Long-Term Anatomical and Functional Outcomes after Combined Cataract and Idiopathic Epiretinal Membrane Surgery.

PURPOSE: To describe the 2-year functional and anatomical outcomes in patients operated on for combined cataract and idiopathic epiretinal membrane (ERM) and to study the relationship between best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) throughout the follow-up. METHODS: This retrospective observational case series included 72 eyes operated on for combined cataract and idiopathic ERM. They were followed with clinical and SD-OCT examinations preoperatively and 1, 6, 12, and 24 months after surgery. Foveolar thickness (FT), photoreceptor status and morphological parameters were assessed. RESULTS: BCVA and FT substantially improved at 24 months. Postoperatively, no significant improvement was observed beyond 6 months for BCVA and 12 months for FT. Outer limiting membrane and inner and outer segment junction disruption scores were well correlated with BCVA both pre- and postoperatively, and significant visual improvement was demonstrated in each subgroup except in those with the highest scores. FT was correlated with BCVA only from 6 to 24 months postoperatively. CONCLUSION: After combined cataract and idiopathic ERM surgery, BCVA and FT improved rapidly. Most functional and anatomical recovery took place within the first 6 months, but this did not preclude late improvement, in particular in patients with the most disorganized photoreceptor layers. At each time point, the amount of photoreceptor damage seemed closely correlated with visual acuity, but concerning FT, this relationship remains questionable.

Retinal Vein Occlusions: Therapeutic Switch in Macular Oedema Treatment with a 12-Month Follow-Up.

PURPOSE: To compare the visual and anatomical outcomes of patients with macular oedema secondary to retinal vein occlusion (RVO) after a switch from bevacizumab to intravitreal injection of a dexamethasone implant (IVI-DEX) or conversely. METHODS: 48 patients - 40 in the antivascular endothelial growth factor (VEGF) DEX sequence (AD group), 8 in the DEX anti-VEGF sequence (DA group) - were included in this multicentre retrospective study and evaluated at baseline, 1, 3, 6 and 12 months after the switch. The outcome measurements were visual acuity (VA) and central macular thickness (CMT) evaluated by spectral domain optical coherence tomography. Patients were defined as 'good responders' if CMT was ≤ 300 µm after the switch. RESULTS: VA significantly improved at 1 month in the AD group (p = 0.03) but not in the DA group (p = 0.40). CMT decreased significantly in the AD group at 1, 6 and 12 months (p = 0.002, p = 0.005 and p = 0.002, respectively). In the DA group, VA did not change from baseline at any time point, and CMT decreased at 1 month (p = 0.02) but not later on. CONCLUSIONS: In patients with macula oedema secondary to RVO, the switch from bevacizumab to IVI-DEX seems more beneficial in terms of short-term VA and long-term reduction of CMT than the DEX anti-VEGF agent sequence.

Comparison between subjective and objective internal limiting membrane peeling area during epiretinal membrane surgery.

PURPOSE: To determine the reliability of surgeons in estimating internal limiting membrane peeling area during epiretinal membrane surgery and to evaluate their ability to remove a predetermined internal limiting membrane surface. METHODS: One senior surgeon and two junior surgeons were asked to reach a target internal limiting membrane peeling surface (ILMPS) with an eccentricity of 1 optic disk diameter (centered on the fovea) in patients undergoing epiretinal membrane surgery. The ILMPS was measured on video recordings during epiretinal membrane surgery with no dye and then after brilliant blue G staining. RESULTS: Thirty patients were included. Median (interquartile range) ILMPS was 9.3 mm(2) (5.7-16.3 mm(2)) and 7.4 mm(2) (3.7-16.4 mm) before and after brilliant blue G, respectively (P = 0.17). The ILMPS was significantly larger in eyes operated by the senior surgeon than in those operated by the junior surgeons (P = 0.01). The senior surgeon reached the target ILMPS more often than the junior surgeons: 87% versus 47%, respectively (P = 0.02). CONCLUSION: Subjective estimation of the ILMPS with no dye was fair, but this area was larger for the surgeon with greater surgical expertise.

Long-term anatomical and functional outcomes of idiopathic macular hole surgery. The yield of spectral-domain OCT combined with microperimetry.

