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Purpose: To compare the outcomes of papillomacular bundle (PMB) sparing internal limiting membrane (ILM) peeling (group LP) and conventional ILM peeling (group CP) for treatment of idiopathic macular hole (MH) of ?400 ?m. Methods: Fifteen eyes were included in each group. In group CP, conventional 360° peeling was done, while in group LP, ILM was spared over PMB. The changes in peripapillary retinal nerve fiber layer (pRNFL) thickness and ganglion cell?inner plexiform layer (GC?IPL) thickness were analyzed at 3 months. Results: MH was closed in all with comparable visual improvement. Postoperatively, retinal nerve fiber layer (RNFL) was significantly thinner in the temporal quadrant in group CP. GC?IPL was significantly thinner in the temporal quadrants in group LP, whereas it was comparable in group CP. Conclusion: PMB sparing ILM peeling is comparable to conventional ILM peeling in terms of closure rate and visual gain, with the advantage of less retinal damage at 3 months.
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Objective@#This small case series demonstrated pars plana vitrectomy and silicone tamponade without internal limiting membrane (ILM) peeling to be a simple, safe, and effective surgical technique for the treatment of myopic traction maculopathy (MTM).@*Methods@#This is a small case series consisting of 3 eyes with MTM. In all eyes, pars plana vitrectomy with silicone oil tamponade was performed by a single vitreoretinal surgeon. Functional and anatomic outcomes are reported.@*Results@#All 3 eyes had improved visual acuity with no noted short-term complications such as iatrogenic macular hole and retinal detachment. Although foveoschisis was only partly anatomically resolved in 2 out of the 3 cases, functional outcome, in terms of visual acuity at last visit, was satisfactory.@*Conclusion@#Vitrectomy with silicone oil tamponade without ILM peeling is a simple, effective, and safe optional surgical technique to treat MTM.
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@# As a major innovation in macular surgery over the past 30 years,internal limiting membrane peeling has now become standard operation after all-round improvements. However, how to achieve optimal response and avoid poor prognosis by peeling the internal limiting membrane, which is the basement membrane of the Müller cells representing the structural interface between retina and vitreous, still needs to be explored. Prof. Peter Wiedemann, the co-editor-in-chief of our journal, in view of his long-term outstanding contributions to retinal surgery and the important progress his team has made in foveal regeneration, wrote this review with a special invitation. He gladly completed this article in 2wk, which is comprehensive, outlined, insightful, concise and shining with wisdom. It summarizes the history, rationale, techniques, indications, size and adverse outcomes of internal limiting membrane peeling and the surgery for refractory macular hole. It not only affirms current cognition, but raises existing problems, which are worthy reading and reflecting, so it was translated for readers' convenience.
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Objective:To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and C 3F 8 tamponade for patients with highly myopic macular hole (HM-MH) with and without foveoschisis. Methods:A retrospective case controlled study. From January 2017 to February 2022, 23 eyes of 23 patients with highly myopic macular hole with and without foveoschisis diagnosed in the Shandong Eye Hospital were included in the study. Among them, 5 males had 5 eyes, and 18 females had 18 eyes, the age was (54.43±12.96) years old. The patients with or without foveoschisis were 12 eyes in 12 cases and 11 eyes in 11 cases. Studies were divided into two groups, depending on the presence of a concomitant myopic foveoschisis or not. The groups are high myopia macular hole with foveoschisis (group A) and high myopia macular hole without foveoschisis (group B). Best-corrected visual acuity (BCVA), B-scan ultrasonography, optical coherence tomography and axial length (AL) measurement were performed in all eyes. Snellen chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The age of the two groups, sex, macular hole (MH) diameter, logMAR BCVA, AL, posterior scleral staphyloma, there was no significant difference ( P>0.05). PPV combined with ILM peeling and C 3F 8 filling were performed in all eyes. Follow-up was at least 3 months after the last operation. BCVA changes and MH closure were compared between the two groups after surgery. Wilcoxon test was used to compare BCVA before and after operation. Mann-whiteny U test was used to compare preoperative and postoperative BCVA between groups. Results:After initial surgery, MH was closed in 17 of 23 eyes (74%, 17/23). MH was closed in 8 eyes in group A (66.7%, 8/12). Four eyes were not closed (33.3%, 4/12); MH closed in 9 eyes in group B (81.8%, 9/11). There was no significant difference between the two groups after initial operation ( P>0.05). At 1 and 3 months after surgery, the logMAR BCVA of patients in group A and group B were 1.00±0.46, 1.03±0.83 and 0.53±0.63, 0.55±0.41, respectively. Compared with before operation, there was no significant difference at 1 month ( P=0.783, 0.358), but the difference was statistically significant at 3 months ( P=0.012, 0.007). There was no significant difference in logMAR BCVA between group A and group B at 1 and 3 months after operation ( P=0.687, 0.950). Conclusion:PPV combined with ILM peeling and C 3F 8 tamponade can promote MH closure and improve visual acuity in most affected eyes with HM-MH with and without foveoschisis.
