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Liu Y, Zhang JY, Ding X, He FL, Lu LN, Fu Y. Choroidal structural changes following vitrectomy performed with phacoemulsification in unilateral idiopathic epiretinal membrane. BMC Ophthalmol 2023; 23:52. [PMID: 36747177 PMCID: PMC9901130 DOI: 10.1186/s12886-023-02803-w] [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: 07/22/2022] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study aims to determine the influence of vitrectomy combined with macular epiretinal membrane dissection and internal limiting membrane (ILM) peeling and phacoemulsification on choroidal vasculature in patients with unilateral idiopathic epiretinal membrane (IERM) and concurrent cataract using optical coherence tomography (OCT). METHODS This retrospective study included 26 eyes of 26 patients (8 males and 18 females) with unilateral IERM without vitreomacular traction (VMT) (group 1) and the patients' fellow eyes (n = 26, group 2). Three-port 25-G pars plana vitrectomy (PPV) combined with macular epiretinal membrane dissection and ILM peeling and phacoemulsification was performed on all patients. The comprehensive ophthalmologic examinations of all patients involved OCT measurements at every visit before and after surgery, and the choroidal thickness (CT), central macular thickness (CMT) and choroidal vascularity index (CVI) were calculated. RESULTS The mean age of the IERM patients was 66.58 ± 7.06 years. Postoperatively, best corrected visual acuity (BCVA) was significantly greater than baseline (P = 0.023). The CVI of the IERM eyes was significantly lower (P < 0.01) than that of the fellow eyes at baseline. The subfoveal CT in the IERM eyes was lower than that in the fellow eyes (P = 0.023), but there was, no significant difference in the average CT between the two groups at baseline (P = 0.071). In eyes with IERM, the CVI significantly increased at 1 week, 1 month (P < 0.001), and 3 months (P = 0.049) postoperatively, the subfoveal CT was markedly thickened 1 month after surgery (P = 0.001), the temporal 3 mm and nasal CT significantly increased at 1 week and 1 month postoperatively (P = 0.041, P = 0.022 for temporal 3 mm; P < 0.001, P = 0.047 for nasal 1.5 mm; P = 0.01, P = 0.001 for nasal 3 mm), and only the temporal 3 mm CT increased significantly at 3 months postoperatively (P = 0.017). The baseline CMT of the IERM eyes was significantly thicker than that of the fellow eyes (P < 0.001). CMT significantly decreased at 3 months postoperatively in IERM eyes(P = 0.033). CONCLUSIONS The increase in the CVI in the IERM eyes without VMT after combined PPV with ILM peeling and phacoemulsification persists for at least 3 months.
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Affiliation(s)
- Yan Liu
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Jia Ying Zhang
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Xia Ding
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Fang Lin He
- grid.16821.3c0000 0004 0368 8293Department of Ophthalmology, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China ,grid.16821.3c0000 0004 0368 8293Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Lin Na Lu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Yao Fu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China. .,Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, 639 Zhizaoju Road, Shanghai, 200011, China.
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2
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Norton JC, Soliman MK, Yang YC, Kurup S, Sallam AB. Visual outcomes of primary versus secondary epiretinal membrane following vitrectomy and cataract surgery. Graefes Arch Clin Exp Ophthalmol 2021; 260:817-825. [PMID: 34625846 DOI: 10.1007/s00417-021-05425-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/30/2021] [Accepted: 09/19/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare visual outcomes, incidence of cystoid macular edema (CME), and rate of repeat epiretinal membrane (ERM) surgery following phacovitrectomy for primary and secondary ERM. METHODS Retrospective review of 178,856 cataract surgeries from 2003 to 2015. Eyes that underwent cataract surgery combined with ERM peel were included (n = 708). Eyes were divided into primary (n = 538) and secondary (n = 170) ERM groups. Patient demographics, visual acuity (VA), and postoperative CME were recorded. RESULTS Patients with secondary ERM had worse preoperative VA, 0.9 ± 0.6 logMAR (20/160 Snellen equivalent) as compared to patients with primary ERM, 0.6 ± 0.3 (20/80), respectively (p < 0.0001). There was no difference between the secondary and primary ERM groups in postoperative vision (0.5 ± 0.4 logMAR vs. 0.5 ± 0.3; p = 0.9962) or proportion with VA ≥ 20/40 (46.4% vs. 43.1%; p = 0.6744) at 12-24 weeks. Postoperative CME was twice as likely in the secondary ERM group (16.5%) compared to the primary ERM group (7.8%) (p = 0.0018). There was no difference in the rate of repeat ERM surgery between the secondary ERM group (1.8%) and the primary ERM group (1.5%) (p = 0.7308). CONCLUSION Eyes with secondary ERM had significant postoperative improvement in VA. They had worse preoperative VA and had a twofold increase in postoperative CME than primary ERM.
