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1.
BMC Ophthalmol ; 22(1): 198, 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35501767

RESUMO

BACKGROUND: This study aimed to evaluate macular vessel tortuosity using optical coherence tomography angiography (OCTA) and its association with visual outcomes in eyes undergoing surgery for epiretinal membrane (ERM). METHODS: The study included 22 consecutive patients who underwent vitrectomy for ERM between May 2019 and July 2020 and OCTA at Osaka University Hospital. All patients underwent ophthalmologic examinations, including swept-source OCTA. Standard vitrectomy was performed, and the patients were followed up for 6 months postoperatively. Distortion of retinal vessels was calculated using two parameters: the actual vessel length in the vessel section (VL) and the direct vessel branching point distance (BD) in the three quadrants (nasal, temporal, and superior-inferior) of the macula. We analyzed the correlation between these parameters and visual outcomes. RESULTS: Significantly longer VL was found at 1, 3, and 6 months postoperatively (p = 0.006, 0.008, and 0.022, respectively) in the temporal quadrant compared to baseline temporal VL. Significantly shorter VL was found in nasal quadrants at 1 and 3 months (p = 0.046 and p = 0.018) in the comparison of nasal baseline VL. VL/BDs were correlated with the same postoperative best-corrected visual acuity (BCVA) at 1, 3, and 6 months (p = 0.035, 0.035, and 0.042, respectively) in the superior-inferior quadrant. A significant association of changes in VL and BCVA was found at 3 and 6 months postoperatively in the nasal quadrant (p = 0.018 and 0.0455, respectively). CONCLUSIONS: Changes in vascular distortion after ERM surgery can be measured using OCTA. The change in vessels around the macula became more linear; this was associated with visual outcomes after surgery.


Assuntos
Membrana Epirretiniana , Macula Lutea , Angiografia , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/cirurgia , Humanos , Tomografia de Coerência Óptica/métodos , Acuidade Visual
2.
Rom J Ophthalmol ; 66(1): 79-83, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35531456

RESUMO

Objective: To describe the development of retinal pigment epithelium (RPE) atrophy after uncomplicated pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and/or internal limiting membrane (ILM) peeling in 2 patients. Cases description: Case 1: A 79-years-old female with diagnosis of a full-thickness macular hole in her right eye (OD) with best corrected visual acuity (BCVA) of: 20/100 and left eye (OS): 20/70. After surgery she developed large RPE hyperplasia and presented hand movement that did not improve with pinhole. Case 2: A 69-years-old female patient who had ERM in her OS with BCVA of 20/30 in both eyes (OU). PPV was assisted with brilliant blue (BB) to better visualize the ILM. During follow-up visits we evidenced RPE atrophy in the zone where peeling was done. In the last control after 2-years, her visual acuity was 20/40 that did not improve with pinhole. Discussion: There are three possible mechanisms to explain this complication: toxic damage, mechanical trauma during the membrane removal with forceps, or a combination of both. In our cases, a combination of them is probably the cause of the presence of RPE atrophy. Conclusion: Vitrectomy with membrane removal is successful in most cases with low rate of complications. Because RPE atrophy is infrequent, our suggestion is to continue performing this technique and if possible, it should be done without dye staining to minimize risks. Abbreviations: ERM = epiretinal membrane, ILM = internal limiting membrane, MH = macular hole, RPE = Retinal pigment epithelium, OD = right eye, BCVA = Best corrected visual acuity, OS = left eye, OU = both eyes, IOL = intraocular lens, OCT = Optical coherence tomography, BB = Brilliant blue, TB = Trypan blue, ICG = indocyanine green.