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Background: Vitreomacular traction (VMT) is a commonly encountered entity in our routine practice. The key question is whether to observe or operate by clinical and imaging based judgement of the visual prognosis in every case. Purpose: This video encapsulates diagnostics, surgical method, and prognosis in a case of VMT released with vitrectomy. Synopsis: A 56-year-old businessman was diagnosed with VMT in the OPD and was advised surgical release of the same. The patient was extremely keen to know the visual prognosis, where the OCT imaging helped. The surgical method demonstrates the method to find the edge of the PVD to release the traction. Also, a simple ILM peel procedure has been described to reduce recurrences in cases like these. Highlights: 1. Judging the prognosis in VMT cases on basis of imaging. 2.Finding the edge (FTE) method of inducing the PVD. 3. ILM peeling simplified
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Background: Falciform folds are congenital tractional retinal folds due to strong contractile forces and hyperextensibility of retina resulting in temporal dragging of the macula and often associated with familial exudative vitreoretinopathy and retinal detachment (RD). Retinologists are reluctant to treat these entities in view of their poor visual recovery. Purpose: To describe a novel surgical technique to unfold the falciform folds. Synopsis: This video demonstrates innovative surgical techniques to remove both pre?retinal and sub?retinal adhesions and unfold these folds, managing its consequences and visual recovery. We describe cases of congenital falciform folds with poor visual acuity, where we did vitrectomy, membrane adhesion removal, peeling of the internal limiting membrane (ILM) the macula, mechanical stretching of the folded retina by Tanno scraper or Finesse flex loop, then sub?retinal injection of balanced salt solution (BSS) by 38 gauge sub?retinal needle o create multiple blebs around the folded retina and finally sulphur hexafluoride tamponade. Post? operative macular hole with RD can be a complication. When this falciform fold is complicated by RD, there is risk of intraoperative subretinal migration of infusion cannula and therefore the need for peripheral relaxing retinectomy for redundant retinal fold as well as silicone oil as endotamponade. Vision improved in all our patients after the surgery. Highlights: Both long?standing pre? retinal adhesions as well as sub?retinal adhesions are responsible for he tformation of congenital falciform folds. For pre?retinal adhesions, vitrectomy with removal of all the adhesions along with peeling of the sticky ILM and then mechanical stretching of folded retina by Tanno scraper or Finesse flex loop are necessary. To remove sub?retinal adhesions, sub?retinal injection of BSS is necessary to stretch the folded retina from behind, but it should be done away from the retina to avoid formation of macular hole.
