Les membranes épirétiniennes maculaires

Evaluation of the effects of vitrectomy with primary epiretinal membrane peel on optical quality using double-pass aberrometry

INTRODUCTION

We performed a prospective, single-center, cohort study in order to evaluate the effects of vitrectomy with epiretinal membrane (ERM) peel on optical quality in patients with primary ERM.

METHODS

Thirty patients treated for primary ERM by vitrectomy with ERM peel were included from our tertiary university hospital ophthalmology department. The main study outcome was variation in optical quality parameters measured using the HD Analyzer™ between pre-operative and two-month post-operative evaluations in operated eyes. Optical quality parameters comprised point spread function (PSF) width at 10% and 50%, objective scatter index (OSI), and modulation transfer function (MTF) cutoff. Contralateral non-operated eyes were used as an internal control for measurement reproducibility.

RESULTS

Mean PSF width at 10% (42.22 vs 27.37 arc/min; p = 0.0002) and mean OSI (3.32 vs 2.32; p = 0.0003) were significantly improved between pre- versus post-operative evaluations. Mean PSF width at 50% and mean MTF cutoff showed no changes. Subgroup analysis according to crystalline lens status gave similar results demonstrating that improvements in mean PSF width at 10% and OSI were not lens-related. Non-operated eyes showed no changes in any of the parameters analyzed.

CONCLUSION

Reduced light scattering measured by OSI indicates improved optical quality following vitrectomy with ERM peel among patients with primary ERM. OSI measurement could thus be a new parameter of interest in the pre-operative assessment of primary ERM and other pre-vitrectomy assessments.

Identification and Characterization of Epivascular Glia Using En Face Optical Coherence Tomography

PURPOSE

The purpose of this study was to describe the clinical features of epivascular glia (EVG) using en face optical coherence tomography (OCT).

DESIGN

Retrospective cross-sectional study.

METHODS

Single-institution en face OCT images were reviewed. Eyes displaying EVG were captured with manual internal limiting membrane (ILM) segmentation and analyzed with customized segmentation . A random age- and sex-matched control group was selected to determine relative epiretinal membrane (ERM) prevalence.

RESULTS

Characteristic hyper-reflective ILM plaques with dendrite-like radiations were identified using en face OCT and displayed vascular predilection. A total of 161 eyes with EVG (the EVG group) and 2,315 eyes without EVG (control group) were identified from a total cohort of 1,298 patients (or 2,476 eyes). The prevalence of EVG was 161 of 2,476 eyes (6.5%) and 119 of 1,298 patients (9.2%) in the cohort. Mean age was 79.3 ± 10.7 years old in the EVG group and 55.9 ± 24.6 years old in the control group (P <.001). An advanced posterior vitreous detachment (PVD) stage was more common in the EVG group (grade 3: 41.7%; grade 4: 48.6%) than in the control group (grade 3: 18.5%; grade 4: 26.9%; P <.001). Contractile ERM was present in 71 of 161 eyes (44.1%) with EVG compared to 30 of 161 eyes (18.6%) in a random age- and sex-matched control cohort without EVG (P <.001).

CONCLUSIONS

EVG previously described with histopathology and scanning electron microscopy can be identified using en face OCT. In this study, these lesions were associated with older age, pseudophakia, and advanced PVD, supporting the role of Müller cell activation through ILM breaks triggered by PVD, a pathogenic mechanism proposed by previous studies.

Intraocular pressure might play a role in the surgical management of patients with epiretinal membrane

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.

Anatomic and functional results of idiopathic macular epiretinal membrane surgery

AIM

To assess the impact of macular surgery on the functional and anatomic outcomes in patients with grade 2 epiretinal membrane (ERM), and the effect of internal limiting membrane (ILM) peeling on visual acuity and to analyze the long-term effect of pars plana vitrectomy (PPV) on intraocular pressure (IOP).

METHODS

Pseudophakic eyes (62 eyes) diagnosed as idiopathic grade 2 ERM with at least 6mo postoperative follow-up were included in this retrospective study. The fellow eye was nonvitrectomized. Patients were divided into two groups: group 1 (29 eyes) treated with ERM and ILM peeling and group 2 (33 eyes) with only ERM peeling. Preoperative and postoperative best corrected visual acuity (BCVA), slit-lamp, and a dilated fundus examination was performed. IOP was measured with Goldman applanation tonometer before, day 1 and first week and each visit after surgery. The incidence of significant IOP elevation was compared between vitrectomized eyes and nonvitrectomized fellow eyes.