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Affiliation(s)
- J Corbin Norton
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Mohamed K Soliman
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Yit C Yang
- Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals NHS Trust, New Cross, Wolverhampton, UK
| | - Shree Kurup
- Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, OH, USA
| | - Ahmed B Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.
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3
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[25-Gauge macular surgery: comparison with and without combined phacoemulsification and artificial lens implantation]. Ophthalmologe 2021; 119:176-180. [PMID: 34297191 DOI: 10.1007/s00347-021-01461-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: 04/20/2021] [Revised: 06/23/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND With the surgical methods continuously developed in recent years, macular surgery has become an increasingly less traumatic procedure for the eye. For patients with additional lens opacification, a 1-stage procedure with combined cataract surgery is recommended. OBJECTIVE The aim of this retrospective study was to record the functional results and complications after elective macular surgery with and without combined phacoemulsification and artificial lens implantation. MATERIAL AND METHODS The retrospective study included all patients who were operated on with a pars plana vitrectomy (ppV; 25 gauge) for epiretinal membrane, macular hole or vitreoretinal traction between 2010 and 2016 and who had a follow-up period of at least 3 months. The functional results and possible risk factors as well as complications that occurred were then recorded. RESULTS A total of 781 eyes were identified of which 517 (66%) had a phacoemulsification and artificial lens implantation with a 25-gauge vitrectomy, membranectomy, ILM peeling and SF6 gas or air tamponade. The mean follow-up time was 17 months. The mean logMAR visual acuity was 0.59 preoperatively and 0.4 postoperatively. From 64 phacic eyes which did not receive a combined phacoemulsification and artificial lens implantation 40 (62.5%) required phacoemulsification and artificial lens implantation within 13.6 months due to complicated cataract, 18 even within 6 months. In terms of complications, there were comparable results between ppV alone and the combined operation, particularly with respect to an IOL dislocation or iris capture. CONCLUSION Overall elective macular surgery is a procedure with few complications both without and above all with combined phacoemulsification and artificial lens implantation. Therefore, a combined operation makes sense in terms of surgical management and postoperative rehabilitation, especially in times of a pandemic with limited surgical resources.
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4
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Chen YC, Chen SJ, Li AF, Huang YM. Visual outcomes and incidence of pseudophakic cystoid macular oedema in eyes with cataract and idiopathic epiretinal membrane after two-step sequential surgery. Eye (Lond) 2021; 36:1597-1603. [PMID: 34290439 PMCID: PMC9307847 DOI: 10.1038/s41433-021-01673-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To determine whether pars plana vitrectomy (PPV) or cataract surgery should be performed first in concurrent epiretinal membrane (ERM) and cataract treatment with respect to visual outcome and pseudophakic cystoid macular oedema (PCMO) incidence. METHODS Patients who underwent PPV and cataract surgery sequentially at a tertiary medical centre were retrospectively recruited. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) measured from optical coherence tomography (OCT) images collected before and after each surgery were documented. OCT-defined PCMO incidence and its influence on visual outcomes were analysed. RESULTS In total, 259 and 159 eyes received PPV (ERM-CATA) before and after cataract surgery (CATA-ERM), respectively. The ERM-CATA group had better final BCVA (logMAR: 0.274 vs. 0.558, p < 0.001) and greater BCVA gain (logMAR VA change: -0.379 vs. -0.220, p = 0.001) than did the CATA-ERM group. Baseline BCVA was positively correlated with final BCVA (p < 0.001), whereas baseline CMT, final CMT, and postoperative CMT changes were not. PCMO incidence did not differ significantly between the two groups (15.4% vs. 19.5%, p = 0.287), and final BCVA changes did not significantly differ between eyes with and without PCMO. PCMO incidence was much higher (29.40% vs. 16.30%, p = 0.008) in eyes with baseline CMT ≥ 500 μm. CONCLUSIONS When managing ERM and cataract, PPV should be performed before cataract surgery to yield better visual outcomes. Both surgical sequences yield similar PCMO rates. Greater baseline CMT is a risk factor for PCMO after cataract surgery.
