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Martín JCM, Sánchez LF, Piñero DP, Navarro NC. Immunohistochemical, functional, and anatomical evaluation of patients with idiopathic epiretinal membrane. Graefes Arch Clin Exp Ophthalmol 2024; 262:1443-1453. [PMID: 38197992 PMCID: PMC11031491 DOI: 10.1007/s00417-023-06366-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/11/2024] Open
Abstract
PURPOSE The main purpose of this study was to perform an immunohistochemical, functional, and anatomical evaluation of patients with idiopathic epiretinal membrane (ERM). METHODS Twenty-four specimens of idiopathic ERM from 24 consecutive patients who underwent 23 G pars plana vitrectomy for ERM and internal limiting membrane (ILM) peeling at the San Juan University Hospital in Alicante (Spain) in 2019 were analyzed. All patients underwent a complete ophthalmological examination including measurement of best corrected visual acuity (BCVA) and macular analysis by spectral-domain optical coherence tomography (SD-OCT) at the time of diagnosis and 3 months after surgery. Specific glial fibrillar acid protein antibodies (GFAP) and S100 calcium-binding protein β (S100β) immunostaining markers were used to identify the macroglial component of the ERM, Müller cells, and astrocytes. Ionized calcium-binding adapter molecule 1 protein (Iba1) antibodies were used as specific markers for inflammatory cells, such as microglia and macrophages. RESULTS Mean preoperative BCVA measured with Snellen chart was 0.3 and 0.6 preoperatively and at 3 months after surgery, respectively. SD-OCT identified 15 patients (62.5%) with a disruption of the outer retinal hyperreflective bands. The immunohistochemical study showed the presence of Müller cells in almost all cases (91.6%), as well of abundant microglia and macrophages. Microglia and macrophages were more frequently present in earlier stages of ERM. Microglia were present in ERM independently of the outer retinal hyperreflective bands integrity as measured by SD-OCT. A greater presence of macrophages was found in those ERMs with no outer retinal hyperreflective band disruption. CONCLUSIONS Müller cells seem to be the most frequent cell group in ERMs, with also presence of microglia cells and macrophages. Astrocytes were more frequently found in early stages of ERMs. Microglia and macrophages were most frequent in ERMs with early stage (1, 2, or 3) than in advanced stages (4).
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Affiliation(s)
- Julio Cesar Molina Martín
- Department of Ophthalmology, San Juan University Hospital, N-332, S/NSant Joan d'Alacant, 03550, Alicante, Spain.
| | - Laura Fernández Sánchez
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig S/NSan Vicente del Raspeig, 03690, Alicante, Spain
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Crta San Vicente del Raspeig S/NSan Vicente del Raspeig, 03690, Alicante, Spain.
| | - Nicolás Cuenca Navarro
- Department of Physiology, Genetic and Microbiology, University of Alicante, San Vicente del Raspeig, Alicante, Spain
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Choi KE, Kim S, Kim SW. Anatomical changes in idiopathic epiretinal membrane at 2-year follow-up assessed using spectral domain optical coherence tomography and optical coherence tomographic angiography. Graefes Arch Clin Exp Ophthalmol 2024; 262:1465-1474. [PMID: 38117309 DOI: 10.1007/s00417-023-06332-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/16/2023] [Accepted: 12/01/2023] [Indexed: 12/21/2023] Open
Abstract
PURPOSE To evaluate anatomical changes in the low-stage partial attachment-type idiopathic epiretinal membrane (iERM) over 2 years. METHODS Data from patients with low-stage partial attachment-type iERM (stage 2) were analyzed. The main outcome measures were anatomical changes, including changes in the foveal avascular zone (FAZ) area, vessel density (VD) in the vascular plexus, and thickness of retinal sublayers during the follow-up period. RESULTS Thirty patients (mean age: 68±12 years) were included in the study. The FAZ area on the superficial vascular plexus (SVP) significantly decreased from baseline (0.12±0.08 mm2) to month 24 (0.10±0.08 mm2, p=0.024). However, the FAZ area on the deep vascular plexus (DVP) did not significantly decrease from baseline (0.15±0.13 mm2) to month 24 (0.14±0.14 mm2, p=0.099). VDs on both the SVP and DVP did not show significant change from baseline (29.51±8.14% vs. 28.35±5.63%) to month 24 (29.79±9.77%, p=0.564 vs. 28.17±5.75%, p=0.417). Parafoveal ganglion cell and inner plexiform layer (GCIPL) thickness decreased from baseline (108.77±13.61 μm) to month 24 (103.03±15.54 μm, p=0.004). The central total retinal layer thickness did not significantly change from baseline (396.07±64.86 μm) to month 24 (392.04±72.72 μm, p=0.570). CONCLUSION Even in low-stage ERM, inner retinal changes, including GCIPL thickness, occurred during follow-up periods, which might be owing to degenerative changes or centrifugal movement.
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Affiliation(s)
- Kwang-Eon Choi
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Seungheon Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea
| | - Seong-Woo Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.
- Department of Ophthalmology, Korea University Guro Hospital 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
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Belkin A, Harel G, Shtayer C, Bercovich O, Rubowitz A. THE EFFECT OF INTERNAL LIMITING MEMBRANE PEELING ON THE INNER RETINAL LAYERS IN PATIENTS WITHOUT MACULAR PATHOLOGIC CONDITION. Retina 2024; 44:831-836. [PMID: 38194675 PMCID: PMC11027973 DOI: 10.1097/iae.0000000000004042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND To examine the effect of internal limiting membrane peeling on the inner retinal layers in patients without macular pathological condition. METHODS A prospective nonrandomized trial of patients undergoing pars plana vitrectomy with internal limiting membrane peeling for pathologic condition outside the macula was performed. Optical coherence tomography including macular ganglion cell layer, inner plexiform layer, and peripapillary retinal nerve fiber layer imaging was performed before surgery, 1, 3, and 6 months postoperatively, and at the end of follow-up (ranges between 4 and 17 months). Patients with any macular pathological condition on optical coherence tomography before surgery were excluded. The main outcome measure was change in thickness of the ganglion cell layer and inner plexiform layer. RESULTS Ten patients who underwent pars plana vitrectomy with internal limiting membrane peeling for macula-on retinal detachment were included in the analysis. The mean age was 55 years, and the mean follow up was 10.8 months. All patients completed at least two postoperative follow-up visits that included an optical coherence tomography as per the protocol (range 2-6 months). There was an immediate reduction in the global (G), inferotemporal, superotemporal, and superior (S) ganglion cell layer thickness at the first follow up as compared with the preoperative state ( P = 0.028, P = 0.027, P = 0.026, and P = 0.027 respectively). From the first follow-up visit onward until the final follow-up, the thinning persisted, although there was no further statistically significant thinning. CONCLUSION Peeling of the internal limiting membrane causes significant ganglion cell layer thinning in maculae without pathologic condition before surgery. At up to 17 months of follow-up, this effect seems to be immediate and nonprogressive.
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Affiliation(s)
- Avner Belkin
- Department of Ophthalmology, Meir Medical Center, Kfar-Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Gal Harel
- Department of Ophthalmology, Meir Medical Center, Kfar-Saba, Israel
| | - Chen Shtayer
- Department of Ophthalmology, Meir Medical Center, Kfar-Saba, Israel
| | - Or Bercovich
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah-Tikva, Israel
| | - Alexander Rubowitz
- Department of Ophthalmology, Meir Medical Center, Kfar-Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; and
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Lin YC, Wang CT, Chen KJ, Chou HD. Traumatic terson syndrome with a peculiar mass lesion and tractional retinal detachment: a case report. BMC Ophthalmol 2024; 24:153. [PMID: 38589883 PMCID: PMC11003055 DOI: 10.1186/s12886-024-03407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND To report a case with bilateral Terson syndrome presented with a unique mushroom-like mass lesion on the optic disc along with proliferative vitreoretinopathy and tractional retinal detachment. CASE PRESENTATION A 33-year-old man was injured during a traffic accident and had diffuse brain swelling and intraocular hemorrhage. Poor vision in both eyes was noted after the patient regained consciousness. B-scan ultrasonography showed extensive vitreous opacity with a posterior vitreous detachment and without obvious retinal detachment. Vitrectomy was performed in both eyes five months after the accident. After clearing up the vitreous opacity, a peculiar pigmented mushroom-like mass lesion was noted in the posterior pole and had severe adhesion to the underneath optic disc. Extensive multilayered peripapillary epiretinal membrane was found covering the posterior pole and led to tractional retinal detachment around the macula. The mass was presumed to be an organized vitreous hemorrhage originated from the optic disc. The extensive and adherent epiretinal membrane together with the mass lesion were removed as much as possible and silicon oil was injected for tamponade. However, in the right eye, the retina redetached under silicon oil, whereas in the left eye, his vision improved to 20/100. CONCLUSIONS Terson syndrome usually has a favorable prognosis but may be complicated by proliferative vitreoretinopathy and tractional retinal detachment. Careful monitoring is warranted and early vitrectomy should be considered in cases suspecting additional pathologies.
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Affiliation(s)
- Yung-Chen Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Ting Wang
- Department of Ophthalmology, Linkou Branch, Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, 333423, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Linkou Branch, Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, 333423, Taoyuan, Taiwan
| | - Hung-Da Chou
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Department of Ophthalmology, Linkou Branch, Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, 333423, Taoyuan, Taiwan.
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Hu W, Huang Y, Kou P, Huang X. Increased serum cystatin C levels in patients with idiopathic epiretinal membrane. Clin Exp Optom 2024; 107:318-323. [PMID: 37218573 DOI: 10.1080/08164622.2023.2215381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
CLINICAL RELEVANCE Increased serum cystatin C may play a role in the pathogenesis of idiopathic epiretinal membrane (IERM). Physicians should be aware of this relationship and should refer patients to the ophthalmology clinic for screening. BACKGROUND To evaluate the serum cystatin C level in patients with IERM, and its associations with visual acuity. METHODS Sixty-eight patients with IERM and sixty-nine controls were enrolled in this cross-sectional study. Based on the results of optical coherence tomography, patients with IERM were divided into four stages (I, II, III and IV). Serum cystatin C was measured in all participants. Serum cystatin C levels were compared between the control group and IERM group and between the IERM group with different optical coherence tomography stages. Multiple linear regression was used to evaluate the relationship between serum cystatin C and IERM stages and best corrected visual acuity. RESULTS Serum cystatin C level was higher in the IERM group than in the control group (P < 0.001). There were statistically significant differences in serum cystatin C among different stages of IERM (PI vs II = 0.011, PI vs IV < 0.001 and PIII vs IV = 0.040, respectively). There were significant differences in best corrected visual acuity among different stages of IERM (PI vs III = 0.018, PI vs IV < 0.001, PII vs IV < 0.001 and PIII vs IV < 0.001, respectively). Regression analysis showed a positive correlation between serum cystatin C and best corrected visual acuity (t = 2.238 P = 0.029). The cut-off value of receiver operation characteristic curve of serum cystatin C for IERM was 0.775. CONCLUSION This study revealed that serum cystatin C may be involved in the pathogenesis of IERM and can predict its occurrence. Elevated serum cystatin C appears to be associated with the severity of the disease and relatively poor vision acuity in IERM patients.
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Affiliation(s)
- Weiwen Hu
- Department of Ophthalmology, The First Affiliated Hospital of Hainan Medical University, Hainan, People's Republic of China
| | - Yikeng Huang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Pengyuan Kou
- Department of Ophthalmology, The First Affiliated Hospital of Hainan Medical University, Hainan, People's Republic of China
| | - Xionggao Huang
- Department of Ophthalmology, The First Affiliated Hospital of Hainan Medical University, Hainan, People's Republic of China
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Lee D, Lee S, Choi KS. Clinical Performance Comparison of Ultrahigh-speed Dual Pneumatic Vitrectomy Probes: Is Faster and Smaller Better? Korean J Ophthalmol 2024; 38:122-128. [PMID: 38351482 PMCID: PMC11016684 DOI: 10.3341/kjo.2023.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/27/2023] [Accepted: 02/08/2024] [Indexed: 04/16/2024] Open
Abstract
PURPOSE Various vitrectomy probes are currently being used commercially, and there are ongoing efforts toward developing probes with higher cutting rates and smaller gauges. This study aimed to compare the efficiency and safety of various commercially available small gauge ultrahigh-speed dual pneumatic vitrectomy probes. METHODS We retrospectively analyzed the medical records of patients and recorded intraoperative videos while they underwent microincision three-port vitrectomy surgery for idiopathic epiretinal membrane at Soonchunhyang University Seoul Hospital. The patients were categorized into four groups based on the vitrectomy probe used during surgery: 23-7500 (UltraVit 23-gauge 7,500 cuts per minute [CPM]), 23-7500 (UltraVit 25-gauge 7,500 CPM), 25-10K (Advanced UltraVit 25-gauge 10,000 CPM), and 27-10K (Advanced UltraVit 27-gauge 10,000 CPM). RESULTS In total, 82 eyes from 82 patients were included in this work, with 16, 11, 26, and 29 eyes in groups 23-7500, 25-7500, 25-10K, and 27-10K, respectively. The corresponding vitrectomy times were 295.56 ± 53.55, 293.09 ± 50.28, 299.92 ± 59.42, and 349.38 ± 67.23 seconds, respectively. There was a significant difference in the vitrectomy time between the groups (p = 0.004). The mean number of sutures was 3, 3, 2.96, and 0.83, respectively. In the 23-7500 group, there was one case of iatrogenic retinal break, while in the 27-10K group, there was one case of postoperative hypotony. CONCLUSIONS Although advancements have been made in the 27-gauge vitrectomy probe, it still takes more vitrectomy time than it does when using the 23- and 25-gauge probes. However, the delay was within an average of 1 minute, and considering the significantly reduced need for sutures, there is a substantial benefit in terms of postoperative discomfort. Therefore, when choosing a probe for epiretinal membrane surgery among the four options, it is reasonable to select the 27-gauge probe according to the surgeon's preference.