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A 44?year?old female with a vision of 10/200 in the right eye had double pits in the temporal segment of the optic disc with serous macular detachment. Spectral?domain optical coherence tomography (SD?OCT) confirmed serous retinal detachment, an outer layer hole, and double optic disc pits. The patient underwent pars plana vitrectomy with modified ILM flap surgery involving fovea?sparing internal limiting membrane peeling (FSIP) technique with inverted ILM flap tucking with gas tamponade. Post surgery, the communications between perineural and intraretinal spaces were obliterated with flaps of ILM covering the pits, with reduced serous macular detachment and BCVA of 20/120. FSIP with inverted internal limiting membrane flap tuck can be an effective technique to manage rare cases of double ODP?M
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Purpose: To evaluate the outcome of vitrectomy with multilayered inverted internal limiting membrane flap technique (ML?IILM) versus vitrectomy with standard ILM peeling for large macular holes in terms of visual acuity and anatomical closure. Methods: A hospital?based, prospective, randomized, interventional study was conducted during three calendar years with a total 150 eyes (75 in each group) in two groups—vitrectomy with ILM peeling (Group A) and vitrectomy with ML?IILM flap technique (Group B) after informed consent of study participants who met the inclusion criteria. Results: The mean minimum and maximum diameter of macular hole did not differ statistically in both the groups. Macular hole index had no significant difference between both groups Pre?operative visual acuity was not statistically significantly different between the two groups. During follow?up, best corrected visual acuity (BCVA) at 1 month, 3 months, 6 months, and 12 months was significantly better in Group B (0.12 ± 0.07 at 1 month, 0.14 ± 0.10 at 3 months, 0.18 ± 0.11 at 6 months, and 0.19 ± 0.12 at 12 months) compared to Group A (0.20 ± 0.11 at 1 month, 0.22 ± 0.13 at 3 months, 0.30 ± 0.12 at 6 months, and 0.31 ± 0.14 at 12 months) (P = 0.001 for each). Type 1 anatomical closure (flattening of cuff and opposition of edges of hole) was achieved in 78.66% (59/75) cases in Group A and 93.33% (70/75) cases in Group B (P 0.0016). Conclusion: Vitrectomy with multilayered inverted ILM flap technique had significantly higher anatomical closure and better visual outcome than vitrectomy with standard ILM peeling
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Purpose: To report a simple modification of internal limiting membrane (ILM) peeling tailored to the shape of the macular hole to improve the closure rates. Methods: This is a single?center interventional case series. conducted between 2016 and 2020. The minimum follow?up was 4 months. All surgeries were performed by one surgeon. Twenty consecutive patients (21 eyes) with large idiopathic macular holes (horizontal diameter: ?600 ?m) were enrolled; vertical hole diameters were also measured using spectral?domain optical coherence tomography (OCT). Following vitrectomy, ILM peeling was performed over a horizontally oval area (additional 1 disc?diameter temporally); perfluoropropane gas (C3F8, 15%) tamponade was used. Hole closure and change in best?corrected visual acuity (BCVA) were monitored after absorption of the gas. Preoperative and postoperative visual acuities were compared using paired t?test. IBM SPSS (ver. 26) was used for analysis. Results: The macular holes were horizontally oval rather than circular without exception: mean horizontal and vertical diameters were 714 ?m (range: 600–1020 ?m) and 602 ?m (490–844 ?m), respectively. Following vitrectomy, macular hole closure was obtained in 20/21 eyes by the last follow?up (mean: 28 months, median: 34 months; range 4–48 months). Mean Snellen BCVA improved from 20/200 to 20/63 (P < 0.0001). Conclusion: All the macular holes in the study were observed to be horizontally oval. A corresponding horizontal enlargement of the ILM rhexis yielded excellent anatomical and satisfactory visual outcomes
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@#AIM: To observe the difference of curative effect between internal limiting membrane(ILM)inversion and insertion and ILM peeling and to analyze the influence of different surgical methods on the morphology of hiatus healing.<p>METHODS: A retrospective analysis of the clinical data of 22 patients with macular hole, who received vitrectomy in the First People's Hospital of Zunyi City from June 2017 to June 2020. According to the surgical methods, they were divided into 8 cases and 8 eyes in the ILM peeling group and 14 cases and 14 eyes in the ILM inversion covering group. The two groups of patients underwent best corrected visual acuity(BCVA)test, non-contact intraocular pressure and optical coherence tomography(OCT)examination before and 1wk, 1, and 3mo after operation were analysed. <p>RESULTS: The macular hole closure rate in the ILM peeling group was 75%, and the hole closure rate in the ILM inversion and insertion group was 93%. There was no statistically significant difference in the hole closure rate between the two groups(P=0.527). The trends of BCVA over time in the two groups were similar, but there were differences in time(Ftime=18.426, Ptime<0.001)and no difference between groups and interactions(Fbetween groups=1.319, Pbetween groups=0.289; Fbetween groups×time=1.658, Pbetween groups×time=0.211). The BCVA of the two groups was statistically significant 1wk after operation compared with that before operation(t= -2.200, -3.092; all P<0.05); The BCVA of the ILM inversion and insertion group was improved 3mo after operation compared with that before operation, and the difference in the group was statistically significant(t=2.503, P=0.019). There was no difference in overall foveal thickness between the two groups after surgery(Ftime=1.054, Ptime=0.346; Fbetween groups=0.110, Pbetween groups=0.750; Fbetween groups×time=2.391, Pbetween groups×time=0.152).<p>CONCLUSION: Both ILM inversion and insertion and ILM peeling can effectively increase the rate of macular hole closure. The macular structure healing after the ILM inversion and insertion is better, and the postoperative visual function improvement is more satisfactory.