RESULTS

Visual improvement was statistically significant and similar in both groups (P=0.008 in group 1, P=0.002 in group 2, P=0.09 inter-group). The amount of decrease in central macular thickness was statistically significant and similar in both groups (P=0.005 group 1, P=0.008 group 2, P=0.37 intergroup). At the final follow-up (14.1±9.6mo) the incidence of significant IOP elevation was 4% in vitrectomized eyes (three eyes) and 3% (two eyes) in the nonvitrectomized fellow eyes (P=0.12). Four eyes (12.1%) had recurrent ERM after a mean follow-up of 8.6±1.1mo in group 2, there was no recurrence in group 1 (P=0.01).

CONCLUSION

Recurrence of ERM may be decreased by ILM peeling during ERM surgery. However, it seems that ILM peeling do not affect the functional outcome and 23-gauge PPV alone do not have a significant effect on IOP.

Macular microvasculature features before and after vitrectomy in idiopathic macular epiretinal membrane: an OCT angiography analysis

PURPOSE

To evaluate pre-operative and post-operative morphologic characteristics in idiopathic macular epiretinal membrane (ERM) by optical coherence tomography angiography (OCTA).

METHODS

Thirty-three subjects with unilateral idiopathic ERM were enrolled and the contralateral eyes served as controls. Vascular parameters including superficial capillary plexus (SCP), deep capillary plexus (DCP), outer capillary plexus (OCP), and choroidal capillary plexus (CCP) were evaluated by OCTA.

RESULTS

The superficial foveal avascular zone (FAZ) was significantly smaller in eyes with ERM (P < 0.0001). The vessel densities (VDs) were significantly increased in the fovea but dramatically decreased in the parafovea in SCP and DCP of ERM eyes (all P < 0.0001), in contrast to those in OCP and CCP. The blood flow was augmented in OCP but declined in choroid compared with the controls. In CCP, the mean foveal VD in ERM was significantly smaller (P = 0.023), whereas parafoveal VD did not significantly change (P = 0.66). At 6 months after surgery, flow area was decreased in OCP (P = 0.0007), and foveal and parafoveal VDs were significantly altered in all layers except the foveal VD in OCP and the choroid (all P < 0.05). The total and inner retinal thickness of the fovea and parafovea were correlated with pre-operative and post-operative visual outcomes, respectively. Smaller FAZ and greater interocular differences between post-operative and fellow eyes in FAZ were associated with worse post-operative visual outcomes.

CONCLUSIONS

OCTA provides a better display of the vascular network of the retina and choroid to evaluate the severity and surgical prognosis of ERM patients.

The outcomes of epiretinal membrane peeling in patients with foveal herniation

Background

To evaluate the surgical outcomes of vitrectomy in patients with foveal herniation associated with epiretinal membrane (ERM).

Methods

This was a retrospective case series. The patients who had a foveal herniation associated with ERM, underwent vitrectomy, and had a minimum follow-up period of 12 months were included. The visual and anatomical outcomes were assessed during the first 12 months of follow-up and at the last follow-up visit. The main outcome measure was the reorganization pattern of foveal pit at month 12.

Results

Eleven eyes of 11 patients were included. The mean postoperative follow-up period was 14.8 ± 2.6 months. The foveal contour was completely restored in 5 eyes (45.5%), partially restored in 5 eyes (45.5%), and was not restored in 1 eye (9.1%) at postoperative month 12 follow-up visit. The mean preoperative best corrected visual acuity was 0.61 ± 0.16 LogMAR and increased to 0.49 ± 0.16 LogMAR at month 12 (p < 0.0001). The mean preoperative central retinal thickness was 476 ± 128 micrometers and decreased to 302 ± 70 micrometers at month 12 (p < 0.0001).

Conclusion

The foveal contour was restored in 45.5% of the eyes and visual acuity was significantly increased by a mean of 1.2 LogMAR lines at month 12 in patients with foveal herniation associated with ERM.