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Affiliation(s)
- Donghyeon Lee
- Department of Ophthalmology, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sooyeon Lee
- Department of Ophthalmology, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Kyung Seek Choi
- Department of Ophthalmology, Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Choi SH, Cho IH, Jeon GS, Chang IB, Ma DJ, Hong IH. Comparative Evaluation of Visual Outcomes in Combined Cataract and Vitrectomy for Idiopathic Epiretinal Membrane with an Advanced or Conventional Intraocular Lens. Ophthalmic Res 2024; 67:221-231. [PMID: 38493781 DOI: 10.1159/000538316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 03/08/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION The aim of this study was to investigate the efficacy of new monofocal intraocular lens (IOL) in comparison with conventional monofocal IOL in patients undergoing combined cataract and vitrectomy surgery for epiretinal membrane (ERM). METHODS This prospective non-randomized comparative study included 65 eyes of 65 patients who underwent combined cataract and vitrectomy for ERM with implantation of advanced monofocal IOL (Eyhance ICB00, 33 patients) and standard monofocal IOL (Tecnis ZCB00, 32 patients). Monocular visual acuities were measured 6 months post-operatively, including corrected and uncorrected distance visual acuity (CDVA, UCDVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected near visual acuity (UCNVA). Furthermore, contrast sensitivity and metamorphopsia were measured. RESULTS There was no significant difference between two groups regarding operation time, post-operative CDVA, UCDVA, UCNVA, and spherical equivalent (p > 0.05). Monocular UCIVA was significantly higher in the Eyhance IOL group than in the Tecnis IOL group (p = 0.005). The photopic and mesopic contrast sensitivities were comparable between each group for any spatial frequency (p > 0.05). The correlation coefficients from correlations between retinal wrinkling ratio and M score did not differ significantly between groups (p = 0.877), and the degree of metamorphopsia was not significantly related to the type of IOL (p = 0.969). CONCLUSIONS In combined cataract and vitrectomy for ERM, Eyhance IOL provided significant better visual performance at intermediate distance than standard monofocal IOL without compromising operation time, distance vision, contrast sensitivity, and evaluating metamorphopsia. Eyhance IOL can be a useful option for both surgeons and patients.
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Affiliation(s)
- Se Hyun Choi
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang-si, Republic of Korea
| | - In Hwan Cho
- Department of Ophthalmology, College of Medicine, Soonchunhyang University, Cheonan-si, Republic of Korea
| | - Gang Seok Jeon
- Dasan Samsung Bright Eye Clinic, Seoul, Republic of Korea
| | | | - Dae Joong Ma
- Department of Ophthalmology, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - In Hwan Hong
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, Hwaseong-si, Republic of Korea
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Zhang Y, Zhang KR, Gao S, Zhang MX. [Clinical observation of the intraocular distribution characteristics of indocyanine green after epiretinal membrane peeling using a fluorescence detection system developed in Python]. Zhonghua Yan Ke Za Zhi 2024; 60:242-249. [PMID: 38462372 DOI: 10.3760/cma.j.cn112142-20231211-00282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Objective: To utilize a Python-based fluorescence area detection system to observe and quantitatively analyze the intraocular distribution characteristics and metabolic patterns of Indocyanine Green (ICG) following epiretinal membrane peeling. Methods: A prospective case series study was conducted on patients with idiopathic epiretinal membrane undergoing vitrectomy at West China Hospital of Sichuan University from March 2019 to March 2021. ICG staining was applied during surgery for peeling the epiretinal membrane and internal limiting membrane. Patients were followed up at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively, with assessments including best-corrected visual acuity, intraocular pressure, fundus photography, near-infrared fundus fluorescence imaging (NIR-FF), and optical coherence tomography (OCT). A Python-based ICG intraocular metabolism detection system was developed to measure the residual area of ICG fluorescence on NIR-FF, predict the ICG metabolic pattern equation, and correlate it with postoperative visual acuity and peripapillary retinal nerve fiber layer thickness. Results: A total of 64 patients (64 eyes) were included, with an average age of 64.6±8.4 years, including 25 males (39.1%) and 39 females (60.9%). Preoperative NIR-FF images showed no ICG strong fluorescence. At 1 week postoperatively, diffuse ICG strong fluorescence appeared in the posterior pole, and the internal limiting membrane removal area exhibited a ring-like weak fluorescence. Over time, ICG strong fluorescence was observed along the vascular arch and nerve fiber trajectory, gradually diminishing toward the optic disc, with residual ICG fluorescence still visible at the optic disc at 1 year. The Python-based ICG fluorescence area detection system effectively measured intraocular residual ICG area. A predictive equation for the 12-month residual ICG area was constructed through linear regression analysis (Residual ICG area=0.22 × Residual ICG area at 6 months, R2=16%, P=0.002). Except for a negative correlation between the ICG residual area at 1 month and postoperative visual acuity (P=0.017, r=-0.195), no correlation was found between intraocular ICG fluorescence residual area and postoperative visual acuity or peripapillary retinal nerve fiber layer thickness at other follow-up times (all P>0.05). Conclusions: In patients with idiopathic epiretinal membrane undergoing ICG staining for internal limiting membrane peeling, ICG exhibits characteristic metabolic processes in the eye, with strong fluorescence along the vascular arch and nerve fiber trajectory, gradually converging toward the optic disc over time. The Python-based ICG fluorescence area detection system provides a clear display of the intraocular distribution characteristics of ICG after epiretinal membrane peeling and serves as a tool for predicting the metabolic patterns of ICG in the eye.
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Affiliation(s)
- Y Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - K R Zhang
- Department of Ophthalmology, People's Hospital of Chongqing Liang Jiang New Area, Chongqing 401121,China
| | - S Gao
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - M X Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu 610041, China
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Rodríguez-Fernández CA, Morwani R, Arias L. Epiretinal neovascular membrane in Macular Telangiectasia type 2: Multimodal imaging diagnosis. Eur J Ophthalmol 2024; 34:NP13-NP16. [PMID: 37743592 DOI: 10.1177/11206721231204379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
PURPOSE To characterize an epiretinal neovascular membrane (ERNM) through multimodal imaging in the context of a patient with Macular Telangiectasia type 2 (MacTel) and ipsilateral concomitant ocular ischemic syndrome (OIS). METHODS Case report, with ultra-wide field (UWF) retinography, fluorescein angiography (FA), swept source optical coherence tomography (ss-OCT), and OCT-angiography (OCTA). Written informed consent for patient information and images to be published was provided by the patient. Approval from the Research Ethics Committee of the Hospital was obtained for publication. CASE REPORT Yearly follow up of a 51 year-old-female patient with advanced bilateral MacTel showed new punctate hemorrhages in all four quadrants of her right eye (OD). OCTA showed an ERNM in the superficial capillary plexus of the same eye and FA confirmed the ERNM and demonstrated peripheral ischemia. Carotid ultrasound was performed and complete right carotid artery occlusion was confirmed. These findings allowed the diagnosis of an ERNM associated with Mactel and OIS. CONCLUSIONS Interestingly, this case shows an ERNM diagnosed by multimodal imaging in a patient with advanced MacTel and a concomitant OIS. Mactel is a neurodegenerative disease which in its neovascular stage has been associated with macular neovascular membranes, but also ERNM have recently been described by OCTA.
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Affiliation(s)
| | - Rahul Morwani
- Ophthalmology Department, Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Arias
- Ophthalmology Department, Bellvitge University Hospital. L'Hospitalet de Llobregat, Barcelona, Spain
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Naftali S, Della Rocca K, Gershoni A, Ehrlich R, Ratnovsky A. Mechanical impact of epiretinal membranes on the retina utilizing finite element analysis. Comput Methods Programs Biomed 2024; 245:108020. [PMID: 38237448 DOI: 10.1016/j.cmpb.2024.108020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/14/2023] [Accepted: 01/11/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND OBJECTIVE Epiretinal membrane (ERM) is a transparent membrane that forms on the surface of the neurosensory retina, causing tangential traction on the retinal surface, which may contribute to cell proliferation and contraction. Epiretinal membranes (ERMs) may be asymptomatic in some patients, while in others the membranes can progress, resulting in macular thickening and macular traction, thus distorting and inducing loss of central visual function and metamorphopsia. Currently, treatment options include follow-up or pars plana vitrectomy with an ERM peel, aiming to relieve the macular traction and improve vision and metamorphopsia. No specific criteria exist for predicting which patients might progress and need early surgery to improve and maintain good vision. The decision for surgery is based on the individual's symptoms and the physician's judgment. This study aimed to evaluate the mechanical impact in terms of stress and deformations of the ERM and to qualitatively compare them with the clinical progression of fovea thickening observed through optical coherence tomography (OCT) images. METHODS Numerical simulation on a three-dimensional geometrical retina and ERM model was applied to isolate factors that can be used to predict its progression and prognosis. OCT images of 14 patients with ERM were used to derive the fovea thickness progression before and after vitrectomy surgery with ERM peeling. RESULTS The results clearly show that the increase in ERM contractility level increases the developed stress at the fovea, which spreads and advances toward its base. The highest stress level (2.1 kPa) was developed at the highest and asymmetric contractility, producing non-uniform distributed deformations that distort the fovea structure. CONCLUSIONS These findings imply that high and asymmetric ERM contractility should be evaluated clinically as a factor that might signal the need for early vitrectomy surgery to avoid irreversible visual loss. Moreover, the OCT images revealed that in some cases, the thickness of the fovea indeed remains high, even after ∼12 months postoperatively, which also indicates that the deformation of the fovea in these cases is irreversible.
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Affiliation(s)
- Sara Naftali
- School of Medical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, 6998812, Israel.
| | - Keren Della Rocca
- School of Medical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, 6998812, Israel
| | - Assaf Gershoni
- Ophthalmology Division, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Rita Ehrlich
- Ophthalmology Division, Rabin Medical Center, Petach Tikva, Israel; Faculty of Medicine, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Anat Ratnovsky
- School of Medical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, 6998812, Israel
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Yan Y, Huang X, Jiang X, Gao Z, Liu X, Jin K, Ye J. Clinical evaluation of deep learning systems for assisting in the diagnosis of the epiretinal membrane grade in general ophthalmologists. Eye (Lond) 2024; 38:730-736. [PMID: 37848677 PMCID: PMC10920879 DOI: 10.1038/s41433-023-02765-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Epiretinal membrane (ERM) is a common age-related retinal disease detected by optical coherence tomography (OCT), with a prevalence of 34.1% among people over 60 years old. This study aims to develop artificial intelligence (AI) systems to assist in the diagnosis of ERM grade using OCT images and to clinically evaluate the potential benefits and risks of our AI systems with a comparative experiment. METHODS A segmentation deep learning (DL) model that segments retinal features associated with ERM severity and a classification DL model that grades the severity of ERM were developed based on an OCT dataset obtained from three hospitals. A comparative experiment was conducted to compare the performance of four general ophthalmologists with and without assistance from the AI in diagnosing ERM severity. RESULTS The segmentation network had a pixel accuracy (PA) of 0.980 and a mean intersection over union (MIoU) of 0.873, while the six-classification network had a total accuracy of 81.3%. The diagnostic accuracy scores of the four ophthalmologists increased with AI assistance from 81.7%, 80.7%, 78.0%, and 80.7% to 87.7%, 86.7%, 89.0%, and 91.3%, respectively, while the corresponding time expenditures were reduced. The specific results of the study as well as the misinterpretations of the AI systems were analysed. CONCLUSION Through our comparative experiment, the AI systems proved to be valuable references for medical diagnosis and demonstrated the potential to accelerate clinical workflows. Systematic efforts are needed to ensure the safe and rapid integration of AI systems into ophthalmic practice.
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Affiliation(s)
- Yan Yan
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Xiaoling Huang
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Xiaoyu Jiang
- College of Control Science and Engineering, Zhejiang University, Hangzhou, 310027, China
| | - Zhiyuan Gao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Xindi Liu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Kai Jin
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China.
| | - Juan Ye
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China.
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Venkatesh R, Mangla R, Handa A, Parmar Y, Sangoram R, Chhablani J. Epiretinal membrane formation and optic disc vascularisation in type 2A macular telangiectasia (MacTel). Eur J Ophthalmol 2024; 34:NP78-NP82. [PMID: 37644815 DOI: 10.1177/11206721231198888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE To describe a rare clinical finding of epiretinal membrane (ERM) and abnormal optic disc vascularisation in type 2A macular telangiectasia (MacTel). CASE DESCRIPTION A 52-year-old asymptomatic healthy male was examined in the retina clinic. In both eyes, corrected visual acuity was 20/20, N6. Anterior segment examination and intraocular pressure were both normal in both eyes. RESULTS The right eye's dilated fundus examination revealed loss of retinal transparency and superficial intraretinal crystals. A thick ERM extending from the optic disc to the macula obscured the details of the underlying perifoveal region in the left eye fundus. The diagnosis of bilateral type 2 MacTel was confirmed by confocal blue reflectance imaging, fluorescein angiography (FA), and macular optical coherence tomography (OCT). The left eye macular OCT scan also revealed a thick ERM without causing significant retinal traction. Furthermore, FA of the left eye revealed early hyperfluorescence with intense late leakage at the inferior aspect of the optic disc, giving the impression of abnormal optic disc vascularisation. No other cause for the disc vascularisation could be identified. OCT scan through the area with the optic disc leakage revealed a tuft of irregular hyperreflective tissue lying over the ERM. OCT angiography imaging confirmed the vascularity within the tuft of hyperreflective tissue over the ERM. Over a two-year period, no changes in clinical or imaging features were observed. CONCLUSION In type 2A MacTel eyes, ERM formation and abnormal disc vascularisation are uncommon findings. More histopathologic research is needed to characterise these membranes.