Assuntos
Membrana Epirretiniana , Perfurações Retinianas , Idoso , Atrofia , Membrana Basal/cirurgia , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/cirurgia , Feminino , Humanos , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/etiologia , Perfurações Retinianas/cirurgia , Epitélio Pigmentado da Retina , Estudos Retrospectivos , Tomografia de Coerência Óptica , Vitrectomia/efeitos adversos , Vitrectomia/métodos
3.
BMC Ophthalmol ; 22(1): 169, 2022 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-35421936

RESUMO

BACKGROUND: We report for the first time a way to predict the 2-dimensional extension of an internal limiting membrane (ILM) defect by detecting the area with dissociated optic nerve fiber layer (DONFL)-like spots in the preoperative optical coherence tomography (OCT) en-face images. CASE PRESENTATIONS: Case 1 was a 67-year-old man with metamorphopsia and decreased vision in his right eye. His best-corrected visual acuity (BCVA) was 20/100, with a pterygium, a moderate nuclear cataract, and an epiretinal membrane (ERM). Case 2 was a 73-year-old man with metamorphopsia and decreased vision in his left eye. His BCVA was 20/25, with a moderate nuclear cataract and an ERM. Both patients underwent simultaneous cataract surgery and pars plana vitrectomy with ERM and ILM peeling. Brilliant Blue G staining, performed before ERM and ILM peeling, revealed an unstained area. A careful evaluation of the area showed that it was not covered by either the ERM or ILM. A postoperative evaluation of the preoperative OCT images obtained from these cases showed DONFL-like low-brightness spots in the ILM defect area on the OCT en-face images. CONCLUSIONS: OCT en-face images may indicate the area of the ILM defect. To avoid iatrogenic damage to the retinal nerve fiber layer by touching/pinching it with forceps, detecting areas with DONFL-like spots in the preoperative OCT en-face images may be useful to predict an ILM defect.


Assuntos
Catarata , Membrana Epirretiniana , Idoso , Membrana Basal/cirurgia , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/cirurgia , Humanos , Masculino , Fibras Nervosas , Nervo Óptico , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Vitrectomia/métodos
4.
Turk J Ophthalmol ; 52(2): 109-118, 2022 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-35481732

RESUMO

Objectives: To evaluate the associations between anatomical changes and visual outcomes in patients with idiopathic epiretinal membrane (ERM). Materials and Methods: We performed a prospective study of 130 consecutive idiopathic ERM patients and report their visual outcomes and the factors associated with visual outcome and anatomical changes. Results: Of 130 eyes of 130 patients, 87 eyes underwent surgery, while the remaining 43 eyes were observed. At 6-month follow-up, the best-corrected visual acuity (BCVA) increased in the whole population. Mean Early Treatment Diabetic Retinopathy Study letter score changed from 51 to 65 in the surgical group and from 67 to 68 in the non-surgical group. The surgical group had improvement in BCVA at all ERM stages and grades of disorganization of the retinal inner layers (DRIL) (p<0.01). In multivariable analysis of the surgical group, factors associated with BCVA of ETDRS 60 letters or more were no or mild DRIL and the absence of ellipsoid zone disruption at baseline (p=0.002 and p=0.034, respectively) and this statistically significant positive correlation was still maintained at 12-month follow-up. Conclusion: Baseline DRIL grade and presence of ellipsoid zone disruption were the most informative prognostic factors in patients with idiopathic ERMs. Patients with severe DRIL and/or advanced ERMs had improved vision after ERM removal.


Assuntos
Membrana Epirretiniana , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/cirurgia , Humanos , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual
5.
Retina ; 42(4): 697-703, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35350048

RESUMO

PURPOSE: To evaluate the anatomical and functional outcomes of internal limiting membrane (ILM) peeling and the inverted ILM flap technique for rhegmatogenous retinal detachment coexisting with macular hole. METHODS: This retrospective study evaluated the medical records of 79 eyes with concurrent rhegmatogenous retinal detachment and macular hole received vitrectomy and silicone oil tamponade, with ILM peeling on 56 eyes and the inverted ILM flap technique on 23 eyes. RESULTS: The Type 1 closure rate was greater in the inverted ILM flap group than the ILM peeling group (82.6% vs. 55.4%, P = 0.038). Lines of improvement were 7.8 ± 5.3 in the ILM peeling group and 8.9 ± 5.6 in the inverted ILM flap group. Postoperative epiretinal membrane and retinal reattachment rates were similar in two surgical groups (16.1% vs. 21.7%, P = 0.535 and 94.6% vs. 95.7%, P = 0.999, respectively). Type 1 closure was significantly correlated with the inverted ILM flap technique (OR = 5.568, P = 0.023). The inverted ILM flap technique showed no significant association with the final logarithm of the minimum angle of resolution best-corrected visual acuity in multivariate model analysis. CONCLUSION: The inverted ILM flap technique was more effective in restoring the macular structure in patients with rhegmatogenous retinal detachment and coexisting macular hole, but the functional outcomes of the two strategies were comparable.


