomy was 0.3 in the discontinuous group,which was superior to 0.0 of the continuous group.Conclusions The continuity of extraretinal layers and CFT by OCT are closely associated with the improvement of vision after vitrectomy in the eyes with IMEM.Postoperative vision is better in IMEM eye with continuous retinal reflective strips before operation,and majority of IMEM eyes can improve vision after operation.Preoperative OCT seems to be an important diagnostic tool for the selection of patients who benefit or not from surgery to certain extent.
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BackgroundIdiopathic epiretinal membranes(ERMs) is a common eye disease condition that leads to progressive decline of visual acuity. Studying the risk factors relating to this disease will shed light on its pathogenesis and allow opthalmologists to screen the affected individuals among the high-risk population and prepare for prevention and management strategies. ObjectiveThis survey was to investigate the risk factors of idiopathic ERMs in the population undergoing routine health check-ups. MethodsThe clinical data of idiopathic ERMs was obtained from the population of routine health check-ups in Peking Union Medical College Hospital from November 2009 to October 2010. The examination outcomes were compared between the individuals with and without idiopathic ERMs. The demographic and clinical factors associated with idiopathic ERMs were analyzed and assessed using univariate and multivariate logistic regression analyses. Result A total of 27 400 people were included in the survey and idiopathic ERMs were diagnosed in 76 cases. No obvious eye complaint was obtained from the idiopathic ERMs. The number of people affected with idiopathic ERMs was 12 ( 12/11 659 ) in the below 40 years group, 21 (21/4595) in the 51-60 years group and 32 (32/2544) in the over 60 years group. Hypertension, diabetes, diedyslipidemia, renal function insufficiency ,and cataract were found in 42％ ,5％ ,66％ ,6％ and 8％ of the patients, respectively. The univariate logistic regression analyses revealed that significant correlations were found between age,hypertension,hyperlipidemia and history of cataract( P＜0. 01 ). Multivariate regression models showed that the risk of idiopathic ERMs increased in age of 51-60( OR=2. 5,95％ CI:1. 2-5.4,P=0.02) and over 60 years( OR =7.3,95％ CI:3.4-15.6 ,P＜0.01 ) and patients suffering from hyperlipidemia ( OR--2. 1,95％ CI:1. 3-3.5, P＜0. 01 ). ConclusionsOver the age of 50 years and hyperlipidemia are primary risk factors of idiopathic ERM.
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Objective To study the characteristics of optical coherence tomography (OCT) in idiopathic macular epiretinal membranes (IMEM) and the relationship between the thickness of fovea and the vision of affected eyes. Methods Total of 67 cases (73 eyes) with clinical diagnosis of IMEM by direct, indirect ophthalmoscopy, three mirror contact lens, fundus color photography or fundus fluorescein angiography(FFA) were examined with OCT. Results Epiretinal membranes(ERMs) with macular edema were found in 32 eyes, proliferative ERMs in 20 eyes, ERMs with macular pseudoholes in 14 eyes and ERMs with laminar macular holes in 7 eyes. Based on OCT, the ERMs were clearly and partially seperated from the retina (27 eyes, 38.36%), the retinal thickness of the fovea was the thickest in proliferative ERMs and the thinnest in ERMs with laminar macular holes. The statistical analysis showed there was a negative correlation between the thickness of fovea and visual acuity (r=-0.454, P= 0.000 ). Conclusion There were four types of image of OCT in IMEM: ERMs with macular edema, proliferative ERMs, ERMs with macular pseudohole and ERMs with laminar macular hole;and the thicker the fovea under the OCT, the poorer the visual acnity in the affected eyes with ERMs.