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Affiliation(s)
- Yen-Cheng Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan
| | - An-Fei Li
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Ophthalmology, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yi-Ming Huang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan. .,National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan.
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Mukkamala LK, Avaylon J, Welch RJ, Yazdanyar A, Emami-Naeini P, Wong S, Storkersen J, Loo J, Cunefare D, Farsiu S, Moshiri A, Park SS, Yiu G. Intraoperative Retinal Changes May Predict Surgical Outcomes After Epiretinal Membrane Peeling. Transl Vis Sci Technol 2021; 10:36. [PMID: 34003921 PMCID: PMC7910632 DOI: 10.1167/tvst.10.2.36] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate whether intraoperative retinal changes during epiretinal membrane (ERM) peeling affect anatomic or functional outcomes after surgery. Methods We measured retinal thickness using an intraoperative optical coherence tomography (iOCT) device in patients undergoing pars plana vitrectomy with membrane peeling for idiopathic ERM. Changes in intraoperative central macular thickness (iCMT) were compared with postoperative improvements in CMT and best-corrected visual acuity (VA). Results Twenty-seven eyes from 27 patients (mean age 68 years) underwent iOCT-assisted ERM peeling surgery. Before surgery, mean VA was logMAR 0.50 ± 0.36 (Snellen 20/63), and mean baseline CMT was 489 ± 82 µm. Mean iCMT before peeling was 477 ± 87 µm, which correlated well with preoperative CMT (P < 0.001). Mean change in iCMT was −39.6 ± 37 µm (range −116 to +77 µm). After surgery, VA improved to logMAR 0.40 ± 0.38 (Snellen 20/50) at month 1 and logMAR 0.27 ± 0.23 (Snellen 20/37) at month 3, whereas CMT decreased to 397 ± 44 µm and 396 ± 51 µm at months 1 and 3. Eyes that underwent greater amount of iCMT change (absolute value of iCMT change) were associated with greater CMT reduction at month 1 (P < 0.001) and month 3 (P = 0.010), whereas those with greater intraoperative thinning (actual iCMT change) showed a trend toward better VA outcomes at months 1 (P = 0.054) and 3 (P = 0.036). Conclusions Intraoperative changes in retinal thickness may predict anatomic and visual outcomes after idiopathic ERM peeling surgery. Translational Relevance Our study suggests that intraoperative retinal tissue response to ERM peeling surgery measured by iOCT may be a prognostic indicator for restoration of retinal architecture and for visual acuity outcomes.
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Affiliation(s)
- Lekha K Mukkamala
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Jaycob Avaylon
- California Northstate University, College of Medicine, Elk Grove, CA, USA
| | - R Joel Welch
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Amirfarbod Yazdanyar
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Parisa Emami-Naeini
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Sophia Wong
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Jordan Storkersen
- California Northstate University, College of Medicine, Elk Grove, CA, USA
| | - Jessica Loo
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - David Cunefare
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Ala Moshiri
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Susanna S Park
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
| | - Glenn Yiu
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, CA, USA
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Hashimoto Y, Michihata N, Matsui H, Ishimaru M, Fushimi K, Yasunaga H, Aihara M, Takao M, Obata R. Recent trends in vitreoretinal surgery: a nationwide database study in Japan, 2010-2017. Jpn J Ophthalmol 2020; 65:54-62. [PMID: 33111254 DOI: 10.1007/s10384-020-00777-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE We clarified recent trends in vitreoretinal surgery in Japan, which is a rapidly aging country. STUDY DESIGN Retrospective cohort study. METHODS We used the Diagnostic Procedure Combination database (2010-2017), a national inpatient database in Japan. Patients undergoing vitreoretinal surgery were included. We measured the number of surgeries stratified by procedures, diagnoses, age categories, and combined cases of cataract surgery per fiscal year. We also considered changes in the Japanese population. RESULTS From 2010 to 2017, the total number of vitreoretinal surgeries per fiscal year increased by 7.8% (from 36,988 to 39,873). Among the diagnoses categories, epiretinal membrane (ERM) increased by 71%, rhegmatogenous retinal detachment (RRD) with pars plana vitrectomy (PPV) by 50%, and macular hole (MH) by 12% throughout the observed period. Diabetic retinopathy (DR) decreased by 20%, RRD with scleral buckling (SB) by 40%, and vitreous hemorrhage (VH) by 10%. We observed remarkable increases in ERM among patients in their 60s and 70s, in MH in their 70s and 80s, and in RRD with PPV in their 50s and 60s. We observed remarkable decreases in RRD with SB in patients in their 20s-70s, in DR in their 60s, and in VH in their 60s and 70s. These findings did not change greatly when population changes were considered. All age groups from the 30 to 80s showed significant increases in the proportions of combined vitreoretinal and cataract surgery. CONCLUSION The total number of cases of vitreoretinal surgery per fiscal year increased throughout the period. The increases in ERM and RRD with PPV and the decreases in DR and RRD with SB were remarkable.