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Affiliation(s)
- Ramesh Venkatesh
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru 560010, Karnataka, India
| | - Rubble Mangla
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru 560010, Karnataka, India
| | - Ashit Handa
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru 560010, Karnataka, India
| | - Yash Parmar
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru 560010, Karnataka, India
| | - Rohini Sangoram
- Department of Retina and Vitreous, Narayana Nethralaya, #121/C, 1st R Block, Chord Road, Rajaji Nagar, Bengaluru 560010, Karnataka, India
| | - Jay Chhablani
- Department of Retina and Vitreous, University of Pittsburgh School of Medicine, Medical Retina and Vitreoretinal Surgery, 203 Lothrop Street, Suite 800, Pittsburg 15213, PA, USA
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Imai H, Iwane Y, Kishi M, Sotani Y, Yamada H, Matsumiya W, Miki A, Kusuhara S, Nakamura M. Color enhancement and achromatization to increase the visibility of indocyanine green-stained internal limiting membrane during digitally assisted vitreoretinal surgery. Jpn J Ophthalmol 2024; 68:105-111. [PMID: 38311686 DOI: 10.1007/s10384-023-01042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/29/2023] [Indexed: 02/06/2024]
Abstract
PURPOSE To investigate the impact of using digital assisted vitrectomy (DAV) for color enhancement in color channel and achromatization in color profile on the visibility of indocyanine green (ICG)-stained internal limiting membrane (ILM). STUDY DESIGN Retrospective observational study. METHODS Twenty eyes from 20 patients (7 men, 13 women) who underwent 27-gauge pars plana vitrectomy for epiretinal membrane removal were included. The presettings of five different imaging modes of the NGENUITY® 3D visualization system (Alcon laboratories, Inc.), were adjusted, and intraoperative images of ILM removal were captured under each presetting. The color contrast ratios (CCR) between the ICG-stained ILM area and peeled ILM area were compared across presettings objectively. Subjective visibility of ILM in each patient for different presettings was ranked using a Likert scale and evaluated by five examiners. Data on sex, age, preoperative and postoperative best-corrected visual acuity (BCVA), preoperative and postoperative intraocular pressure (IOP), and postoperative complications were analyzed. RESULTS Compared to other presettings the best CCR was achieved by adjusting the color channel to enhance red and by modifying the color profile to create a monochrome image (P<0.01). The same presetting resulted in a highest subjective visibility (P<0.01). Mean preoperative BCVA and 6-month postoperative BCVA (logMAR) were 0.11±0.18 and 0.05±0.19, respectively (p=0.24). Mean preoperative IOP and 6-month postoperative IOP were 13.8±2.8 mmHg and 13.3±3.4 mmHg, respectively (p=0.51). No apparent intra- and post-operative complications were observed. CONCLUSION Color enhancement and achromatization using DAV may offer potential advantages to enhance the visibility of ICG-stained ILM.
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Affiliation(s)
- Hisanori Imai
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yukako Iwane
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Maya Kishi
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yasuyuki Sotani
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hiroko Yamada
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Wataru Matsumiya
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Akiko Miki
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Sentaro Kusuhara
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Makoto Nakamura
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Nawrocka ZA, Nawrocki J. PREDICTIVE FACTORS OF SURGICAL SUCCESS WITH THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE. Retina 2024; 44:400-405. [PMID: 37948738 DOI: 10.1097/iae.0000000000003986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To present new morphologic features correlating with functional and anatomical outcomes of the inverted internal limiting membrane flap technique in full-thickness macular hole. METHODS A retrospective study of 51 successful and 22 failed full-thickness macular hole surgeries. In all eyes, preoperative spectral domain optical coherence tomography (SD-OCT) or swept source optical coherence tomography (SS-OCT) were reviewed. The presence of supraretinal pigment epithelium granular deposits, presence of an epiretinal membrane or epiretinal proliferation, visibility of posterior hyaloid, continuity of the interdigitation zone or external limiting membrane, presence of cystoid spaces, irregular surface of the margins of full-thickness macular hole, visibility of the suprachoroidal space, and diameters of full-thickness macular hole were analyzed. RESULTS In multivariate analysis, the success of the first surgery depended solely on the absence of epiretinal membrane ( P < 0.05).In univariate analysis, the success of the first surgery was correlated moreover with the absence of preoperative supraretinal pigment epithelium granular deposits ( P = 0.0010), the absence of an epiretinal proliferation ( P = 0.0060), and the absence of an irregular border of the hole ( P = 0.010). CONCLUSION In multivariate analysis, epiretinal membranes were a negative prognostic factor for macular hole closure when the inverted internal limiting membrane flap technique was used. Worse final visual acuity was observed in patients with primary anatomical failure, even if the hole was successfully closed during the second intervention.
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Sartini F, Menchini M, Palma A, Casini G, Figus M. Epiretinal membrane development after Ex-Press glaucoma filtration device implant: 2-year results of a case control study. Int Ophthalmol 2024; 44:93. [PMID: 38367121 PMCID: PMC10874323 DOI: 10.1007/s10792-024-02958-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/04/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND The most common retinal complications after glaucoma surgery are choroidal detachment, hypotony maculopathy, malignant glaucoma, vitreous hemorrhage, endophthalmitis and retinal detachment. However, if glaucoma surgery is a risk factor for the ERM development needs to be clarified. This study aims to assess the incidence of epiretinal membrane (ERM) in 2 years of follow-up in patients with primary open-angle glaucoma (POAG) treated with Ex-Press shunt implant. METHODS A prospective, consecutive, single-center, case-control study. We enrolled patients affected by POAG and scheduled for Ex-Press device implant with or without concomitant cataract surgery. The control group was the contralateral eyes which continues anti-glaucomatous eyedrops. Complete ophthalmologic evaluation and spectral-domain optical coherence tomography were performed before surgery, at 6 months and 24 months of follow-up. RESULTS Eighty-two eyes of 41 consecutive patients, 18 males and 23 females with a mean age of 70, 29 ± 8,45, were analyzed at 24 months. 39.1% of eyes developed ERM: 29.3% were cellophane macular reflex (CMR) and 9.8% were pre-macular fibrosis (PMF). In the control group, 19.5% of eyes developed ERM: 17.1% were CMR and 2.4% were PMF. No statistically significant difference was reported (p = 0.121) between treated and control group. ERM development did not affect significantly the central foveal thickness (260.13 ± 35.01 μm at baseline, 265.03 ± 34.90 μm at 6 months and 275.18 ± 33.31 μm at 24 months) and macular volume (7.75 ± 0.43 mm3 at baseline, 7.77 ± 0.48 mm3 at 6 months and 7.77 ± 0.46 mm3 at 24 months), remained comparable to reported average measures in healthy individuals during the follow-up. Concomitant cataract surgery did not increase the ERM incidence. CONCLUSION Ex-Press implant may increase the ERM incidence regardless concomitant cataract surgery, accelerating or inducing a posterior vitreous detachment, such as other ocular surgical procedure. Nevertheless, the vast majority of ERM are CMR, not affecting the macular profile.
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Affiliation(s)
- Francesco Sartini
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Martina Menchini
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Alessandro Palma
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Giamberto Casini
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi, 10, 56126, Pisa, Italy
| | - Michele Figus
- Ophthalmology, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi, 10, 56126, Pisa, Italy.
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Matoba R, Kanzaki Y, Morita T, Kimura S, Hosokawa MM, Shiode Y, Morizane Y. Evaluation of epiretinal membrane formation after scleral buckling for treating rhegmatogenous retinal detachment: En face optical coherence tomography image-based study. Graefes Arch Clin Exp Ophthalmol 2024; 262:469-476. [PMID: 37864637 DOI: 10.1007/s00417-023-06285-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/07/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023] Open
Abstract
PURPOSE To assess epiretinal membrane (ERM) formation, severity, and the associated risk factors after scleral buckling using en face optical coherence tomography (OCT) images. METHODS Medical records of 61 consecutive patients (66 eyes) with rhegmatogenous retinal detachment who underwent scleral buckling were retrospectively reviewed. Posterior vitreous detachment (PVD) was determined based on B-scan OCT images. En face OCT images were used to visualize the ERM and retinal folds. ERM formation was identified by comparing en face images pre- and post-surgery. The maximum depth of the retinal folds (MDRF) was measured using en face imaging to objectively assess traction strength. RESULTS ERM formation occurred in 15 (22.7%) eyes at the final visit; the foveal pit was preserved in all cases. Parafoveal retinal folds were present in 5 (7.6%) eyes, with a mean MDRF of 21.8 ± 12.6 µm. No significant difference was observed in best-corrected visual acuity (logarithm of the minimal angle of resolution) between the ERM formation (-0.019 ± 0.128) and non-ERM formation (-0.001 ± 0.213) groups at the final visit (P = 0.593; Mann-Whitney U test). Multivariate logistic regression analysis revealed that older age and the presence of PVD were significant risk factors for ERM formation (odds ratio 1.07, 95% confidence interval 1.01-1.14, P = 0.032; odds ratio 5.26, 95% confidence interval 1.06-26.10, P = 0.042; respectively). CONCLUSION ERM occurred in 22.7% of cases but was mild and did not affect visual acuity. Older age and the presence of PVD are risk factors for ERM formation.
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Affiliation(s)
- Ryo Matoba
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan.
| | - Yuki Kanzaki
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan
| | - Tetsuro Morita
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan
| | - Shuhei Kimura
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan
| | - Mio Morizane Hosokawa
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan
| | - Yusuke Shiode
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho Kita-Ku, Okayama City, Okayama, 700-8558, Japan
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Steinkerchner MS, Russell MW, Sharma N, Kumar M, Talcott KE, Singh RP. Long-Term Visual Outcomes in Patients With Idiopathic Epiretinal Membrane Surgery. Ophthalmic Surg Lasers Imaging Retina 2024; 55:71-77. [PMID: 38198614 DOI: 10.3928/23258160-20231207-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND AND OBJECTIVE Our aim was to assess long-term outcomes following surgical repair of idiopathic epiretinal membrane (ERM) with pars plana vitrectomy (PPV) and membrane peel (MP). PATIENTS AND METHODS A retrospective study evaluated patients with idiopathic ERM who underwent surgical repair at a single academic tertiary center with five to nine years of postoperative follow-up, assessing preoperative characteristics, surgical techniques, best visual acuity (BVA), and optical coherence tomography biomarkers at various time points. RESULTS The study involved 67 patients (72 eyes) with an average postoperative follow-up of 82.8 ± 18.8 months. Patients with cone outer segment tips integrity at initial presentation and 1-year follow-up and patients with external limiting membrane and ellipsoid zone integrity at 1-year follow-up were noted to have significantly better long-term visual acuity than those without. More than 85% of patients achieved a BVA > 70 seven years after surgical repair. CONCLUSIONS Vitreoretinal surgery for idiopathic ERM resulted in improved anatomical recovery and sustained visual acuity gain over long-term follow-up. [Ophthalmic Surg Lasers Imaging Retina 2024;55:70-77.].
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Catania F, Romano MR, Crincoli E, Allegrini D, Miere A, Chehaibou I, Abdelmassih Y, Beaumont W, Chapron T, Souied EH, Caputo G. Phenomenology of spontaneous closure in degenerative and mixed type lamellar macular hole. Eye (Lond) 2024; 38:315-320. [PMID: 37524832 PMCID: PMC10810871 DOI: 10.1038/s41433-023-02681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 07/04/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE To the describe OCT imaging characteristics of a cohort of patients showing spontaneously closing degenerative or mixed type lamellar macular holes (LMH) and to compare them to the ones of a sex and age matched group showing stable lesions. METHODS Patients diagnosed with degenerative and mixed type LMHs showing OCT-documented spontaneous anatomical closure were retrospectively selected from 3 specialized retina centres. An equal number of age and sex matching subjects were randomly selected among patients with anatomically stable lesions. RESULTS Eleven (11) spontaneously closing (SC group) and 11 stable (ST group) degenerative LMH with a mean follow up of 4 years were recruited. Hyperreflective inner border (HIB) and linear hyperreflectivity in the outer plexiform layer (LHOP) at baseline were significantly more prevalent in SC group in processed images (respectively p = 0.007 and p = 0.003). A borderline significance in lamellar hole associated epiretinal proliferation (LHEP) at last follow up was detected (p = 0.085). As for mixed type LMH, 10 patients for SC group and 10 for ST group were recruited. LHOP at baseline in processed images was significantly more prevalent in SC group (p = 0.005). CONCLUSIONS Spontaneously closing LMHs show higher prevalence of HIB and LHOP at the beginning of the closing process, a difference which is enhanced by image processing. These signs might be a signal of microglial and Muller cells coordinated activation.