BACKGROUND: To evaluate the correlations between anatomical and functional changes studied with microperimetry (MPM) and spectral-domain OCT (SD-OCT) in patients after successful repair of idiopathic macular hole (MH). METHODS: Monocentric, retrospective, interventional study in 23 eyes of 23 patients who underwent successful surgery for MH defined as closure of the hole, at least 1 year before. Reported data were pre- and postoperative best-corrected visual acuity (BCVA), retinal sensitivity values on MPM, macular and foveal thicknesses, and retinal anatomic lesions on SD-OCT. RESULTS: Macular sensitivity (MS) and foveal sensitivity (FS) were lower and the number of lesions of the outer retinal layers was higher in patients with a poorer postoperative VA (P = 0.029, P = 0.011 and P = 0.003 respectively). Preoperative MH size was lower and MS and FS were better in patients with a preserved junction line between the inner and outer segments of photoreceptors (IS/OS) (P = 0.045, P = 0.001, and P = 0.001 respectively). Better postoperative VA was correlated with better preoperative VA (P = 0.012, r = 0.513). Postoperative VA was correlated with MS and FS (P = 0.032, r = 0.449, and P = 0.019, r = 0.483 respectively). Greater foveal thickness was associated with better postoperative VA (P = 0.020, r = 0.482). CONCLUSION: Postoperative outer retinal layer integrity is associated with better final retinal sensitivity. Further studies are warranted to assess the role of SD-OCT and microperimetry in the pre- and postoperative evaluation of idiopathic macular holes.

Preoperative Prognostic Factors and Predictive Score in Patients Operated On for Combined Cataract and Idiopathic Epiretinal Membrane.

PURPOSE: To report preoperative prognostic factors associated with visual acuity recovery 1 year after combined cataract and idiopathic epiretinal membrane (ERM) surgery and to introduce a predictive score. DESIGN: Interventional case series and estimation of a predictive score. METHODS: One hundred forty-two patients (1 eye per patient) operated on for combined cataract and idiopathic ERM in the University Hospital of Dijon were followed for 12 months. Preoperative clinical features and spectral-domain optical coherence tomography (OCT) parameters were compared between eyes that recovered ≥20/20 final best-corrected visual acuity (BCVA) and those with <20/20 final BCVA. Multivariate analysis and predictive score were provided. RESULTS: At 12 months, 60 eyes (42%) recovered ≥20/20 BCVA and 82 (58%) had lower visual results. Logistic regression analysis showed that final BCVA was associated with age (P = .040), duration of symptoms (P = .025), initial BCVA (P = .002), and inner and outer segment (IS/OS) junction disruption on spectral-domain OCT (P = .010). The preoperative 10-point predictive score including these parameters reached 82% sensitivity and 66% specificity. With a score >5, patients had a ≥56% chance of recovering 20/20 final BCVA instead of ≤27% when the score was ≤5. CONCLUSIONS: Age, duration of symptoms, and initial BCVA appear to be reliable prognostic factors in patients undergoing combined cataract and idiopathic ERM surgery. Combining these factors with analysis of the IS/OS junction provides a predictive score to estimate individual chances of good visual outcome.

Erythrocyte phospholipid and polyunsaturated fatty acid composition in diabetic retinopathy.

BACKGROUND: Long chain polyunsaturated fatty acids (LCPUFAs) including docosahexaenoic acid and arachidonic acid are suspected to play a key role in the pathogenesis of diabetes. LCPUFAs are known to be preferentially concentrated in specific phospholipids termed as plasmalogens. This study was aimed to highlight potential changes in the metabolism of phospholipids, and particularly plasmalogens, and LCPUFAs at various stages of diabetic retinopathy in humans. METHODOLOGY AND PRINCIPAL FINDINGS: We performed lipidomic analyses on red blood cell membranes from controls and mainly type 2 diabetes mellitus patients with or without retinopathy. The fatty acid composition of erythrocytes was determined by gas chromatography and the phospholipid structure was determined by liquid chromatography equipped with an electrospray ionisation source and coupled with a tandem mass spectrometer (LC-ESI-MS/MS). A significant decrease in levels of docosahexaenoic acid and arachidonic acid in erythrocytes of diabetic patients with or without retinopathy was observed. The origin of this decrease was a loss of phosphatidyl-ethanolamine phospholipids esterified with these LCPUFAs. In diabetic patients without retinopathy, this change was balanced by an increase in the levels of several phosphatidyl-choline species. No influence of diabetes nor of diabetic retinopathy was observed on the concentrations of plasmalogen-type phospholipids. CONCLUSIONS AND SIGNIFICANCE: Diabetes and diabetic retinopathy were associated with a reduction of erythrocyte LCPUFAs in phosphatidyl-ethanolamines. The increase of the amounts of phosphatidyl-choline species in erythrocytes of diabetic patients without diabetic retinopathy might be a compensatory mechanism for the loss of LC-PUFA-rich phosphatidyl-ethanolamines.