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Affiliation(s)
- Yohei Hashimoto
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Miho Ishimaru
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Muneyuki Takao
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Ryo Obata
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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7
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Dong F, Yu CY, Zhu N, Lou DH. One-year follow-up evaluation of combined phacovitrectomy for idiopathic epiretinal membrane. Int J Ophthalmol 2020; 13:952-959. [PMID: 32566508 DOI: 10.18240/ijo.2020.06.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 03/02/2020] [Indexed: 01/26/2023] Open
Abstract
AIM To evaluate the therapeutic effect of combined phacovitrectomy with membrane peeling and intraocular lens (IOL) implantation in patients with severe idiopathic epiretinal membrane (iERM) and concurrent cataract. METHODS A total of 34 eyes from 34 patients who underwent phacovitrectomy and epiretinal membrane (ERM) peeling at the First Affiliated Hospital of Zhejiang University between 2015 and 2017. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured preoperatively and at 1, 3, 6mo and 1y postoperatively. Temporal changes and bivariate correlations of these parameters were analyzed. RESULTS Mean logMAR BCVA improved and CFT decreased significantly (P<0.001) until 6mo after surgery. Correlation analysis revealed a positive correlation between preoperative and postoperative logMAR BCVA (r=0.716, P<0.001 at 1mo, r=0.417, P=0.014 at 3mo, r=0.359, P=0.037 at 6mo, and r=0.369, P=0.032 at 12mo post-op respectively), but preoperative CFT was neither associated with postoperative CFT nor with postoperative logMAR BCVA. There was a positive correlation between CFT and logMAR BCVA at 1mo (r=0.346, P=0.045), 6mo (r=0.347, P=0.045), and 12mo (r=0.342, P=0.048) post-operatively. The intra- and postoperative complications were relatively mild, and the incidences were generally low. CONCLUSION For severe iERM patients with significant visual symptoms, combined phacovitrectomy with membrane peeling and IOL implantation is safe and effective in improving BCVA and decreasing CFT. Early surgery in selected patients may help preserving better visual function.
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Affiliation(s)
- Feng Dong
- Department of Ophthalmology, the First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Chen-Ying Yu
- Department of Ophthalmology, the First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Ning Zhu
- Department of Ophthalmology, the First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Ding-Hua Lou
- Department of Ophthalmology, the First Affiliated Hospital of Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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8
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Hardin JS, Gauldin DW, Soliman MK, Chu CJ, Yang YC, Sallam AB. Cataract Surgery Outcomes in Eyes With Primary Epiretinal Membrane. JAMA Ophthalmol 2019; 136:148-154. [PMID: 29270636 DOI: 10.1001/jamaophthalmol.2017.5849] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Primary epiretinal membrane (ERM) is a common retinal disorder with a prevalence of 4% to 18.5%. Although ERM and cataracts commonly occur together, to our knowledge, no studies have investigated the outcome of cataract surgery alone in this setting. Objective To analyze the visual outcome and cystoid macular edema risk with cataract surgery in eyes with primary ERM. Design, Setting, and Participants In this retrospective clinical database study, data were collected from July 2003 to March 2015 from 8 locations in the United Kingdom. Cataract surgery data of 217 557 eyes were extracted from the electronic medical record of the UK National Health Service. After exclusion of 57 561 eyes with combined surgery, prior vitrectomy, copathology, and complications, 812 eyes with primary ERM and 159 184 reference eyes were analyzed. Main Outcomes and Measures We report on visual acuity (VA), the incidence of cystoid macular edema, and the need for ERM surgery. Results The mean (SD) age of patients in the