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Affiliation(s)
- Fiammetta Catania
- Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, 29 Rue Manin, 75019, Paris, France
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy
| | - Mario R Romano
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele - Milan, Italy
- Department of Ophthalmology, Humanitas Gavazzeni - Castelli, Via Giuseppe Mazzini 11, 24128, Bergamo, Italy
| | - Emanuele Crincoli
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, avenue de Verdun, 94100, Créteil, France.
| | - Davide Allegrini
- Department of Ophthalmology, Humanitas Gavazzeni - Castelli, Via Giuseppe Mazzini 11, 24128, Bergamo, Italy
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, avenue de Verdun, 94100, Créteil, France
| | - Ismael Chehaibou
- Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, 29 Rue Manin, 75019, Paris, France
| | - Youssef Abdelmassih
- Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, 29 Rue Manin, 75019, Paris, France
| | - William Beaumont
- Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, 29 Rue Manin, 75019, Paris, France
| | - Thibaut Chapron
- Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, 29 Rue Manin, 75019, Paris, France
| | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil 40, avenue de Verdun, 94100, Créteil, France
| | - Georges Caputo
- Departement of Ophthalmology, Hopital Fondation Adolphe De Rothschild, 29 Rue Manin, 75019, Paris, France
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Yang X, Wu X, Qi B, Zhang K, Yu Y, Wang X, Feng X, Jia Q, Jin ZB, Liu W. Foveal Microstructure and Visual Outcomes after Pars Plana Vitrectomy in Patients with Different Types of Epiretinal Membrane Foveoschisis. Ophthalmic Res 2024; 67:137-144. [PMID: 38246146 DOI: 10.1159/000536206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The aim of this study was to evaluate the clinical characteristics and surgical outcomes of the epiretinal membrane foveoschisis (ERM-FS) with different morphological types. METHODS This retrospective observational study reviewed 44 consecutive ERM-FS patients who underwent ERM surgery. According to the optical coherence tomography images, ERM-FS was classified into three groups: group A, FS crossed the fovea with the foveola elevated; group B, FS located at the foveal edges with a near-normal central foveal point thickness; and group C, FS with undermined foveal edges with a near-normal central foveal point thickness. RESULTS There were 10 eyes in group A, 20 eyes in group B, and 14 eyes in group C. Preoperatively, eyes in group A had the best best-corrected visual acuity (BCVA), the thickest central foveal point thickness, and the highest ellipsoid zone (EZ) intact rate among the three groups. After surgery, a resolution of foveoschisis was observed in 40.0%, 45.0%, and 50.0% of the eyes in group A, group B, and group C (p = 0.928), respectively. BCVA was significantly improved postoperatively. Although there was no significant difference in BCVA among the three groups at 1 month postoperatively, BCVA of group A was the best at 4 and 10 months. Correlation analysis indicated that the type of ERM-FS, baseline BCVA, central foveal point thickness, and postoperative EZ continuity (all p < 0.05) were important factors for the final BCVA. CONCLUSIONS The damage to the retinal structure and visual function was milder in group A ERM-FS. Our study emphasized the necessity of OCT-based subtyping in patients with ERM-FS.
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Affiliation(s)
- Xiaohan Yang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xijin Wu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Biying Qi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Ke Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Yanping Yu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xinbo Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Xiao Feng
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Qinlang Jia
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Manayath GJ, Ninan RS, Verghese S, Narendran V. Multimodal imaging of epiretinal neovascularization associated with type 3 macular neovascularization. Eur J Ophthalmol 2024; 34:NP54-NP59. [PMID: 36908203 DOI: 10.1177/11206721231163618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE To report a case of type 3 macular neovascularization presenting with an epiretinal neovascularization. METHODS Case report. RESULTS A 65-year-old gentleman presented with complaints of reduced vision in the left eye (LE) having a best corrected visual acuity (BCVA) of 20/200. Based on fundus examination and multimodal imaging findings he was diagnosed with type 3 macular neovascularization (MNV). An additional unusual finding was the presence of an epiretinal membrane (ERM) and epiretinal neovascularization (ERN), with the latter finding being confirmed on optical coherence tomography angiography (OCTA). He underwent three doses of intravitreal ranibizumab injection following which there was reduction in the epiretinal vascularity. CONCLUSIONS Multimodal imaging of this case highlights the presence of epiretinal neovascularization associated with type 3 MNV, which has not been reported previously.
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Affiliation(s)
- George J Manayath
- Department of Retina & Vitreous, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Rohan Suresh Ninan
- Department of Retina & Vitreous, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Shishir Verghese
- Department of Retina & Vitreous, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - Venkatapathy Narendran
- Department of Retina & Vitreous, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Coimbatore, India
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21
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Yap A, Lu LM, Sims JL, Welch S, Niederer RL. Epiretinal membrane in uveitis: Rate, visual prognosis, complications and surgical outcomes. Clin Exp Ophthalmol 2024; 52:54-62. [PMID: 38108156 DOI: 10.1111/ceo.14338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Epiretinal membrane (ERM) is a common finding in patients with uveitis that contributes to visual impairment. We describe the long-term visual acuity (VA) and morphometric progression in patients with uveitis and epiretinal membrane (ERM). METHODS Retrospective cohort study of patients with uveitic ERM from a tertiary centre database. Multivariate analysis of risk factors for ERM progression was calculated using a marginal Cox regression model to estimate hazard ratios (HR). RESULTS Two hundred and sixteen eyes (4%) of a total 5450 eyes with uveitis were identified to have an ERM. The most common diagnosis was idiopathic uveitis in 45 patients (28.7%), followed by sarcoidosis in 21 (13.4%), HLAB27-related uveitis in 15 (9.6%) and toxoplasmosis in 15 (9.6%). Risk factors for ERM development include age (HR 1.03), intermediate uveitis (HR 2.33), posterior uveitis (HR 1.53) and ERM fellow eye (HR 18.28). Anterior uveitis (HR 0.53) and alternating disease (HR 0.53) were protective. Median VA was 20/40 at diagnosis of ERM and 20/40 at final follow up. Progression of ERM grade occurred in 17 eyes (7.9%) during the study period. ERM peel was performed in 44 eyes (20.4%). Median VA was 20/60 and 20/40 at baseline and 12 months after surgery, respectively. Improvement in visual acuity occurred in 23 eyes (60.5%) following surgery. CONCLUSIONS In addition to intermediate and posterior uveitis, fellow eye involvement is a strong risk factor for ERM development. In treated uveitis, the majority maintain their long-term vision and rates of ERM progression are low.
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Affiliation(s)
- Aaron Yap
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Lucy M Lu
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Joanne L Sims
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Sarah Welch
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
| | - Rachael L Niederer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Auckland District Health Board, Auckland, New Zealand
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22
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Nawrocka ZA, Trebinska M, Nawrocka Z, Nawrocki J. Idiopathic epiretinal membranes: postoperative changes in morphology. Can J Ophthalmol 2023; 58:582-591. [PMID: 35901968 DOI: 10.1016/j.jcjo.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/21/2021] [Accepted: 06/23/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe retinal morphology in idiopathic epiretinal membranes (ERMs) and to evaluate factors influencing function at different postoperative times up to 24 months. DESIGN Retrospective study. PARTICIPANTS A total of 121 eyes of 117 patients followed with spectral-domain optical coherence tomography for 24 months. METHODS The following details were analyzed: type of ERM, central retinal thickness, and status of all retina layers in the fovea, especially the outer nuclear layer (ONL) and photoreceptor layer. We evaluated the presence of disorganization of retinal inner layers (DRIL), ectopic inner foveal layer (EIFL), elevation (stretching) of the ONL, cotton ball sign, and type connection between the retina and ERMs (complete adherence or multiple junction spots). RESULTS The percentage of DRIL, EIFL, and stretched ONL decreased. Several factors negatively influenced visual acuity during the early postoperative controls: age, interdigitation zone defects; presence of cotton ball sign, DRIL, EIFL, and stretched ONL; and strong adhesion of the ERMs to the retina. Twenty-four months after surgery, only DRIL and strong adhesion between ERMs and the retina remained statistically significant. CONCLUSIONS Younger patients (p < 0.001) and patients without DRIL (p < 0.001) experienced a faster recovery of function. The length of follow-up was associated with a decrease of factors influencing the final outcome. After 24 months, only the presence of DRIL and strong adhesion between the ERMs and the retina were significant. Assuming that DRIL appears in more advanced stages when compared with EIFL, this allows us to suggest that earlier surgery might be of more benefit in idiopathic ERMs.
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Berco E, Arnon R, Kozlov Y, Shad JL, Shoham-Hazon N, Tuli R, Hilely A. Internal limiting membrane flap with viscoelastic device for lamellar hole surgery with no postoperative positioning. Graefes Arch Clin Exp Ophthalmol 2023; 261:3395-3401. [PMID: 37542557 DOI: 10.1007/s00417-023-06196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023] Open
Abstract
PURPOSE To propose a novel technique of an internal limiting membrane (ILM) flap using ophthalmic viscoelastic device (OVD) with no requirement for postoperative head posture for the treatment of lamellar macular hole (LMH) repair. METHODS A retrospective analysis of 16 consecutive eyes of LMH patients who underwent vitrectomy with ILM flap with OVD. Best-corrected visual acuity (BCVA), central macular thickness (CMT), simultaneous cataract extraction, and ellipsoid zone disruption preoperatively and at the final follow-up were compared. RESULTS The mean age was 73.19 ± 7.26 years, and ten patients (62%) were females. The mean follow-up was 5.06±1.43 months (range 3-6). For all patients, BCVA was significantly improved at the final visit, from 0.65±0.36 logMAR units to 0.42±0.29 (p < 0.001). None of the patients had visual loss. Six patients had epiretinal membrane (ERM) foveoschisis, and the rest had LMH with epiretinal proliferation. Both subgroups presented a significant improvement in their BCVA with a trend for better improvement in the latter (p=0.09). Ellipsoid zone disruption was seen in 7 patients including one patient with a macular scar. There was no significant effect of ellipsoid zone disruption on the final BCVA (p=0.33). Twelve eyes (75%) underwent simultaneous cataract extraction. Mean BCVA at the final postoperative visit improved regardless of whether the eyes underwent simultaneous cataract surgery (p=0.39). CMT was also significantly improved at the final visit, from 200.06±46.8 μm preoperatively to 305.00±85.5 μm (p<0.001). No full-thickness macular holes were developed postoperatively. No intraoperative or postoperative complications were observed. CONCLUSIONS Treatment of LMH with ILM flap with OVD showed promising anatomical and functional results with no postoperative head position requirements.
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Affiliation(s)
- Efraim Berco
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Roee Arnon
- Dan-Petah-Tiqwa District, Clalit Health Services, 13th David Ben Gurion, Bnei Brak, Israel.
| | - Yuval Kozlov
- Department of Military Medicine and "Tzameret", Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Nir Shoham-Hazon
- Dalhousie University Nova Scotia, Eye NB Centre of Excellence, Miramichi, New Brunswick, Canada
| | - Raman Tuli
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Assaf Hilely
- Ophthalmology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Yang X, Mo B, Yu Y, Qi B, Zhang K, Wu X, Wang X, Liu W. Clinical features of idiopathic epiretinal membrane in children and the factors influencing postoperative visual acuity. Graefes Arch Clin Exp Ophthalmol 2023; 261:3651-3657. [PMID: 37354268 DOI: 10.1007/s00417-023-06156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023] Open
Abstract
PURPOSE To describe the characteristics and surgical outcomes of idiopathic epiretinal membrane (iERM) in children and to determine the factors associated with postoperative visual acuity (VA). METHODS We retrospectively reviewed the medical records of 17 patients with iERM (age, < 18 years) who had undergone ERM surgery from 2009 to 2021. Spectral-domain optical coherence tomography features were documented. The eyes with iERMs involving the fovea were assigned to the localized and diffused groups depending on the morphological description of the membrane. Multiple linear regression analysis was used to explore the factors associated with the final VA. RESULTS The mean age was 9.2 ± 3.8 years. The mean follow-up period was 38.9 ± 45.4 months. After surgery, the central foveal thickness and the best-corrected VA (BCVA) improved significantly (all, P < 0.05). Fourteen eyes with iERMs showed involvement of the foveal area (localized group, six eyes; diffused group, eight eyes). There were no significant differences in the preoperative BCVA between the two groups (P = 0.064). However, the final BCVA was better in the diffused group than in the localized group (P = 0.043). Multiple regression analysis indicated that the localized membrane (P = 0.042) and lower preoperative BCVA (P = 0.043) were factors associated with a worse final VA in pediatric iERMs. CONCLUSIONS Surgical removal of ERM showed a high anatomical and functional success rate in children. In pediatric patients with iERMs involving the fovea, a good VA was more common when the membrane was diffused than when it was localized.
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Affiliation(s)
- Xiaohan Yang
- Dongcheng District, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, No. 1, Dongjiaominxiang, 100730, China
| | - Bin Mo
- Dongcheng District, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, No. 1, Dongjiaominxiang, 100730, China
| | - Yanping Yu
- Dongcheng District, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, No. 1, Dongjiaominxiang, 100730, China
| | - Biying Qi
- Dongcheng District, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, No. 1, Dongjiaominxiang, 100730, China
| | - Ke Zhang
- Dongcheng District, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, No. 1, Dongjiaominxiang, 100730, China
| | - Xijin Wu
- Dongcheng District, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, No. 1, Dongjiaominxiang, 100730, China
| | - Xinbo Wang
- Dongcheng District, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, No. 1, Dongjiaominxiang, 100730, China
| | - Wu Liu
- Dongcheng District, Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, No. 1, Dongjiaominxiang, 100730, China.
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Dormegny L, Foch M, Messerlin A, Bourcier T, Sauer A, Gaucher D. Binocular visual function improvement after pars plana vitrectomy for epiretinal membrane. Acta Ophthalmol 2023; 101:807-814. [PMID: 37092556 DOI: 10.1111/aos.15669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE To report binocular visual function changes after pars plana vitrectomy for epiretinal membrane (ERM) and the related outcomes. METHODS Twenty-three eyes of 23 patients operated on for ERM were included in a retrospective study. Clinical data, best-corrected visual acuity (BCVA), contrast sensitivity and binocular visual function were assessed pre- and 1 and 3 months post-operatively. Binocular visual function assessment included the evaluation of fusional amplitudes (i.e., vergences) by the synoptophore, far distance stereopsis using polarized glasses and near stereopsis using Randot and TNO tests. Central macular thickness (CMT) was measured on Spectral Domain - Optical Coherence Tomography. RESULTS Mean age of the patients was 67 years. Mean BCVA and contrast sensitivity significantly improved post-operatively at one (p = 0.0006 and p = 0.0022, respectively) and 3 months (p < 0.0001 and p < 0.0001, respectively), while CMT significantly decreased after 1-3 months (p < 0.0001 and p < 0.0001, respectively). Fusional amplitudes improved after 3 months (p < 0.0001). Far distance and near stereopsis significantly improved after 3 months (p < 0.0001 and p = 0.0007 for Randot test, and p < 0.0001 for TNO test, respectively). CONCLUSIONS Pars plana vitrectomy for ERM surgery leads to an improvement of monocular and binocular visual functions (i.e., binocular fusion, near and far distance stereopsis), within 3 months post-operatively.