Assuntos
Membrana Epirretiniana , Descolamento Retiniano , Perfurações Retinianas , Membrana Basal/cirurgia , Membrana Epirretiniana/complicações , Membrana Epirretiniana/cirurgia , Humanos , Retina , Descolamento Retiniano/complicações , Descolamento Retiniano/cirurgia , Perfurações Retinianas/complicações , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Vitrectomia/métodos
7.
J Coll Physicians Surg Pak ; 32(2): 226-229, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35108796

RESUMO

OBJECTIVE: To assess the functional and surgical long-term outcomes following epiretinal membrane surgery. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Layton Rahmatulla Benevolent Trust Tertiary Care Eye Hospital, Karachi, from January 2016 to December 2020. METHODOLOGY: A medical record review was carried out of patients, who had undergone surgical management of ERM and had presented for follow-up for at least three years. Best corrected visual acuity (BCVA) and Optical Coherence Tomography (OCT) parameter [(integrity of ellipsoid zone (EZ)] was evaluated. BCVA, using Snellen's chart, is performed routinely on each visit, which was converted to logMAR chart for analysis in this study. OCT was also performed to evaluate the integrity of outer retinal layers using Heidelberg OCT. RESULTS: Sixty-five eyes of 54 patients were included in the study, including 41 eyes of 36 men (63%) and 24 eyes of 18 women (37%). Mean age was 46.2 ± 8.9 years. The mean BCVA significantly improved from 0.88 ± 0.28 logMAR (6/45 Snellen) preoperatively to 0.64 ± 0.21 (6/27) at the end of first year (p <0.001), which improved to 0.54 ± 0.19 (6/21) at the end of second year, and 0.53 ± 0.20 (6/20) after three years of follow-up. The post-op vision at three years was stratified according to the integrity of EZ on OCT performed at the same follow-up; and a significant difference was observed. EZ was intact in 52 eyes with a mean BCVA of 0.49 ± 0.16 logMAR (6/18 Snellen); while it was found disrupted in 13 eyes, where the BCVA was 0.68 ± 0.26 (6/29). CONCLUSION: Anatomically intact outer retinal layer significantly correlated with improved BCVA. Key Words: Epiretinal membrane, Optical coherence tomograghy, Best corrected visual acuity.


Assuntos
Membrana Epirretiniana , Adulto , Membrana Epirretiniana/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retina/diagnóstico por imagem , Retina/cirurgia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual
8.
Indian J Ophthalmol ; 70(3): 909-913, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35225542

RESUMO

PURPOSE: To evaluate the outcome of vitrectomy with multilayered inverted internal limiting membrane flap technique (ML-IILM) versus vitrectomy with standard ILM peeling for large macular holes in terms of visual acuity and anatomical closure. METHODS: A hospital-based, prospective, randomized, interventional study was conducted during three calendar years with a total 150 eyes (75 in each group) in two groups-vitrectomy with ILM peeling (Group A) and vitrectomy with ML-IILM flap technique (Group B) after informed consent of study participants who met the inclusion criteria. RESULTS: The mean minimum and maximum diameter of macular hole did not differ statistically in both the groups. Macular hole index had no significant difference between both groups Pre-operative visual acuity was not statistically significantly different between the two groups. During follow-up, best corrected visual acuity (BCVA) at 1 month, 3 months, 6 months, and 12 months was significantly better in Group B (0.12 ± 0.07 at 1 month, 0.14 ± 0.10 at 3 months, 0.18 ± 0.11 at 6 months, and 0.19 ± 0.12 at 12 months) compared to Group A (0.20 ± 0.11 at 1 month, 0.22 ± 0.13 at 3 months, 0.30 ± 0.12 at 6 months, and 0.31 ± 0.14 at 12 months) (P = 0.001 for each). Type 1 anatomical closure (flattening of cuff and opposition of edges of hole) was achieved in 78.66% (59/75) cases in Group A and 93.33% (70/75) cases in Group B (P 0.0016). CONCLUSION: Vitrectomy with multilayered inverted ILM flap technique had significantly higher anatomical closure and better visual outcome than vitrectomy with standard ILM peeling.