ERM group was 73.7 (9.23) years, and 395 of 812 were men (46.8%). The mean (SD) age of patients in the reference group was 74.4 (12.19) years, and 65 265 of 159 184 were men (41%). Epiretinal membrane eyes assessed at 4 to 12 weeks postoperatively gained 0.27 (0.32) logMAR (approximately 3 Snellen lines), with 200 of 448 (44.6%) improving by 0.30 logMAR or more (≥3 Snellen lines) and 32 of 448 (7.1%) worsening by 0.30 logMAR or more. Reference eyes gained a mean (SD) of 0.44 (0.26) logMAR (approximately 4 Snellen lines), with 48 583 of 77 408 (62.8%) improving by 0.30 logMAR or more and 2125 of 77 408 (2.7%) worsening by 0.30 logMAR or more. Although all eyes with preoperative VA of 20/40 or less improved, only reference eyes with preoperative VA of more than 20/40 showed improvement. Cystoid macular edema developed in 57 of 663 ERM eyes (8.6%) (95% CI, 6.69-10.98) and 1731 of 125 435 reference eyes (1.38%) (95% CI, 1.32-1.45) (P < .001). Epiretinal membrane surgery was performed in 43 of 663 (6.5%) ERM eyes. Conclusions and Relevance On average, VA improved 0.27 logMAR (approximately 3 Snellen lines) in eyes with ERM. Eyes with ERM and VA of 20/40 or less showed more benefit after cataract surgery than those with better preoperative vision. However, compared with eyes without ERM, higher rates of cystoid macular edema and a lower postoperative VA gain were noted.
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Affiliation(s)
- Joshua S Hardin
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Donald W Gauldin
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Mohamed K Soliman
- Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Ophthalmology, University of Ottawa, Ottawa, Ontario, Canada
| | - Colin J Chu
- School of Clinical Sciences, University of Bristol and Bristol Eye Hospital, Bristol, United Kingdom
| | - Yit C Yang
- Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals National Health Service Trust, New Cross, Wolverhampton, United Kingdom.,Sandwell and West Birmingham National Health Service Trust, Birmingham, United Kingdom
| | - Ahmed B Sallam
- Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock.,Ophthalmology Department, Gloucestershire Hospitals National Health Service Trust, Cheltenham, United Kingdom
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9
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Patel SB, Snyder ME, Riemann CD, Foster RE, Sisk RA. Short-term outcomes of combined pars plana vitrectomy for epiretinal membrane and phacoemulsification surgery with multifocal intraocular lens implantation. Clin Ophthalmol 2019; 13:723-730. [PMID: 31114150 PMCID: PMC6485319 DOI: 10.2147/opth.s195928] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the functional and anatomical outcomes of combined phacovitrectomy with multifocal intraocular lens (mfIOL) implantation. Methods Retrospective, interventional, non-comparative case series of six eyes that received a combined phacoemulsification surgery with apodized, diffractive mfIOL implantation for cataract and pars plana vitrectomy (PPV) with membrane peeling for epiretinal membrane (ERM). Outcome measures included distance and near visual acuities (DVA and NVA), central macular thickness (CMT), intraocular pressure (IOP), and disruption of external limiting membrane (ELM) or inner-segment outer-segment (IS/OS) junction. Results Mean logMAR glare DVA improved from 0.40 (Snellen 20/50) preoperatively to a mean uncorrected DVA of 0.038 (Snellen 20/22) (P=0.004) at 6 months after surgery. All eyes achieved NVA of J2 or better by 12 months postoperatively. Median CMT improved by 10 µm and mean IOP increased by 1 mmHg at 12 months postoperatively. Percentage of patients with ELM or IS/OS disruptions decreased from 66.7% to 33.3%. Two eyes demonstrated residual metamorphopsia on Amsler grid testing postoperatively. Postoperatively, four eyes required laser capsulotomy and one required LASEK for refractive correction. Conclusion Combined phacovitrectomy, membrane peeling, and mfIOL implantation improved VA in patients with idiopathic ERM. Multifocality was achieved, but final visual outcome was delayed due to posterior capsular opacification and macular healing.