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Affiliation(s)
- Lea Dormegny
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Maxime Foch
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Arnaud Messerlin
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Tristan Bourcier
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - Arnaud Sauer
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
| | - David Gaucher
- Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, FMTS, Strasbourg, France
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Lee S, You DH, Park S, Oh HS, Kwon OW. Distribution of Neurofilament in Peeled Internal Limiting Membrane. Ophthalmic Surg Lasers Imaging Retina 2023; 54:643-648. [PMID: 37956316 DOI: 10.3928/23258160-20231011-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim was to study the distribution of neurofilament in peeled internal limiting membrane (ILM). PATIENTS AND METHODS Prospective case study. Vitrectomy and ILM peeling were performed in patients with epiretinal membrane and macular hole. ILM flap specimens were obtained as one disc area size from five locations. Immunofluorescent staining was performed with an antineurofilament heavy antibody. Using a confocal microscope, retinal cell debris density was studied using the ImageJ program. RESULTS Percent of stained neurofilament was 1.58 ± 1.14% in total (2.45 ± 1.37% in extranasal, 1.97 ± 0.75% in extratemporal, 1.93 ± 1.26% in juxta-nasal, 0.89 ± 0.69% in fovea, and 0.63 ± 0.46% in juxtatemporal). The Kruskal-Wallis test revealed significant differences among groups (P < 0.05). Bonferroni post hoc analysis only confirmed significant difference between juxtatemporal and extranasal groups (P < 0.05). CONCLUSIONS In peeled ILM flap, neurofilaments are rarely detected in the juxtatemporal area. However, they are frequently detected in the extranasal area. [Ophthalmic Surg Lasers Imaging Retina 2023;54:643-648.].
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Mihalache A, Huang RS, Ahmed H, Patil NS, Popovic MM, Kertes PJ, Muni RH. Pars Plana Vitrectomy with or without Internal Limiting Membrane Peel for Epiretinal Membrane: A Systematic Review and Meta-Analysis. Ophthalmologica 2023; 247:30-43. [PMID: 37899043 DOI: 10.1159/000534851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/23/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND The safety and effectiveness of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling remains poorly understood for the treatment of epiretinal membrane (ERM). OBJECTIVES Our study aims to compare the safety and effectiveness of PPV with and without ILM peeling for ERM. METHODS A systematic literature search was conducted on Ovid MEDLINE, Embase, Cochrane Library, and Google Scholar from January 2000 to January 2023 for comparative studies reporting visual and anatomical outcomes for patients with ERM that received PPV with or without ILM peeling. Primary outcomes included best-corrected visual acuity (BCVA) at last study observation and change in BCVA from baseline. Secondary outcomes included retinal thickness (RT) at last study observation, change in RT from baseline, risk of ERM recurrence, and adverse events. A random-effects meta-analysis was performed. Risk of bias of randomized controlled trials was assessed using the Risk of Bias 2 tool of observational studies using the Risk of Bias in Non-randomized Studies of Interventions-I tool. The certainty of evidence of outcomes was evaluated using Grading of Recommendations, Assessment, Development and Evaluation criteria. RESULTS Nineteen studies reporting on 1,291 eyes at baseline were included. PPV with and without ILM peel achieved a similar BCVA at last study observation (p = 0.68) and change in BCVA from baseline (p = 0.79). These findings remained consistent irrespective of whether simultaneous phacoemulsification was performed. PPV with ILM peel achieved a significantly lower incidence of ERM recurrence (risk ratio [RR] = 0.26, 95% CI = [0.13, 0.51], p < 0.0001) and additional surgery (RR = 0.17, 95% CI = [0.04, 0.74], p = 0.02) compared to PPV without ILM peel. CONCLUSION PPV with and without ILM peel achieved a similar BCVA at last study observation in ERM patients. Patients treated with PPV and ILM peel also had a reduced risk of ERM recurrence and lower reoperation risk. These conclusions are associated with a moderate certainty of evidence and potential for bias from multiple non-randomized studies.
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Affiliation(s)
- Andrew Mihalache
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,
| | - Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Haleema Ahmed
- Faculty of Science, York University, Toronto, Ontario, Canada
| | - Nikhil S Patil
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marko M Popovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Peter J Kertes
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rajeev H Muni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Ophthalmology, St. Michael's Hospital/Unity Health Toronto, Toronto, Ontario, Canada
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Jun SY, Kong M. Microperimetric analysis of eyes after macular hole surgery with indocyanine green staining: a retrospective study. BMC Ophthalmol 2023; 23:430. [PMID: 37875860 PMCID: PMC10594931 DOI: 10.1186/s12886-023-03161-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Indocyanine green (ICG) aids in the visualization of the internal limiting membrane (ILM). Retinal damage from ICG dye toxicity has been reported through in vitro and in vivo studies. However, the clinical toxic effect of ICG during macular surgery has not been functionally evaluated. In this study, we evaluated functional and structural changes in retinal sensitivity and retinal thickness associated with ICG toxicity using microperimetry before and after ICG-assisted ILM peeling in patients with macular holes. METHODS ICG staining was performed only on the macular area below the horizontal line connecting the fovea and optic disc. ILM peeling was performed over the entire macular area inside the vascular arcade. Visual acuity assessment, spectral domain optical coherence tomography, and microperimetry were performed at baseline and one, three, and six months postoperatively. The mean retinal sensitivity of four macular areas was calculated and analyzed. RESULTS Eleven eyes were included. Macular holes were successfully closed in all patients. Six months postoperatively, retinal sensitivity improved insignificantly in Area 1 (ICG-/ILM-) and Area 2 (ICG-/ILM+) but decreased in Area 4 (ICG+/ILM-). Three months postoperatively, retinal sensitivity significantly decreased in Area 3 (ICG+/ILM+; 26.63 ± 1.80 vs. 25.52 ± 2.08 dB, p = 0.036). However, the statistical significance of this result was lost six months after the surgery (p = 0.059). The change of Gc-IPL thickness in Area 3 was significantly different compared to Area 2 at post-operative 3- and 6-months (p = 0.01, 0.05). CONCLUSIONS Retinal sensitivity decreased three months after ICG-assisted ILM peeling. However, the statistical significance was lost six months after surgery. ICG staining can be performed with caution during macular hole surgery.
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Affiliation(s)
- Sung Yeon Jun
- Department of Retinal service, Hangil Eye Hospital, Incheon, South Korea
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mingui Kong
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, 03181Korea, Seoul, South Korea.
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Kim K, Yoon K, Park JB, Kang MS, Kim ES, Yu SY. Perifoveal Microvascular Changes following Internal Limiting Membrane Peeling Surgery for Epiretinal Membrane and Macular Hole. Ophthalmologica 2023; 246:324-332. [PMID: 37806298 DOI: 10.1159/000534314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 09/24/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION The aim of the study was to evaluate perifoveal microvasculature changes following pars plana vitrectomy with internal limiting membrane peeling for the epiretinal membrane (ERM) and macular hole (MH). METHODS This retrospective study included 59 eyes from 59 patients. Subjects were divided into two groups: an ERM group (n = 43) and an MH group (n = 16) based on the initial diagnosis. Swept-source optical coherence tomography angiography (SS-OCTA) was performed in the macular area, pre- and postoperatively. Perifoveal microvascular changes were calculated using MATLAB from the 6 × 6 mm SS-OCTA images, excluding the foveal avascular zone. Pre- and postoperative perifoveal vessel densities (pfVDs) were separately analyzed in six sectors (superior, superotemporal, inferotemporal, inferior, inferonasal, and superonasal) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP). The baseline characteristics and other clinical factors were compared between the ERM and MH groups. RESULTS The postoperative best-corrected visual acuity significantly improved in both groups (p < 0.05). One year after surgery, the pfVD in the SCP of the ERM group significantly decreased in the inferotemporal sector (p = 0.049). The postoperative pfVD in the DCP of the MH group significantly decreased in temporal sectors (p < 0.05). The postoperative mean pfVD in the SCP in the MH group was significantly lower than that in the ERM group (p = 0.003). The presence of a dissociated optic nerve fiber layer (DONFL) was 75% in the MH group and 22% in the ERM group (p = 0.018). The correlation between the pfVD and DONFL was not statistically significant. CONCLUSION Postoperative pfVD reduction in the temporal sector, a corresponding area in which DONFL is present after MH surgery, was significantly observed. After vitreoretinal surgery in MH patients, OCTA may serve as a useful tool for monitoring perifoveal microvascular changes, especially in temporal sectors.
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Affiliation(s)
- Kiyoung Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Kyungwoo Yoon
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Jong Beom Park
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Min Seok Kang
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Eung Suk Kim
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
| | - Seung-Young Yu
- Department of Ophthalmology, Kyung Hee University Hospital, Kyung Hee University, Seoul, Republic of Korea
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Hikichi T, Kubo N, Tabata M. Epiretinal membrane fragments: the origin of recurrent membranes after epiretinal membrane peeling. Can J Ophthalmol 2023; 58:472-479. [PMID: 35718024 DOI: 10.1016/j.jcjo.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/24/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the participation of residual fragments of epiretinal membranes (ERMs) in recurrent ERMs after pars plana vitrectomy (PPV) for ERMs. DESIGN Retrospective comparison study. PARTICIPANTS Consecutive 195 eyes of 195 patients with ERMs who underwent PPV. METHODS Internal limiting membrane (ILM) was removed without use of Brilliant Blue G (BBG) dye in any eyes until May 2017 (group 1) and thereafter using BBG dye in all eyes (group 2). Optical coherence tomography (OCT) images were obtained 3 days and 3 years after PPV. RESULTS Group 1 was made up of 87 eyes, and group 2 was made up of 108 eyes. OCT images obtained 3 days after PPV showed ERM fragments with retinal surface wrinkling in 53 eyes (27.2%) and retinal surface wrinkling alone in 9 eyes (4.6%). OCT images obtained 3 years postoperatively showed ERMs in 63 eyes (32.3%), all of which except 1 eye had ERM fragments and (or) retinal surface wrinkling on OCT image 3 days after PPV. Residual ERM 3 days postoperatively grew in 20 (64.5%) of the 31 eyes with residual ERM 3 days postoperatively in group 1 and 5 (22.7%) of the 22 eyes with residual ERM 3 days postoperatively in group 2, which rates were significantly different (p = 0.003). CONCLUSIONS ERM fragments may be the source of recurrent ERMs after PPV, and ILM peeling assisted with BBG dye may prevent growth of residual ERM. Eliminating ERM and ILM fragments intraoperatively may effectively reduce another surgery for ERM peeling.
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Muller YG, Soudier G, Olteanu S, Lenoble P. [Effects of internal limiting membrane peeling in epiretinal membrane surgery on OCT-angiography]. J Fr Ophtalmol 2023; 46:896-907. [PMID: 37625996 DOI: 10.1016/j.jfo.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE To assess macular microvascular parameters using OCT-angiography (OCT-A) in idiopathic epiretinal membrane surgery with or without internal limiting membrane peeling. MATERIALS AND METHODS We retrospectively studied 17 eyes of 17 patients who underwent vitrectomy surgery for idiopathic epiretinal membrane with (n=10) or without (n=7) internal limiting membrane peeling. Patients operated on between July 2020 and June 2022 at the Colmar Hospital (France) by a single surgeon were evaluated before and 1 month after surgery, using OCT-A (Spectralis OCT-A module, Heidelberg Engineering®, Germany). The parameters studied were the area, perimeter and acircularity index of the foveal avascular zone (FAZ), the foveolar (FVD) and parafoveolar (PRVD) perfusion density and the macular vessel density ratio (MVR) in the superficial vascular complex (SVC) and the deep vascular complex (DVC). These parameters were measured using ImageJ software (National Institutes of Health, Bethesda, Maryland, USA). RESULTS We found no statistically significant difference between the two groups postoperatively in either area, perimeter, or acircularity index of the FAZ, FVD, PRVD, or MVR in either the SVC or DVC. CONCLUSION Our results with regard to macular microvasculature demonstrate no difference related to peeling of the internal limiting membrane and thus do not argue against this practice during epiretinal membrane surgery.