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@#Introduction: Kawasaki disease (KD) is an acute febrile illness of unknown etiology that primarily affects children younger than 5 years of age. The diagnosis is predominantly clinical and at times difficult, due to the absence of any confirmatory and specific diagnostic test. Early diagnosis of this disease is of paramount importance due to long term cardiovascular complications related to coronary artery aneurysm. Literature search has revealed many atypical presentations of Kawasaki disease not fulfilling the clinical diagnostic criteria. The reason for this could be the diversity in clinical manifestations involving gastrointestinal, endocrinal, musculoskeletal and nervous system. Case Series: Here we describe three cases with non-classic presentation of Kawasaki disease. These three cases presented with persistent fever unresponsive to antibiotics. Two cases (case one and three) later developed perianal rash and peeling that helped in early diagnosis. In the remaining case (case two) sequential appearance of features helped in the establishment of diagnosis. It was interesting to note that all the three cases were having identical laboratory parameters, highlighting the importance of laboratory investigations in case of atypical presentation. Conclusion: This case series culminates the importance of keeping the possibility of atypical Kawasaki disease (KD) as one of the differentials in patients with prolonged fever not responding to antibiotics, in the absence of classical diagnostic criteria.
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Objective:To observe the treatment effect of 25-gauge pars plana vitretomy with the inverted internal limiting membrane (ILM) flap and autologous serum coverage in high myopia macular hole (HMMH) eyes.Methods:17 patients (17 eyes) with HMMH were selected from the Affiliated Hospital of Chinese Medicine Hospital of Xinjiang Medical University from June 2019 to March 2020. The minimum diameter of macular hole in all patients was ≤500 μm. They were diveded into group A (10 eyes) and group B (7 eyes) according to the random number table method. The group A underwent 25-gauge pars plana vitretomy + inverted ILM falp technique + autologous serum coverage; The group B (5 eyes) underwent 25-gauge pars plana vitretomy with ILM peeling technique. The best corrected visual acuity (BCVA) before and after surgey and the macualr hole closure rates were observed.Results:There was no significant difference in BCVA between the two groups before operation and at 6 months after operation ( P>0.05); The postoperative macular hole closure rate was 8/10 in group A and 4/7 in group B. There was no significant difference in macular hole closure rate between the two groups ( P>0.05); The BCVA of the two groups at the last follow-up after operation was significantly higher than that before operation ( P<0.05). Conclusions:Vitrectomy combined with inverted ILM falp technique is a safe and effective method in the treatment of high myopia macular hole with diameter ≤500 μm.
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Objective:To analyze the effect of vitrectomy combined with internal limiting membrane (ILM) peeling on the prevention of post-vitrectomy epiretinal membrane (ERM) in macular-off rhegmatogenous retinal detachment (RRD) and its influence on visual outcomes.Methods:A cohort study was conducted.Seventy-four patients (74 eyes) with macular-off RRD, who realized retinal reattachment after vitrectomy and silicone oil tamponade from January 2015 to January 2018 in Baoding NO.1 Central Hospital, were enrolled.The patients were divided into the non-ILM peeling group (36 cases, 36 eyes) and ILM peeling group (38 cases, 38 eyes) according to whether they received ILM peeling or not.The patients underwent silicone oil removal within 3 to 5 months after the surgery.Best corrected visual acuity (BCVA), slit-lamp microscopy, indirect ophthalmoscopy, fundus photography and optical coherence tomography (OCT) were examined before and at 1, 6 and 12 months after the surgery.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Baoding NO.1 Central Hospital (No.[2019]042). Written informed consent was obtained from each patient.Results:There was no ERM found in the two groups at 1 month after the operation.There were 3 eyes (8.33%) with ERM in the non-ILM peeling group and 2 eyes (5.26%) in the ILM peeling group at 6 months after the operation, with no statistically significant difference between them ( P=0.067). There were 9 eyes (25.00%) with ERM in the non-ILM peeling group and 4 eyes (10.53%) in the ILM peeling group at 12 months postoperatively, with no statistically significant difference between them ( χ2=2.674, P=0.102). There was a significant difference in BCVA between before and after the operation in the two groups ( Ftime=31.692, P<0.001). Postoperative 1-, 6-and 12-month BCVA were all significantly better than the preoperative BCVA in the two groups (all at P<0.05). There was no significant difference in BCVA between the two groups ( Fgroup=0.117, P=0.773). OCT images showed that there were 25 eyes (77.78%) and 30 eyes (78.95%) with the intact ellipsoid zone in the non-ILM peeling group and ILM peeling group at 12 months after the operation, respectively, with no statistically significant difference between them ( χ2=0.875, P=0.350). Conclusions:Compared with vitrectomy alone, the vitrectomy combined with ILM peeling does not show better efficacy in the prevention of ERM occurrence in macula-off RRD patients and has no obvious influence on postoperative visual acuity.