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Affiliation(s)
- Sunny B Patel
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA,
| | - Michael E Snyder
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA, .,Cincinnati Eye Institute, Cincinnati, OH, USA,
| | - Christopher D Riemann
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA, .,Cincinnati Eye Institute, Cincinnati, OH, USA,
| | - Robert E Foster
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA, .,Cincinnati Eye Institute, Cincinnati, OH, USA,
| | - Robert A Sisk
- Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA, .,Cincinnati Eye Institute, Cincinnati, OH, USA,
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10
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Kang EC, Lee KH, Koh HJ. Changes in choroidal thickness after vitrectomy for epiretinal membrane combined with vitreomacular traction. Acta Ophthalmol 2017; 95:e393-e398. [PMID: 27229756 DOI: 10.1111/aos.13097] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 03/19/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare choroidal thickness after vitrectomy between epiretinal membrane (ERM) with and without vitreomacular traction (VMT). METHODS In this retrospective study, 228 consecutive participants with ERM who underwent vitrectomy were categorized into two groups according to the presence of VMT on spectral domain-optical coherence tomography: VMT group (ERM with VMT, n = 21) and non-VMT group (ERM without VMT, n = 207). The primary outcome was the mean subfoveal choroidal thickness (SFCT) at baseline, and at 3 and 6 months postsurgery. RESULTS At baseline, the prevalence of VMT in eyes with ERM was 9.6% (21/228), and mean SFCT was greater in the VMT than in the non-VMT group (270.3 ± 93.4 vs. 223.7 ± 82.1 μm; p = 0.015). After surgery, mean SFCT decreased in the VMT group (241.7 ± 92.3 μm at 3 months and 228.8 ± 86.4 μm at 6 months; p < 0.001), but remained unchanged in the non-VMT group (223.6 ± 78.9 μm at 3 months and 223.3 ± 82.6 μm at 6 months; p = 0.696). There were no differences in mean SFCT between the groups at 3 and 6 months after surgery (p = 0.339 and p = 0.772, respectively). CONCLUSION Choroidal thickness was greater in ERM eyes with than without VMT possibly due to direct anteroposterior traction on the retina and choroid, increased vascular endothelial growth factor associated with stress on retinal pigment epithelial cells and inflammation. After vitrectomy, mean SFCT reduced in the eyes with VMT, but not in those without VMT.
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Affiliation(s)
- Eui Chun Kang
- Institute of Vision Research; Department of Ophthalmology; Yonsei University College of Medicine; Seoul Korea
| | - Kyou Ho Lee
- Institute of Vision Research; Department of Ophthalmology; Yonsei University College of Medicine; Seoul Korea
| | - Hyoung Jun Koh
- Institute of Vision Research; Department of Ophthalmology; Yonsei University College of Medicine; Seoul Korea
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Comparison of refractive error in phacovitrectomy for epiretinal membrane using ultrasound and partial coherence interferometry. Eur J Ophthalmol 2016; 26:356-360. [PMID: 26742877 DOI: 10.5301/ejo.5000732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the postoperative refractive error (RE) using A-scan ultrasound (US) and partial coherence interferometry (PCI) after phacovitrectomy for idiopathic epiretinal membrane (iERM) and cataract. METHODS Eighty-eight participants (88 eyes) with iERM and cataracts underwent phacovitrectomies with internal limiting membrane removal. Postoperative RE was the main outcome measured, calculated by subtracting intended spherical equivalent (SE) from 6-month postoperative SE. Secondary outcomes included axial length (AL) measured by 2 methods, change in best-corrected visual acuity (BCVA), and change in central subfield thickness (CSFT). RESULTS Mean postoperative RE using US showed greater myopic shift compared with that using PCI (-0.569 ± 0.571 D vs -0.169 ± 0.415 D, respectively, p<0.001). The 6-month postoperative RE was within ±0.50 D in 43.2% (38/88) using US vs 84.1% (74/88) using PCI and within ±1.00 D in 84.1% (74/88) using US vs 96.6% (85/88) using PCI. Mean AL measured by US was shorter than that measured by PCI (23.50 ± 1.27 mm vs 23.58 ± 1.30 mm, respectively, p<0.001). Postsurgery, BCVA improved from 0.374 ± 0.264 logMAR to 0.144 ± 0.124 logMAR (p<0.001), and CSFT decreased from 449.2 ± 78.5 µm to 378.2 ± 47.0 µm (p<0.001). The BCVA improvement significantly correlated with decreased CSFT (R = 0.268, p = 0.011). CONCLUSIONS Estimation of intraocular lens power for phacovitrectomies for iERM and cataracts is more accurate when assessed by PCI than by US.