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Affiliation(s)
- Y-G Muller
- Université Louis-Pasteur, 67000 Strasbourg, France.
| | - G Soudier
- Centre ophtalmologique Dromson, Sélestat, France
| | - S Olteanu
- Hôpital Pasteur, 68000 Colmar, France
| | - P Lenoble
- Hôpital Pasteur, 68000 Colmar, France
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Shin DY, Park HYL, Shin H, Oh SE, Kim SA, Jung Y, Lee MY, Park CK. Fluctuation of Intraocular Pressure and Vascular Factors Are Associated With the Development of Epiretinal Membrane in Glaucoma. Am J Ophthalmol 2023; 254:69-79. [PMID: 37327957 DOI: 10.1016/j.ajo.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE To identify factors associated with the development of epiretinal membranes (ERM) in glaucoma patients. DESIGN Multicenter, propensity-score matched, case-control study. METHODS One hundred ninety-two eyes of 192 patients with glaucoma from the Catholic Medical Center Glaucoma Suspect Cohort Study were analyzed. We identified 64 eyes who developed ERM from the cohort, and 128 eyes without ERM were selected by propensity score matching (1:2) according to baseline age and mean deviation (MD) of the visual field (VF). Demographic, systemic, and ocular characteristics were determined at baseline. Intraocular pressure (IOP) was measured, including baseline, mean IOP, and IOP fluctuation. Early-stage ERM, defined as translucent membrane with no underlying retinal distortion, was detected by fundus photography and optical coherence tomography. Central VF progression was considered when new VF defets developed in one either or both hemifields or when there was an increase of 3 or more abnormal points within 12 points of central 10° fixation. Autonomic nervous system status was evaluated by heart rate variability. RESULTS Patients who developed ERM were more frequently receiving medication for systemic hypertension and had higher systolic blood pressure, greater IOP fluctuation, more frequent disc hemorrhage (DH), worse VF MD, and a higher rate of central VF progression than patients without ERM. Additionally, patients with early glaucoma who developed ERM had higher rate of autonomic imbalance while patients with moderate-to-advanced glaucoma who developed ERM had greater baseline and peak IOP and worse MD of the last follow-up VF (MD < 6.0 dB). Older age (P = .048), medication for systemic hypertension (P < .001), IOP fluctuation (P < .001), presence of DH (P < .001), and worse last MD of VF (P = .033) were significantly associated with ERM in Cox proportional hazard analysis. CONCLUSIONS Early stage of ERMs in glaucomatous eyes are significantly associated with glaucoma progression, medication of systemic hypertension, presence of DH, and IOP fluctuation. These suggest that glaucoma patients who develop early stage of ERMs should be carefully monitored in terms of IOP fluctuation, vascular factors, and glaucoma progression.
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Affiliation(s)
- Da Young Shin
- From the Department of Ophthalmology, The Catholic University of Korea (D.Y.S., H.-Y.L.P., H.S., S.E.O., S.A.K., Y.J., M.Y.L., C.K.P.); Eunpyeong St. Mary's Hospital (D.Y.S.)
| | - Hae-Young Lopilly Park
- From the Department of Ophthalmology, The Catholic University of Korea (D.Y.S., H.-Y.L.P., H.S., S.E.O., S.A.K., Y.J., M.Y.L., C.K.P.).
| | - Heejong Shin
- From the Department of Ophthalmology, The Catholic University of Korea (D.Y.S., H.-Y.L.P., H.S., S.E.O., S.A.K., Y.J., M.Y.L., C.K.P.); Seoul St. Mary's Hospital (H.-Y.L.P., H.S., S.E.O., S.A.K., C.K.P.)
| | - Si Eun Oh
- From the Department of Ophthalmology, The Catholic University of Korea (D.Y.S., H.-Y.L.P., H.S., S.E.O., S.A.K., Y.J., M.Y.L., C.K.P.)
| | - Seong Ah Kim
- From the Department of Ophthalmology, The Catholic University of Korea (D.Y.S., H.-Y.L.P., H.S., S.E.O., S.A.K., Y.J., M.Y.L., C.K.P.); Seoul St. Mary's Hospital (H.-Y.L.P., H.S., S.E.O., S.A.K., C.K.P.)
| | - Younhea Jung
- From the Department of Ophthalmology, The Catholic University of Korea (D.Y.S., H.-Y.L.P., H.S., S.E.O., S.A.K., Y.J., M.Y.L., C.K.P.); Yeouido St. Mary's Hospital (Y.J.)
| | - Mee Yon Lee
- From the Department of Ophthalmology, The Catholic University of Korea (D.Y.S., H.-Y.L.P., H.S., S.E.O., S.A.K., Y.J., M.Y.L., C.K.P.); Uijeongbu St. Mary's Hospital (M.Y.L.), Seoul, South Korea
| | - Chan Kee Park
- From the Department of Ophthalmology, The Catholic University of Korea (D.Y.S., H.-Y.L.P., H.S., S.E.O., S.A.K., Y.J., M.Y.L., C.K.P.); Seoul St. Mary's Hospital (H.-Y.L.P., H.S., S.E.O., S.A.K., C.K.P.)
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Schumann RG, Banyai D, Hagenau F, Mautone L, Hammer T, Wolf A, Priglinger SG, Vogt D. PORES OF THE INTERNAL LIMITING MEMBRANE: A Common Finding in Vitreomaculopathies. Retina 2023; 43:1773-1779. [PMID: 37315515 DOI: 10.1097/iae.0000000000003859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To describe presence and distribution of pores of the inner limiting membrane (ILM) in eyes with vitreomaculopathies. METHODS Inner limiting membrane specimens were harvested from 117 eyes of 117 patients during vitrectomy with membrane peeling from eyes with vitreomacular traction syndrome, idiopathic and secondary epiretinal gliosis, and idiopathic full-thickness macular hole. All specimens were processed as flat-mounts for immunocytochemistry and examined by phase-contrast, interference, and fluorescence microscopy. Demographic and clinical data were correlated. RESULTS Inner limiting membrane pores were found in all vitreomaculopathies. They were identified in 47 (40.2%) of 117 eyes being most evident with antilaminin. In eyes with full-thickness macular hole >400 µ m, pores were seen in more than half of all eyes. They occur as numerous and uniformly distributed defects of the flat-mounted ILM with a mean diameter of 9.5 ± 2.4 µ m. Edges of ILM pores are round with an irregular contour and no specific cellular pattern. Pores were distinguished from retinal vessel thinning and iatrogenic artefacts. CONCLUSION Contrary to previous reports, ILM pores are a common finding in vitreomaculopathies easily visible with antilaminin staining. Further studies are needed to clarify whether their presence correlates with differences in disease progression or imaging before and after vitrectomy with ILM peeling.
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Affiliation(s)
- Ricarda G Schumann
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Munich Eye & Vascular Medicine Center, Munich, Germany
| | - Daniel Banyai
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Ophthalmology, University Hospital Halle (Saale), Halle, Germany
| | - Felix Hagenau
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and
| | - Luca Mautone
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and
| | - Thomas Hammer
- Department of Ophthalmology, University Hospital Halle (Saale), Halle, Germany
| | - Armin Wolf
- Department of Ophthalmology, University Hospital Ulm, Ulm, Germany
| | - Siegfried G Priglinger
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Denise Vogt
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Ophthalmology, University Hospital Ulm, Ulm, Germany
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Uemura A, Miyake S, Funatsu R, Yamakiri K. CLINICAL CHARACTERISTICS AND SURGICAL OUTCOMES IN STAGE 4 MACULAR HOLE WITH EPIRETINAL PROLIFERATION. Retina 2023; 43:1550-1556. [PMID: 37262430 DOI: 10.1097/iae.0000000000003848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To investigate the clinical characteristics and surgical outcomes of Stage 4 macular holes (MHs) with epiretinal proliferation (EP) and explore the pathogenesis of MH formation. METHODS This retrospective study included consecutive patients who underwent pars plana vitrectomy for Stage 4 MH. Patients were divided into two groups based on the presence or absence of EP. Baseline characteristics, optical coherence tomography features of MHs, and surgical outcomes were compared between the groups. RESULTS EP was detected in 31 of 102 eyes with Stage 4 MH (30%). Patients with EP were older ( P = 0.044), predominantly male ( P = 0.047), had a greater axial length ( P = 0.008), and had better preoperative visual acuity ( P < 0.001) than those without EP. On optical coherence tomography, eyes with EP had more epiretinal membrane and intraretinal splitting ( P = 0.002 and P < 0.001, respectively) than those without EP. The hole closure rate after primary surgery was comparable, and visual acuity at 6 months after surgery was significantly better in eyes with EP than those without EP ( P = 0.036). In 9 eyes with EP, the medical record documented the presence of complete posterior vitreous detachment before MH development. CONCLUSION Patients of Stage 4 MH with EP were older, predominantly male, and had better preoperative and postoperative visual acuity compared with those without EP. The differences in demographic characteristics and optical coherence tomography findings suggest that the pathogenesis of Stage 4 MH with EP is different from that of Stage 4 MH without EP.
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Affiliation(s)
- Akinori Uemura
- Department of Ophthalmology, Kagoshima City Hospital, Kagoshima, Japan; and
| | - Syoki Miyake
- Department of Ophthalmology, Kagoshima City Hospital, Kagoshima, Japan; and
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ryoh Funatsu
- Department of Ophthalmology, Kagoshima City Hospital, Kagoshima, Japan; and
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Keita Yamakiri
- Department of Ophthalmology, Kagoshima City Hospital, Kagoshima, Japan; and
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Muller YG, Lenoble P. [Clinical and pathophysiological contribution of OCT-angiography to epiretinal membranes]. J Fr Ophtalmol 2023; 46:776-790. [PMID: 37164872 DOI: 10.1016/j.jfo.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 01/30/2023] [Indexed: 05/12/2023]
Abstract
Epiretinal membranes may lead to centripetal contraction forces on the retina and its vessels. OCT-Angiography (OCT-A) is a recent tool which permits a non-invasive understanding of these vascular changes. This review focuses on the OCT-A findings in idiopathic epiretinal membranes, before and after surgery, and the role of internal limiting membrane peeling. It appears that contraction of the epiretinal membrane is associated with both a reduction in the area and perimeter of the foveal avascular zone and alterations in the superficial and deep capillary plexuses. These changes mainly reflect a vascular shift from the perifoveal to the foveal region, increasing with retinal deformation, but also probable dynamic changes in vascular flow. Membrane peeling allows at least partial improvement of these microvascular parameters. Nevertheless, some limitations of OCT-A, such as segmentation errors on a retina with highly modified architecture, can lead to a selection bias in the studies and should call for caution in the interpretation of the results. Finally, internal limiting membrane peeling contributes to changes in the retinal architecture after surgery, in particular by causing a centripetal movement of the macular capillaries and a displacement of the fovea toward the optic nerve head. This role should be clarified in future studies.
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Affiliation(s)
- Y-G Muller
- Université Louis-Pasteur, 67000 Strasbourg, France.
| | - P Lenoble
- Hôpital Pasteur, 68000 Colmar, France
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Tieger MG, Kim LA, Vavvas DG. SPONTANEOUS CLOSURE AND RECURRENT OPENING TIMES TWO OF A MACULAR HOLE IN A SURGICALLY NAIVE EYE. Retin Cases Brief Rep 2023; 17:581-583. [PMID: 37643046 DOI: 10.1097/icb.0000000000001244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE To report a case of an idiopathic macular hole with recurrent opening and spontaneous closure in a surgically naive eye. METHODS A retrospective review of medical records was performed in addition to a review of the current literature. RESULTS An 82-year-old man was referred for the management of a full-thickness macular hole in the right eye. Visual acuity was 20/60, and dilated fundus examination was notable for a posterior vitreous detachment, macular hole, and mild epiretinal membrane. Optical coherence tomography confirmed the presence of a full-thickness macular hole. The patient declined surgical intervention and elected to observe. Five weeks later, optical coherence tomography confirmed spontaneous closure. One year later, a recurrent partial thickness outer retinal hole was noted on dilated fundus examination and optical coherence tomography that subsequently spontaneously closed for the second time. The following year, the patient represented with a new scotoma and metamorphopsia and was found to have a full-thickness macular hole. This time the patient was elected for surgical intervention (25-gauge pars plana vitrectomy, epiretinal membrane peel, and 14% C3F8), resulting in closure of the macular hole and improvement in visual acuity to 20/25+1. CONCLUSION This case highlights a rare presentation of a see-saw pattern of opening and closing of a macular hole in a treatment-naive eye. The presence of a posterior vitreous detachment and epiretinal membrane suggests that other factors than anterior-posterior and tangential traction may be a contributing in the formation and closure of idiopathic macular holes.
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Affiliation(s)
- Marisa G Tieger
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Wen D, Yu Z, Yang Z, Zheng C, Ren X, Shao Y, Li X. Deep learning-based postoperative visual acuity prediction in idiopathic epiretinal membrane. BMC Ophthalmol 2023; 23:361. [PMID: 37599349 PMCID: PMC10440890 DOI: 10.1186/s12886-023-03079-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND To develop a deep learning (DL) model based on preoperative optical coherence tomography (OCT) training to automatically predict the 6-month postoperative visual outcomes in patients with idiopathic epiretinal membrane (iERM). METHODS In this retrospective cohort study, a total of 442 eyes (5304 images in total) were enrolled for the development of the DL and multimodal deep fusion network (MDFN) models. All eyes were randomized into a training dataset with 265 eyes (60.0%), a validation dataset with 89 eyes (20.1%), and an internal testing dataset with the remaining 88 eyes (19.9%). The input variables for prediction consisted of macular OCT images and diverse clinical data. Inception-Resnet-v2 network was utilized to estimate the 6-month postoperative best-corrected visual acuity (BCVA). Concurrently, a regression model was developed using the clinical data and OCT parameters in the training data set for predicting postoperative BCVA. The reliability of the models was subsequently evaluated using the testing dataset. RESULTS The prediction DL algorithm exhibited a mean absolute error (MAE) of 0.070 logMAR and root mean square error (RMSE) of 0.11 logMAR in the testing dataset. The DL model demonstrated a robust promising performance with R2 = 0.80, notably superior to R2 = 0.49 of the regression model. The percentages of BCVA prediction errors within ± 0.20 logMAR amounted to 94.32% in the testing dataset. CONCLUSIONS The OCT-based DL model demonstrated sensitivity and accuracy in predicting postoperative BCVA in iERM patients. This innovative DL model exhibits substantial potential for integration into surgical planning protocols.
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Affiliation(s)
- Dejia Wen
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, 300384, China
| | - Zihao Yu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, 300384, China
| | - Zhengwei Yang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, 300384, China
| | - Chuanzhen Zheng
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, 300384, China
| | - Xinjun Ren
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, 300384, China
| | - Yan Shao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, 300384, China.
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, 251 Fukang Road, Tianjin, 300384, China.