Assuntos
Membrana Epirretiniana , Perfurações Retinianas , Membrana Basal/cirurgia , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/cirurgia , Humanos , Estudos Prospectivos , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento , Vitrectomia/métodos
9.
Sci Rep ; 12(1): 2470, 2022 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-35169203

RESUMO

To investigate the long-term effect of unilateral idiopathic epiretinal membrane (uiERM) removal on monocular and binocular visual function, and on vision-related quality of life (VR-QoL). Prospective, single-center study. The following data were collected before and after surgery: distance monocular and binocular best-corrected visual acuity (BCVA), horizontal and vertical metamorphopsia, horizontal and vertical aniseikonia, stereoacuity and National Eye Institute Visual Function Questionnaire-25 item (NEI VFQ-25). Forty-two patients (mean age: 72.7 ± 7.4 years; 24 men) were included. At 6 months postoperatively, distance monocular BCVA (p < 0.001), horizontal metamorphopsia (p = 0.001) and the composite score of NEI VFQ-25 (p < 0.001) significantly improved, in comparison to baseline. At 2 years postoperatively, distance monocular (p < 0.001) and binocular (p = 0.01) BCVA, horizontal (p < 0.001) and vertical (p = 0.02) metamorphopsia, vertical aniseikonia (p = 0.01), stereoacuity (p < 0.001) and 3 subscales scores of the NEI VFQ-25 (p < 0.05) ("general vision", "mental health", "driving") significantly improved in comparison to baseline. Removal of uiERM improves VR-QoL and achieves good visual outcomes on both monocular and binocular visual parameters over long-term. Visual symptoms induced by macular contraction have different improvement kinetics after surgery. Stereopsis, the highest level of binocular vision, can be improved in some cases.


Assuntos
Membrana Epirretiniana/fisiopatologia , Membrana Epirretiniana/cirurgia , Qualidade de Vida , Visão Binocular/fisiologia , Visão Monocular/fisiologia , Acuidade Visual/fisiologia , Vitrectomia , Idoso , Membrana Epirretiniana/psicologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
10.
BMC Ophthalmol ; 22(1): 4, 2022 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-34980021

RESUMO

PURPOSE: To evaluate the necessity and safety of primary posterior capsulotomy during phaco-vitrectomy for idiopathic epiretinal membrane (ERM). SETTING: Seoul National University Bundang Hospital, Seongnam, Korea. DESIGN: Retrospective consecutive cohort analysis. METHODS: This study enrolled 219 patients (228 eyes) who underwent combined 25-gauge phaco-vitrectomy for idiopathic ERM and cataract, divided into capsulotomy (-) group (152 eyes, 144 patients) and capsulotomy (+) group (76 eyes, 75 patients). The main outcomes were rate of posterior capsular opacity (PCO) occurrence and postoperative complications. Ophthalmic examinations were performed at baseline, 1, 3, 6, and 12 months postoperatively. RESULTS: PCO only occurred in capsulotomy (-) group (20 eyes, 13.2%), with mean onset of 10.59 months. Visually-significant PCO that needed Nd:YAG posterior capsulotomy was present in 9 eyes (45.0% of PCO eyes). The rate of cystoid macular edema (CME) was higher in capsulotomy (+) group (6.6% vs. 15.8%, p = 0.026) with longer duration (1.50 vs. 3.36 months, p = 0.019). Female sex and posterior capsulotomy were significant risk factors for CME occurrence (p < 0.05). CONCLUSION: Primary posterior capsulotomy during phaco-vitrectomy for idiopathic ERM obviated the need for Nd:YAG posterior capsulotomy, but visually-significant PCO that needed Nd:YAG laser was not common. Considering the low rate of visually-significant PCO and high rate of postoperative CME, routine posterior capsulotomy during phaco-vitrectomy may not be necessary for preventing PCO in ERM.