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Moisseiev E, Kinori M, Moroz I, Priel E, Moisseiev J. 25-Gauge Vitrectomy with Epiretinal Membrane and Internal Limiting Membrane Peeling in Eyes with Very Good Visual Acuity. Curr Eye Res 2016; 41:1387-1392. [PMID: 26862944 DOI: 10.3109/02713683.2015.1114654] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of pars plana vitrectomy (PPV) in patients with epiretinal membrane (ERM) and preoperative visual acuity (VA) of 20/40 or better. METHODS 44 eyes that underwent PPV and ERM peeling were included in this retrospective study. Data retrieved included demographic information, VA and intraocular pressure (IOP) preoperatively, after 1 month, 6 months and at final visit, presence of metamorphopsia, surgical reports, and occurrence of any complications. RESULTS Mean preoperative VA was 20/36 (0.24 ± 0.08 logMAR) and had improved to 20/27 (0.13 ± 0.11 logMAR) at the final follow-up (p < 0.001). Thirty (68.1%) eyes had improved by 1 line of vision or more, and 10 (22.7%) achieved final 20/20 vision. Significant improvement in vision was achieved earlier in eyes that underwent vitrectomy combined with cataract extraction. Preoperative OCT scans demonstrated preserved outer retinal layer structure. CONCLUSIONS PPV and ERM peeling is a safe and effective procedure in eyes with very good preoperative VA. PPV combined with cataract extraction offers a faster improvement in VA than PPV alone with deferred cataract surgery. PPV should be considered in symptomatic eyes with ERM and VA of 20/40 or better, in order to preserve and even improve the VA.
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Affiliation(s)
- Elad Moisseiev
- a Department of Ophthalmology , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Michael Kinori
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Department of Ophthalmology , Sheba Medical Center , Tel Hashomer , Israel
| | - Iris Moroz
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Department of Ophthalmology , Sheba Medical Center , Tel Hashomer , Israel
| | - Ethan Priel
- d Ophthalmology Department , MOR Institute , Bnei Brak , Israel
| | - Joseph Moisseiev
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Department of Ophthalmology , Sheba Medical Center , Tel Hashomer , Israel
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Kauffmann Y, Ramel JC, Lefebvre A, Isaico R, De Lazzer A, Bonnabel A, Bron AM, Creuzot-Garcher C. Preoperative Prognostic Factors and Predictive Score in Patients Operated On for Combined Cataract and Idiopathic Epiretinal Membrane. Am J Ophthalmol 2015; 160:185-92.e5. [PMID: 25849521 DOI: 10.1016/j.ajo.2015.03.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 03/29/2015] [Accepted: 03/30/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To report preoperative prognostic factors associated with visual acuity recovery 1 year after combined cataract and idiopathic epiretinal membrane (ERM) surgery and to introduce a predictive score. DESIGN Interventional case series and estimation of a predictive score. METHODS One hundred forty-two patients (1 eye per patient) operated on for combined cataract and idiopathic ERM in the University Hospital of Dijon were followed for 12 months. Preoperative clinical features and spectral-domain optical coherence tomography (OCT) parameters were compared between eyes that recovered ≥20/20 final best-corrected visual acuity (BCVA) and those with <20/20 final BCVA. Multivariate analysis and predictive score were provided. RESULTS At 12 months, 60 eyes (42%) recovered ≥20/20 BCVA and 82 (58%) had lower visual results. Logistic regression analysis showed that final BCVA was associated with age (P = .040), duration of symptoms (P = .025), initial BCVA (P = .002), and inner and outer segment (IS/OS) junction disruption on spectral-domain OCT (P = .010). The preoperative 10-point predictive score including these parameters reached 82% sensitivity and 66% specificity. With a score >5, patients had a ≥56% chance of recovering 20/20 final BCVA instead of ≤27% when the score was ≤5. CONCLUSIONS Age, duration of symptoms, and initial BCVA appear to be reliable prognostic factors in patients undergoing combined cataract and idiopathic ERM surgery. Combining these factors with analysis of the IS/OS junction provides a predictive score to estimate individual chances of good visual outcome.