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Adeghate JO, Goldburg SR, Marr B, Sheyman A, Winokur J, Kaden TR. Repair of a Tractional Retinal Detachment in the Setting of an Idiopathic Vasoproliferative Tumor. Ophthalmic Surg Lasers Imaging Retina 2023; 54:485-488. [PMID: 37535613 DOI: 10.3928/23258160-20230726-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Vasoproliferative tumors (VPT) are benign retinal lesions that may cause epiretinal membrane proliferation and tractional retinal detachments (TRD). We describe a case of a 71-year-old woman who presented with a macula involving TRD in the setting of a VPT. Given the limited number of publications on the management of these cases, we aim to articulate some principles we believe may be helpful in planning a surgical approach that maximizes postoperative anatomic and functional outcomes. We hope that our video provides useful guidance in preparing the vitreoretinal surgeon for managing this uncommon entity. [Ophthalmic Surg Lasers Imaging Retina 2023;54:485-488.].
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Antropoli A, Arrigo A, Bianco L, Cavallari E, Berni A, Casoni F, Consalez G, Bandello F, Cremona O, Battaglia Parodi M. HYPERREFLECTIVE BAND IN THE GANGLION CELL LAYER IN RETINITIS PIGMENTOSA. Retina 2023; 43:1348-1355. [PMID: 36996465 DOI: 10.1097/iae.0000000000003801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
PURPOSE To describe a sign that takes the form of a continuous hyperreflective band within the thickness of the ganglion cell layer (GCL), thus dubbed the "hyperreflective ganglion cell layer band" (HGB), which the authors detected in a fraction of patients affected by retinitis pigmentosa (RP). METHODS Retrospective, cross-sectional, observational study. Optical coherence tomography (OCT) images of patients with RP examined between May 2015 and June 2021 were retrospectively reviewed for the presence of HGB, epiretinal membrane (ERM), macular hole, and cystoid macular edema (CME). The ellipsoid zone (EZ) width was also measured. A subgroup of patients underwent microperimetry in the central 2°, 4°, and 10°. RESULTS One hundred and fifty-four eyes from 77 subjects were included in the study. The HGB was present in 39 (25.3%) eyes with RP. Mean best-corrected visual acuity (BCVA) was 0.39 ± 0.05 logMAR (approximately 20/50 Snellen equivalent) and 0.18 ± 0.03 logMAR (approximately 20/32 Snellen equivalent) in eyes with and without HGB, respectively ( P < 0.001). The two groups did not differ regarding EZ width; mean 2°, 4°, and 10° retinal sensitivity; and prevalence of CME, ERM, and macular hole. The multivariable analysis showed the presence of HGB to be a predictor of poorer BCVA ( P < 0.001). CONCLUSION HGB is an OCT finding detectable in approximately a quarter of eyes with RP and is associated with a poorer visual function. In the discussion, the authors speculate about possible morphogenetic scenarios to explain this observation.
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Affiliation(s)
- Alessio Antropoli
- Department of Ophthalmology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Alessandro Arrigo
- Department of Ophthalmology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Lorenzo Bianco
- Department of Ophthalmology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Elena Cavallari
- Department of Ophthalmology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | - Alessandro Berni
- Department of Ophthalmology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | | | | | - Francesco Bandello
- Department of Ophthalmology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
| | | | - Maurizio Battaglia Parodi
- Department of Ophthalmology, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; and
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Honzawa K, Horiguchi H, Terauchi R, Iida Y, Katagiri S, Gunji H, Nakano T. RHOMBUS DEFORMATION OF RETINAL LATERAL DISPLACEMENT AFTER EPIRETINAL MEMBRANE REMOVAL REVEALED BY DIFFEOMORPHIC IMAGE REGISTRATION. Retina 2023; 43:1132-1142. [PMID: 36893431 DOI: 10.1097/iae.0000000000003775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE To establish an analysis method using diffeomorphic image registration and evaluate microvascular displacement through epiretinal membrane (ERM) removal. METHODS Medical records of eyes that underwent vitreous surgery for ERM were reviewed. Postoperative optical coherence tomography angiography (OCTA) images were converted to the corresponding preoperative images according to a configured algorithm using diffeomorphism. RESULTS Thirty-seven eyes with ERM were examined. Measured changes in the foveal avascular zone (FAZ) area showed a significant negative correlation with central foveal thickness (CFT). The average amplitude of microvascular displacement calculated for each pixel was 69 ± 27 µ m in the nasal area, which was relatively smaller than that in other areas. The vector map, which included both the amplitude and the vector of microvasculature displacement, showed a unique vector flow pattern called the rhombus deformation sign in 17 eyes. Eyes with this deformation sign showed less surgery-induced changes in the FAZ area and CFT and a milder ERM stage than those without this sign. CONCLUSION The authors calculated and visualized microvascular displacement using diffeomorphism. The authors found a unique pattern (rhombus deformation) of retinal lateral displacement through ERM removal, which was significantly associated with the severity of ERM.
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Affiliation(s)
- Koki Honzawa
- Department of Ophthalmology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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Meng J, Chen Y, Cheng K, Qi J, Du Y, Yao Y, He W, Zhang K, Lu Y, Zhu X. LONG-TERM PROGRESSION PATTERN OF MYOPIC TRACTIONAL MACULOPATHY: Outcomes and Risk Factors. Retina 2023; 43:1189-1197. [PMID: 36977327 DOI: 10.1097/iae.0000000000003791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PURPOSE To evaluate the long-term progression pattern of myopic tractional maculopathy and the risk factors. METHODS The prevalence and grade of myopic tractional maculopathy were assessed with optical coherence tomography at enrollment and at the 2-year follow-up. The severity of posterior staphyloma and the presence of dome-shaped macula were also evaluated. RESULTS In total, 610 highly myopic eyes of 610 patients were analyzed. The prevalence of epiretinal membrane, myopic retinoschisis, and macular hole increased from 26.7%, 12.1%, and 4.4% at enrollment to 41.1%, 18.2%, and 9.5% at the 2-year follow-up, respectively. Epiretinal membrane progressed in 21.8% of eyes, but visual acuity did not decline significantly in these eyes. Myopic retinoschisis progressed in 6.8% of eyes, and macular hole progressed in 14.8% of eyes. Significantly greater best-corrected visual acuity reduction was detected in the eyes with myopic retinoschisis or macular hole progression than the rest ( P < 0.05). Multivariate analysis showed that longer axial length, more-severe posterior staphyloma, and absence of dome-shaped macula were associated with myopic tractional maculopathy progression. CONCLUSION In highly myopic eyes, long-term visual acuity was relatively stable in those with epiretinal membrane, but was significantly affected by myopic retinoschisis or macular hole progression. Longer axial length, more-severe posterior staphyloma, and absence of dome-shaped macula were risk factors for myopic tractional maculopathy progression.
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Affiliation(s)
- Jiaqi Meng
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Yuxi Chen
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Kaiwen Cheng
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Jiao Qi
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China; and
| | - Yu Du
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China; and
| | - Yunqian Yao
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China; and
| | - Wenwen He
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China; and
| | - Keke Zhang
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China; and
| | - Yi Lu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China; and
| | - Xiangjia Zhu
- Eye Institute and Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
- NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai 200031, China
- Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai 200031, China; and
- State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200032, China
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Wu M, Ren X, Chen Y, Chen L, Lian H, Li H, Li Q, Zheng B. PATHOLOGIC STUDY OF UNTREATED INTRARETINAL GLIOSIS SURGICALLY EXCISED VIA PARS PLANA VITRECTOMY. Retina 2023; 43:1143-1149. [PMID: 36913626 DOI: 10.1097/iae.0000000000003777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE To evaluate the pathologic process of intraretinal glioses by investigating mass tissues resected from untreated eyes with intraretinal glioses. METHODS Five patients with intraretinal gliosis without previous conservative treatment were included. All patients underwent pars plana vitrectomy. The mass tissues were excised and processed for the pathologic study. RESULTS During surgery, it was observed that the intraretinal gliosis mainly affected the neuroretina and the retinal pigment epithelium was not affected. Pathologic examination revealed that all intraretinal glioses consisted of different proportions of hyaline vessels and hyperplastic spindle-shaped glial cells. In one case, the intraretinal gliosis was mainly composed of hyaline vascular components. In another case, the intraretinal gliosis showed a predominance of glial cells. The intraretinal glioses in the other three cases had vascular and glial components. The proliferated vessels showed different amounts of collagen deposits against different backgrounds. Vascularized epiretinal membrane was found in some intraretinal glioses. CONCLUSION Intraretinal glioses affected the inner retinal layer. Hyaline vessels were the most characteristic pathologic changes; the proportion of proliferative glial cells varied in different intraretinal glioses. The natural course of intraretinal gliosis may involve the proliferation of abnormal vessels in the early stage, which then gradually become scarred and are replaced by glial cells.
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Affiliation(s)
- Mengai Wu
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Xinyu Ren
- Department of Pathology, State Key Laboratory of Complex Severe and Rare Disease, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Chen
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Lifeng Chen
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Hengli Lian
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Haidong Li
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Qiuming Li
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China; and
| | - Bin Zheng
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
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Qin G, Lin T, You Y, Shang M, He W, Pazo EE. Blood inflammatory biomarkers in participants with idiopathic epiretinal membrane: A retrospective case series study. Medicine (Baltimore) 2023; 102:e34225. [PMID: 37390242 PMCID: PMC10313294 DOI: 10.1097/md.0000000000034225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
The objective was to evaluate the levels of monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in patients with idiopathic epiretinal membrane (iERM). This retrospective case series study comprised of participants with iERM and participants with cataract. The values of MLR, NLR, PLR and from participants' peripheral blood were assessed among groups. The best cutoff value of MLR, NLR, and PLR in iERM was found by performing a receiver operating characteristic curve analysis and determining the optimum cutoff value for each variable. In total, 95 participants with iERM were included in the study group, and 61 participants with senile cataract were included as controls. The lymphocyte count in the iERM group was significantly lower than the control group (1.69 ± 0.63 vs. 1.95 ± 0.53, P = .003). The monocyte count in the iERM group was significantly higher than the control group (0.39 ± 0.11 vs. 0.31 ± 0.10, P < .001). The area under the curve of MLR, NLR, and PLR in differentiating patients with IERM and controls was 0.782, 0.645, and 0.657, respectively, according to receiver operating characteristic. The best cutoff value of MLR was > 0.18, with sensitivity and specificity of 74.7% and 75.4%, respectively. The NLR was > 2.06, with a sensitivity and specificity of 50.5% and 83.6%, respectively. The PLR was > 95.89, with a sensitivity and specificity of 86.3% and 41.0%, respectively. The findings of this study suggest that systemic inflammation may be associated with iERM. IERM patients may be prone to have high MLR, NLR, and PLR values.
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Affiliation(s)
| | - Tiezhu Lin
- He Eye Specialist Hospital, Shenyang, China
| | - Yue You
- Sinqi Eye Hospital, Shenyang, China
| | | | - Wei He
- He Eye Specialist Hospital, Shenyang, China
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Tieger MG, Vavvas DG. Impact of phacoemulsification on posterior vitreous detachment formation in eyes with vitreomacular traction. Digit J Ophthalmol 2023; 29:26-30. [PMID: 37727466 PMCID: PMC10506616 DOI: 10.5693/djo.01.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Purpose To investigate the impact of phacoemulsification on posterior vitreous detachment formation in eyes with vitreomacular traction (VMT) with or without macular holes. Methods A retrospective search of the medical records was conducted to identify patients with VMT who underwent cataract surgery at Mass Eye and Ear from 2016 to 2021. Patient demographics, ocular comorbidities, and clinical characteristics were extracted from the record, and optical coherence tomography images were assessed to confirm VMT and the presence of a lamellar or full-thickness macular hole (FMTH). Patients who underwent vitrectomy prior to cataract surgery were excluded. Results A total of 22 patients (15 women [68%]) met inclusion criteria (average age, 71 years). Fifteen eyes had an associated epiretinal membrane (63%), 7 had a lamellar hole (29%), and 8 had an FTMH (33%). Epiretinal membrane was present in 3 of 7 eyes with lamellar holes (43%) and 4 of 8 with a FTMH (50%). No eyes developed a complete posterior vitreous detachment following phacoemulsification. In 2 cases, there was progression of the macular hole stage following phacoemulsification. Ten eyes underwent subsequent pars plana vitrectomy (PPV). There was no statistically significant difference in visual acuity between eyes pre- and post-phacoemulsification; however, there was a statistically significant improvement in visual acuity pre- and post-PPV. Conclusions Unlike other studies, in this case series of 24 eyes with VMT or VMT with holes, no cases of full posterior vitreous detachment occurred following unremarkable phacoemulsification or YAG capsulotomy.
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Affiliation(s)
- Marisa G. Tieger
- Retina Service, Department of Ophthalmology Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Demetrios G. Vavvas
- Retina Service, Department of Ophthalmology Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
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Yeh TC, Chen SJ, Chou YB, Luo AC, Deng YS, Lee YH, Chang PH, Lin CJ, Tai MC, Chen YC, Ko YC. PREDICTING VISUAL OUTCOME AFTER SURGERY IN PATIENTS WITH IDIOPATHIC EPIRETINAL MEMBRANE USING A NOVEL CONVOLUTIONAL NEURAL NETWORK. Retina 2023; 43:767-774. [PMID: 36727822 DOI: 10.1097/iae.0000000000003714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To develop a deep convolutional neural network that enables the prediction of postoperative visual outcomes after epiretinal membrane surgery based on preoperative optical coherence tomography images and clinical parameters to refine surgical decision making. METHODS A total of 529 patients with idiopathic epiretinal membrane who underwent standard vitrectomy with epiretinal membrane peeling surgery by two surgeons between January 1, 2014, and June 1, 2020, were enrolled. The newly developed Heterogeneous Data Fusion Net was introduced to predict postoperative visual acuity outcomes (improvement ≥2 lines in Snellen chart) 12 months after surgery based on preoperative cross-sectional optical coherence tomography images and clinical factors, including age, sex, and preoperative visual acuity. The predictive accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve of the convolutional neural network model were evaluated. RESULTS The developed model demonstrated an overall accuracy for visual outcome prediction of 88.68% (95% CI, 79.0%-95.7%) with an area under the receiver operating characteristic curve of 97.8% (95% CI, 86.8%-98.0%), sensitivity of 87.0% (95% CI, 67.9%-95.5%), specificity of 92.9% (95% CI, 77.4%-98.0%), precision of 0.909, recall of 0.870, and F1 score of 0.889. The heatmaps identified the critical area for prediction as the ellipsoid zone of photoreceptors and the superficial retina, which was subjected to tangential traction of the proliferative membrane. CONCLUSION The novel Heterogeneous Data Fusion Net demonstrated high accuracy in the automated prediction of visual outcomes after weighing and leveraging multiple clinical parameters, including optical coherence tomography images. This approach may be helpful in establishing personalized therapeutic strategies for epiretinal membrane management.