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Objective:To systematically evaluate the effect of pars plana vitrectomy (PPV) combined total peeling of internal limiting membrane (ILM) versus fovea-sparing peeling of ILM for myopic foveoschisis.Methods:A evidence-based medicine study. Chinese and English as search terms for myopic foveoschisis, vitrectomy, and peeling of internal limiting membrane were used to search literature in China National Knowledge Infrastructure, Wanfang database, VIP database, PubMed of National Library of Medicine, Medline, Embase, and Cochrane Library. The high myopic macular schisis was selected as the research object, the intervention method was PPV combined with complete ILM peeling and combined with foveal preservation ILM peeling surgery clinical control study between Jan 1, 2010, and Jun 31, 2021. Incomplete or irrelevant literature and review literature were excluded. The method of Newcastle-Ottawa Scale system was used to evaluate the included literature. The literature was meta-analyzed by RevMan5.3 software. The mean difference ( MD) and a confidence interval ( CI) of 95% were used to describe the effect sizes of continuous data, fixed effects model was performed. The data including the best corrected visual acuity (BCVA), central fovea thickness (CFT), and postoperative macular hole (MH) were analyzed. Results:In those databases, 232 articles based search stratery were totally retrieved, and 10 articles (417 eyes) were finally included for meta-analysis with 245 eyes for PPV combined total peeling of ILM and 172 eyes for PPV combined fovea-sparing peeling of ILM. Meta-analysis results showed there was no significant difference in BCVA and CFT between the two groups (BCVA: MD=0.05, 95% CI 0.00-0.11; P>0.05; CFT: MD=-4.79, 95% CI -18.69-9.11, P>0.05). It was compared with the incidence of MH, the difference was statistically significant (odds ratio=5.70, 95% CI 2.22-14.61, P<0.05). Conclusion:BCVA and CFT could be improved by PPV combined total and fovea-sparing peeling of ILM for myopic foveoschisis; compared with complete ILM peeling, the incidence of MH was lower after foveal-sparing ILM peeling.
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The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.
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The classical surgical operations for foveoschisis in high myopia are vitrectomy, artificial posterior vitreous detachment, removal of the pre-macular vitreous cortex, removal of the inner limiting membrane (ILM) and intraocular gas tamponade, with some minor variations on those basis, including no removal of the ILM or ILM peeling with preservation of the fovea area; with or without gas filling, long-term silicone oil tamponade, etc. All the procedures have achieved certain efficacy and the foveoschis can be fully or partially relieved and the visual acuity can be improved to different degrees. It is worthwhile to emphasize, the most common and serious complication of the surgery is the occurrence of full-thickness macular hole or even postoperative macular hole retinal detachment. To address the risk of such complications, a safe and effective outcome can be achieved in the majority of cases by using ILM peeling with preservation of the fovea area. For high-risk cases where the operator is concerned about intraoperative or postoperative macular hole, a long-term silicone oil tamponade without ILM removal is proposed to prevent the risk of surgery-related macular hole formation.