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Affiliation(s)
- Yann Kauffmann
- Ophthalmology Department, University Hospital, Dijon, France
| | | | | | - Rodica Isaico
- Ophthalmology Department, University Hospital, Dijon, France
| | | | - Arnaud Bonnabel
- Ophthalmology Department, University Hospital, Dijon, France
| | - Alain Marie Bron
- Ophthalmology Department, University Hospital, Dijon, France; Eye and Nutrition Research Group, CSGA, Dijon, France
| | - Catherine Creuzot-Garcher
- Ophthalmology Department, University Hospital, Dijon, France; Eye and Nutrition Research Group, CSGA, Dijon, France.
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Foveal Pit Morphology Evaluation during Optical Biometry Measurements using a Full-Eye-Length Swept-Source OCT Scan Biometer Prototype. Eur J Ophthalmol 2015; 25:552-8. [DOI: 10.5301/ejo.5000630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/20/2022]
Abstract
Purpose To assess the scan quality of foveal pit morphology (FPM) and to quantify central retinal thickness (CRT) during routine optical biometry measurements with a full-eye-length swept-source optical coherence tomography (SS-OCT) scan biometer prototype (IOLMaster700) and to compare these results with standard examinations using spectral-domain optical coherence tomography (SD-OCT) technique (Cirrus4000 SD-OCT). Methods As part of a SS-OCT scan protocol to measure biometric parameters for intraocular lens power calculation, central horizontal 1 mm retinal B scans were taken from phakic (group I) and pseudophakic (group II) nonvitrectomized eyes. To evaluate FPM, macular scans of either examination technique were subjectively analyzed and compared. Repeated CRT measurements were performed to analyze repeatability and consistency of IOLMaster700 recordings. These results were compared with CRT evaluations using SD-OCT. Results Overall, 146 eyes of 146 patients were included in this series. The subjective assessments of FPM are illustrated. Repeated CRT measurements (repeatability) with the IOLMaster700 disclosed an overall intraclass correlation of 0.57 (group I: 0.48; group II: 0.89). Overall coefficient of variation (accuracy) was calculated to be 12.43% (group I: 14.21%; group II: 5.66%). The comparison of CRT measurements between both devices showed significant differences in group I (p = 0.006). Conclusions Compared with SD-OCT, resolution of the 1 mm retinal B scan of SS-OCT scan biometry was lower. However, advanced pathologic characteristics were clearly discernible. Repeatability and accuracy of CRT measurements were acceptable though lower than with the standard SD-OCT technique. The CRT differed significantly in eyes of particular interest (group I) between both devices. The new scan could provide useful information for subsequent patient examination and further treatment planning for cataract surgery.
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Nd:YAG Capsulotomy after Phacoemulsification in Vitrectomized Eyes: Effects of Pars Plana Vitrectomy on Posterior Capsule Opacification. J Ophthalmol 2014; 2014:840958. [PMID: 24868457 PMCID: PMC4020170 DOI: 10.1155/2014/840958] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 03/18/2014] [Accepted: 03/19/2014] [Indexed: 11/17/2022] Open
Abstract
To compare the progression of posterior capsule opacification (PCO) in patients who required Nd:YAG laser capsulotomy following either combined cataract surgery with pars plana vitrectomy (PPV; C-CV), sequential cataract surgery after PPV (S-CV), or cataract surgery alone (CA). The medical records of 321 patients (408 eyes) who underwent Nd:YAG capsulotomy were retrospectively evaluated. The CA group had a significantly longer time interval from cataract surgery to capsulotomy than that of both the CV group (P = 0.006) and the S-CV (P = 0.013) and C-CV (P = 0.042) subgroups when age-matched comparisons were used. CV patients who implanted a hydrophobic acrylic IOL had shorter time intervals than those of CA patients (P = 0.028). CV patients had larger hazard of earlier capsulotomy than CA patients (hazard ratio (HR) = 1.337; 95% confidence interval (CI) 1.100–1.625; P = 0.004). C-CV and S-CV patients both had larger hazard than CA patients in earlier capsulotomy (HR = 1.304; 95% CI = 1.007–1.688; P = 0.044, HR = 1.361; 95% CI = 1.084–1.709; P = 0.008, resp.). PCO progresses more rapidly in patients undergoing combined or sequential cataract surgery and PPV than in patients undergoing CA.
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Khan KN, Rahman R. A cautious approach to interpreting retrospective data. Br J Ophthalmol 2013; 97:1358. [PMID: 23966373 DOI: 10.1136/bjophthalmol-2013-304051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kamron N Khan
- Department of ophthalmology, Leeds Institute of Molecular Medicine, , Leeds, UK
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