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Affiliation(s)
- Tsai-Chu Yeh
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Yu-Bai Chou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - An-Chun Luo
- Industrial Technology Research Institute, Taipei City, Taiwan
| | - Yu-Shan Deng
- Industrial Technology Research Institute, Taipei City, Taiwan
| | - Yu-Hsien Lee
- Industrial Technology Research Institute, Taipei City, Taiwan
| | - Po-Han Chang
- Industrial Technology Research Institute, Taipei City, Taiwan
| | - Chun-Ju Lin
- Industrial Technology Research Institute, Taipei City, Taiwan
| | - Ming-Chi Tai
- Industrial Technology Research Institute, Taipei City, Taiwan
- Department of Materials Science and Engineering, National Tsing-Hua University, Taipei City, Taiwan; and
| | - Ying-Chi Chen
- Division of Computer Science and Engineering, University of Michigan, Ann Arbor, Michigan
| | - Yu-Chieh Ko
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei City, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
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Su YT, Yang CM, Lai TT. Multimodel Imaging Evidence of Traction Component in Lamellar Macular Hole with Epiretinal Proliferation. Ophthalmic Res 2023; 66:835-845. [PMID: 37040723 PMCID: PMC10308544 DOI: 10.1159/000530529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION The aim of this study was to investigate the association of epiretinal traction in idiopathic lamellar macular hole (LMH) with or without lamellar hole-associated epiretinal proliferation (LHEP). METHODS A retrospective consecutive case series included 108 eyes diagnosed with LMH in a single tertiary referral center. Epiretinal traction was determined by the presence of epiretinal membrane (ERM), attached posterior hyaloid, or vascular traction with multimodal imaging studies and intraoperative findings in those received surgical interventions. RESULTS The 53 LMHs with LHEP had similar age, refraction, initial, and final visual acuity to the 55 LMHs without LHEP. Both groups exhibited high incidences of vascular traction (with and without LHEP: 92% and 84%, p = 0.36, respectively) and ERM and/or attached posterior hyaloid (both 100%, p = 1.00). The vision improved 10.5 and 14 ETDRS letters (p = 0.60) in the 30 eyes with and 19 eyes without LHEP that underwent vitrectomy. Vascular tractions released postoperatively in 88% and 100% of LMHs with and without LHEP, respectively (p = 0.27). The LMH, ERM foveoschisis, and mixed subtypes exhibited epiretinal traction in 100% of cases in all subtypes (p = 1.00). CONCLUSION Our findings indicated that epiretinal traction, evaluated by multimodal imaging, is the norm rather than the exception in LMHs showing LHEP. The presence of tractional forces should be taken into consideration when treatment was planned in LMHs.
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Affiliation(s)
- Yu-Ting Su
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tso-Ting Lai
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Wakabayashi T, Torjani A, Mahmoudzadeh R, Swaminathan S, Mansour HA, Salabati M, Yonekawa Y, Regillo CD. Risk Factors for Epiretinal Membrane After Rhegmatogenous Retinal Detachment Repair: Quantitative Ultra Widefield Imaging Analysis. Ophthalmic Surg Lasers Imaging Retina 2023; 54:206-216. [PMID: 37043411 DOI: 10.3928/23258160-20230307-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
BACKGROUND AND OBJECTIVE To utilize quantitative ultra widefield retinal imaging to investigate the risk factors associated with the incidence and severity of postoperative epiretinal membrane (ERM) in patients who underwent primary rhegmatogenous retinal detachment (RRD) repair. PATIENTS AND METHODS This retrospective study included patients who underwent pars plana vitrectomy (PPV) with scleral buckle (SB) for RRD, without a prior history of ERM, and who underwent ultra widefield imaging postoperatively between June 2020 and February 2022. The size and location (distance from the macula) of the drainage retinotomy and the area of peripheral pathology, including retinal breaks and laser scars, were quantitatively measured with cloud-based software. The severity of postoperative ERM formation at 6 months was graded from grade 1 to 4. We investigated the risk factors that were significantly associated with the incidence and severity of postoperative ERM at 6 months. RESULTS We included 80 eyes (80 patients) in this study. Postoperative ERM developed in 37 eyes (46%) at 6 months. The severity of ERM was grade 1 in 24 eyes (65%), grade 2 in 6 eyes (16%), grade 3 in 4 eyes (11%), and grade 4 in 3 eyes (8%). Postoperative ERM was not associated with the presence or the location of drainage retinotomy (P = 0.836 and 0.820, respectively). However, it was significantly associated with larger surface area of drainage retinotomy (P = 0.039). In addition, postoperative ERM was significantly associated with a larger area of peripheral pathology (P = 0.012), a larger extent of RRD (P = 0.013), vitreous hemorrhage (P = 0.026), redetachment within 6 months (P = 0.022), use of silicone oil as a tamponade (P = 0.047), and number of surgeries within 6 months (P = 0.027). These factors, in addition to 360° endolaser, were also significantly associated with the severity of postoperative ERM. In multivariable linear regression analysis, the only variable that remained statistically significant was the size of the drainage retinotomy (P = 0.023). CONCLUSION The pathogenesis of postoperative ERM is multifactorial. Large drainage retinotomies may increase the risk of ERM formation. [Ophthalmic Surg Lasers Imaging Retina 2023;54:206-216.].
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Mahmoudinezhad G, Salazar D, Morales E, Tran P, Lee J, Hubschman JP, Nouri-Mahdavi K, Caprioli J. Risk factors for microcystic macular oedema in glaucoma. Br J Ophthalmol 2023; 107:505-510. [PMID: 34740886 PMCID: PMC9068828 DOI: 10.1136/bjophthalmol-2021-320137] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To identify clinical characteristics and factors associated with microcystic macular edema (MME) in patients with primary open-angle glaucoma (POAG). METHODS We included 315 POAG eyes between 2010 and 2019 with good-quality macular volume scans that had reliable visual fields (VF) available within 6 months in this observational retrospective cohort study. Eyes with retinal pathologies except for epiretinal membrane (ERM) were excluded. The inner nuclear layer was qualitatively assessed for the presence of MME. Global mean deviation (MD) and Visual Field Index (VFI) decay rates, superior and inferior MD rates and pointwise total deviation rates of change were estimated with linear regression. Logistic regression was performed to identify baseline factors associated with the presence of MME and to determine whether MME is associated with progressive VF loss. RESULTS 25 out of 315 eyes (7.9%) demonstrated MME. The average (±SD) age and MD in eyes with and without MME was 57.2 (±8.7) versus 62.0 (±9.9) years (p=0.02) and -9.8 (±5.7) versus -4.9 (±5.3) dB (p<0.001), respectively. Worse global MD at baseline (p=0.001) and younger age (p=0.02) were associated with presence of MME. ERM was not associated with the presence of MME (p=0.84) in this cohort. MME was not associated with MD and VFI decay rates (p>0.49). CONCLUSIONS More severe glaucoma and younger age were associated with MME. MME was not associated with faster global VF decay in this cohort. MME may confound monitoring of glaucoma with full macular thickness.
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Affiliation(s)
| | - Diana Salazar
- Ophthalmology, Glaucoma, University of California Los Angeles, Los Angeles, CA, USA
| | - Esteban Morales
- Ophthalmology, Glaucoma, University of California Los Angeles, Los Angeles, CA, USA
| | - Peter Tran
- Ophthalmology, Glaucoma, University of California Los Angeles, Los Angeles, CA, USA
| | - Janet Lee
- Ophthalmology, Retina, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Kouros Nouri-Mahdavi
- Ophthalmology, Glaucoma, University of California Los Angeles, Los Angeles, CA, USA
| | - Joseph Caprioli
- Ophthalmology, Glaucoma, University of California Los Angeles, Los Angeles, CA, USA
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Li H, Zhang C, Li H, Yang S, Liu Y, Wang F. Effects of disorganization of retinal inner layers for Idiopathic epiretinal membrane surgery: the surgical status and prognosis. BMC Ophthalmol 2023; 23:108. [PMID: 36932394 PMCID: PMC10022165 DOI: 10.1186/s12886-023-02856-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/11/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND To compare the surgical status in idiopathic epiretinal membrane (IERM) patients with or without disorganization of retinal inner layers (DRIL) and to correlate with optical coherence tomography angiography (OCTA) and clinical data. METHODS In 74 eyes from 74 patients with IERM treated by surgery with 12-month follow-up. According to the superficial hemorrhage, the patients were divided into group A (no macular bleeding), group B (macular parafoveal bleeding) and group C (macular foveal bleeding). Optical coherence tomography (OCT) were evaluated for presence of DRIL,central retina thickness and integrity of the inner/outer segment layer recorded at baseline and at 1, 3, 6, and 12 months postoperatively and best-corrected visual acuity (BCVA) was recorded simultaneously. OCTA was conducted at 12 months postoperatively. Main outcome measures is correlation between DRIL and superficial hemorrhage in membrane peeling,and BCVA and OCTA outcomes postoperatively. RESULTS The rate of DRIL and BCVA had statistically significant differences between the three groups at the time points(baseline and 1, 3, 6, and 12 months after surgery), respectively (P < 0.001 for all). FD-300 value (P = 0.001)and DCP in all parafoveal regions (superior: P = 0.001; inferior: P = 0.002;Nasal: P = 0.014;Tempo: P = 0.004) in eyes with DRIL were lower than those without DRIL.There was a linear regression relationship between FD-300 and postoperative BCVA (P = 0.011). CONCLUSION IERM Patients with DRIL have more intraoperative adverse events and limited benefits from surgery which should be considered in the decision whether to perform mebrane peeling.OCT-A provides more detailed vascular information that extends our understanding of persistent DRIL.
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Affiliation(s)
- Huanhuan Li
- Department of Ophthalmology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Suzhou University, Chang Zhou, 213003, China
| | - Conghui Zhang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shang Hai, 200072, China
| | - Hui Li
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shang Hai, 200072, China
| | - Shuai Yang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shang Hai, 200072, China
| | - Yao Liu
- Department of Ophthalmology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Suzhou University, Chang Zhou, 213003, China.
| | - Fang Wang
- Department of Ophthalmology, Shanghai Tenth People's Hospital, Tongji University, Shang Hai, 200072, China.
- Purui Eye Group, Shanghai Purui Eye Hospital, Shang Hai, 200336, China.
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50
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Murphy G, Owasil R, Kanavati S, Ashena Z, Nanavaty MA. Preoperative fundoscopy versus optical coherence tomography to detect occult maculopathy during cataract surgery preassessment. Eye (Lond) 2023; 37:665-669. [PMID: 35332291 PMCID: PMC8945867 DOI: 10.1038/s41433-022-02027-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 03/05/2022] [Accepted: 03/11/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the proportion of maculopathy detectable only on optical coherence tomography (OCT) versus slit lamp indirect ophthalmoscopy (SLIO) during cataract assessment. METHODS Population: Consecutive patients attending cataract assessments. DATA COLLECTION All patients underwent OCT and SLIO. SLIO findings were recorded before reviewing OCT. Scans were examined to compare with recorded SLIO findings. PRIMARY OUTCOME analyse the proportion of eyes with maculopathy missed by SLIO. SECONDARY OUTCOME to assess the proportion of patients with maculopathy on OCT, the incidence of maculopathy in the fellow eye on OCT and proportion with cataracts too dense to allow SLIO or OCT. RESULTS Six hundred twenty-six patients were enroled. Eighty (12.8%) had maculopathy detectable only on OCT which included: 26 (4.2%) epiretinal membrane (ERM), 25 (4%) dry age-related macular degeneration (AMD), 19 (3%) vitreomacular traction (VMT), 5 (0.8%) lamellar macular hole (LMH), 2 (0.3%) cystoid macular oedema (CMO) and 1 (0.2%) wet AMD. 166 (26.5%) had maculopathy on OCT, of which only 48 (7.7%) had known history of maculopathy. In fellow eyes, 29 (4.6%) had significant findings and 29 (4.6%) were unable to have SLIO or OCT due to dense cataract. CONCLUSIONS A quarter of the patients had occult maculopathy. One-tenth of the occult maculopathy were missed without OCT, with ERM, dry AMD, VMT, LMH, CMO and wet AMD being the primary missed diagnosis. Less than 5% had occult maculopathy in fellow eye, and <5% had dense cataracts where neither SLIO nor OCT was not possible.
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Affiliation(s)
- George Murphy
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton, BN2 5BF, UK
| | - Raisah Owasil
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton, BN2 5BF, UK
| | - Sam Kanavati
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton, BN2 5BF, UK
| | - Zahra Ashena
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton, BN2 5BF, UK
| | - Mayank A Nanavaty
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Eastern Road, Brighton, BN2 5BF, UK.
- Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PX, UK.
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