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Objective:To observe the efficacy of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and vitreous injection of mouse never growth factor (mNGF) in the high myopia macular hole (HMMH).Methods:A prospective study. Thirty-one patients (33 eyes) with HMMH diagnosed in Affiliated Eye Hospital of Nanchang University from August 2020 and February 2021 were selected. Before surgery, all included patients were subjected to a complete ophthalmologic evaluation including best corrected visual acuity (BCVA), optical coherence tomography (OCT), macular microperimetry and axial length measurement. The BCVA examination was carried out using the international standard visual acuity chart, which was converted into logarithm of minimum resolution angle (logMAR) visual acuity during statistics. The included subjects were accepted the treatment of PPV combined with ILM peeling and vitreous injection of mNGF (combined group) or PPV united with ILM peeling (simple group), 15 cases with 16 eyes, 16 cases with 17 eyes, respectively. There were no significant differences in logMAR BCVA ( t=0.836), macular hole (MH) diameter (t=0.657), visual acuity (VA) ( t=0.176), the missing length of external limting membrane (ELM) and ellipsoid zone (EZ) ( t=1.255, 0.966) between two groups ( P>0.05). The follow-up time was at least 6 months. The BCVA, closure rate of MH, integrity of ELM and EZ and recovery of VA in macular area were compared and observed between the two groups after surgery. The logMAR BCVA, VA, the deficient lengths of ELM and EZ at different time points were compared by independent-samples t-test between two groups and analysis of variance was used to compare the repeated measurement data of each group. Fisher test was performed for comparison of count data. Results:Six months after surgery, MH closure rates in the simple group and the combined group were 88.24% (15/17) and 93.75% (15/16), respectively, with no significant difference ( P=0.523). At 3 and 6 months after surgery, the integrity recovery of ELM in the combined group was better than that in the simple group, and the difference was statistically significant ( t=2.282, 3.101; P<0.05). At 1, 3 and 6 months after surgery, EZ deletion length in the combined group was lower than that in the simple group, and the difference was statistically significant ( t=1.815, 2.302, 2.784; P<0.05). Compared with 1 week after surgery, VA in macular area of the combined group increased at 1, 3 and 6 months, and the difference was statistically significant ( P=0.007, <0.001, <0.001). At 3 and 6 months after surgery, VA in macular area of affected eyes in the combined group was higher than that in the simple group, and the difference was statistically significant ( t=1.897, 2.250; P<0.05). There was an interaction effect between the surgical method and the follow-up time. The postoperative time was prolonged, and the VA in macular area was decreased in the simple group and increased in the combined group, with statistical significance ( F=12.963, P<0.001). The BCVA and BCVA changes in the two groups increased with the extension of postoperative time. The improvement of BCVA and the difference of BCVA changes in the combined group were significantly higher than those in the simple group at different time points after surgery, with statistically significant differences ( F=12.374, 21.807, 5.695, 4.095; P<0.05). Conclusion:PPV combined with ILM peeling and vitreous injection of mNGF is more effective than PPV with ILM peeling for HMMH, improving both anatomical and functional outcomes.
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@#AIM: To analyze the changes of the epiretinal membrane(ERM)stage, macular status and best corrected visual acuity(BCVA, LogMAR)in cataract patients with idiopathic macular epiretinal membrane(IERM)before and after cataract surgery.METHODS:We conducted a single center retrospective observational case series of patients that underwent sequential cataract and idiopatic ERM surgeries from March 2016 to May 2019 in Anyang Eye Hospital. Full data were obtained for 51 patients(54 eyes).Preoperative and postoperative 1mo ERM stage, central macular edema(CME), central macular thickness(CMT), macular volume(MV), ellipsoid zone disruption, occurrence of neurosensory detachment(NSD)and BCVA were analyzed.RESULTS:In this group of patients, 5 eyes(9%)had ERM grade 1, 23 eyes(43%)had ERM grade 2, 21 eyes(39%)had ERM grade 3, and 5 eyes(9%)had ERM grade 4 before surgery; ERM graded 1mo after surgery were keeping steady. Compared with before operation(0.45±0.16),there was no significant change in BCVA(0.47±0.17)at 1mo after operation(<i>P</i>>0.05), but the incidence of CME, ellipsoid band interruption and NSD were significantly higher than those before operation(<i>P</i><0.05). CONCLUSION: We suggest that phacoemulsification did not significantly accelerate ERM progression and affect BCVA, but patients underwent cataract surgery in the presence of epiretinal membranes need tight follow up to treat and control eventual macular infammatory changes and eventual prompt vitrectomy if BCVA was threatened.
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@#AIM: To analyze the effects of vitrectomy and macular epiretinal membrane dissection combined with or without internal limiting membrane(ILM)peeling on choroid thickness, vision and metamorphopsia in patients with idiopathic macular epiretinal membrane(IMEM).<p>METHODS: Totally 88 patients(88 eyes)with IMEM admitted to the hospital were selected between January 2016 and January 2020. They were divided into group A and group B by random number table method with 44 eyes in each group. Patients in group A were treated with vitrectomy and macular epiretinal membrane dissection combined with ILM peeling, while patients in group B were treated with vitrectomy and macular epiretinal membrane dissection. The choroid thickness, vision, metamorphopsia, central macular thickness(CMT), ellipsoid zone(EZ)continuity were compared between the two groups.<p>RESULTS: Compared with preoperative, the sub-foveal choroidal thickness(SFCT), choroidal thickness 1 000μm from nasal side central of fovea(NFCT)and choroidal thickness 1 000μm from temporal side central of fovea(TFCT)were significantly reduced in the two groups at 3mo and 6mo after operation(<i>P</i><0.05), but there was no statistically significant difference between the groups(<i>P</i>>0.5). Compared with preoperative, the best corrected visual acuity(BCVA)LogMAR was reduced, while mean sensitivity(MS)was increased in the two groups. The number of scotoma points(SP)increased in group A and decreased in group B. Group A had significantly lower MS and higher SP than group B at 1mo, 3mo, and 6mo after operation(<i>P</i><0.05). Compared with preoperative, the M scores(Angle of view when horizontal and vertical variability begins to disappear)and average M scores of the two groups were significantly reduced at 3mo and 6mo after operation, without statistically significant differences between the groups(<i>P</i>>0.05). Compared with preoperative, CMT was significantly reduced in the two groups at 1, 3 and 6mo after operation. The ratio of EZ continuity in group A at 1mo after operation was significantly lower than that before operation. The CMT of group A was larger than that of group B at 3mo and 6mo after operation(<i>P</i><0.05). No statistically significant differences were found in the ratio of EZ continuity and the incidence of complications between the groups(<i>P</i>>0.05).<p>CONCLUSION: Vitrectomy and macular epiretinal membrane dissection combined with or without ILM peeling both can improve vision and metamorphopsia in patients with IMEM, with similar effects on choroid thickness and safety. However, combined use of ILM peeling will lower MS and increase SP as well as CMT. Therefore, it has no significant advantages in the treatment of patients with IMEM.
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@#AIM: To explore the risk factors that affect visual function recovery in patients with idiopathic macular epiretinal membrane(IMEM)undergoing internal limiting membrane peeling(ILMP).<p>METHODS: This study retrospectively reviewed 118 patients(118 eyes)with IMEM who underwent ILMP in the hospital between January 2016 and April 2020. The patients were followed up for 6mo after surgery to evaluate curative effect. Changes in visual acuity before surgery and at 1, 3 and 6mo after surgery, metamorphopsia degree, mean central foveal thickness and volume of macular area were observed. The correlation of mean central foveal thickness and volume of macular area before and after surgery with postoperative visual acuity and metamorphopsia scores was analyzed. The risk factors for poor visual function recovery after surgery were evaluated.<p>RESULTS: In this study, 96 eyes obtained good visual function recovery, and the improvement rate was 81.4%. At 1, 3 and 6mo after surgery, visual acuity was significantly improved(<i>P</i><0.05), metamorphopsia score in horizontal direction, mean central foveal thickness and volume of macular area were significantly reduced(<i>P</i><0.05). The mean central foveal thickness and volume of macular area before surgery and at 6mo after surgery were negatively correlated with visual acuity at 6mo after surgery(<i>P</i><0.05), but positively correlated with metamorphopsia score in horizontal direction(<i>P</i><0.05). The course of IMEM, preoperative corrected visual acuity, preoperative horizontal or vertical metamorphopsia, and preoperative macular edema were influencing factors of visual function recovery after surgery(all <i>P</i><0.05). Poor preoperative corrected visual acuity(<i>OR</i>=3.062), horizontal metamorphopsia(<i>OR</i>=2.438)and preoperative macular edema(<i>OR</i>=2.000)were risk factors for poor visual function recovery.<p>CONCLUSION: The curative of ILMP is effect on IMEM, which can effectively improve visual acuity of operative eyes and reduce metamorphopsia. The longer the course of disease, the worse the preoperative corrected visual acuity, and the more severe the preoperative metamorphopsia, the worse the visual function recovery in patients with preoperative macular edema after ILMP.