Assuntos
Catarata , Membrana Epirretiniana , Terapia a Laser , Facoemulsificação , Catarata/complicações , Catarata/epidemiologia , Membrana Epirretiniana/cirurgia , Feminino , Humanos , Facoemulsificação/efeitos adversos , Capsulotomia Posterior , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Vitrectomia
11.
BMC Ophthalmol ; 22(1): 39, 2022 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-35086499

RESUMO

BACKGROUND: Diffractive intraocular lenses (IOLs) could affect visual acuity in patients with macular pathologies such as epiretinal membrane (ERM) and could influence the results of pars plana vitrectomy (PPV) for ERM removal in pseudophakic eyes with these IOLs. The aim of this study is to evaluate the effect on visual outcomes of a diffractive trifocal IOL in PPV for ERM peeling. METHODS: This is a retrospective cohort study on 20 eyes with a single model of trifocal IOL that underwent PPV for removal of ERM between January 2015 and September 2018 in our clinics. Follow up was at least 1 year. Primary outcome measure was mean change in visual acuity. Secondary outcome measures were mean change in central macular thickness (CMT), recovery of the external retinal layers, and change in spherical equivalent (SE). RESULTS: Mean corrected distance visual acuity (CDVA) was 0.03 ± 0.03 logMAR after phacoemulsification; this worsened to 0.23 ± 0.10 logMAR with ERM, improving to 0.10 ± 0.04 log MAR 12 months after PPV (p = 0.001). Mean uncorrected near visual acuity (UNVA) was Jaeger 2.62 ± 0.51 after lensectomy. This worsened to Jaeger 5.46 ± 1.67 with ERM and improved to the initial Jaeger 2.69 ± 0.84 after PPV (p = 0.005). CMT decreased significantly, from 380.15 ± 60.50 µm with the ERM to 313.70 ± 36.98 µm after PPV. Mean SE after lensectomy was - 0.18 ± 0.38 D, which minimally changed to - 0.18 ± 0.47 D after PPV (p = 0.99). The only complication recorded after PPV was a case of cystoid macular edema. No difficulties in visualization due to IOL design were reported during PPV. CONCLUSION: PPV for ERM in eyes with this trifocal IOL seems to be safe and effective, and allows recovery of the loss of UNVA.


Assuntos
Membrana Epirretiniana , Lentes Intraoculares , Facoemulsificação , Membrana Epirretiniana/cirurgia , Humanos , Desenho de Prótese , Estudos Retrospectivos , Vitrectomia
12.
Int Ophthalmol ; 42(5): 1623-1629, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35091976

RESUMO

BACKGROUND AND OBJECTIVE: To evaluate ocular wavefront aberrations after vitrectomy in patients with vitreomacular interface diseases. METHODS: Thirty eyes of 30 patients with vitreomacular interface diseases were included in this prospective study. A Sirius topographer (SCHWIND eye-tech-solutions, Germany) was used to measure corneal aberrations and a Hartmann Shack aberrometer (IRX-3; Imagine Eyes, Orsay, France) to measure ocular aberrations. Data were recorded at baseline and 3 months after vitrectomy. RESULTS: Eight patients were excluded due to the formation of cataract during the post-operation follow-up period. Data of 22 eyes (13 eyes with epiretinal membrane, two eyes with epiretinal membrane with vitreomacular traction, one eye with vitreomacular traction, and six eyes with macular hole) were analyzed for the study. The corneal aberrations such as coma, trefoil, spherical aberration, and root mean square of total higher-order aberrations did not significantly change after vitrectomy. The preoperative ocular aberrations such as coma 0.33 (0.14-0.47) µm, trefoil 0.28 (0.15-0.44) µm, root mean square of higher-order aberrations 0.51 (0.45-0.68) µm, root mean square of total aberrations 1.38 (1.16-2.60) µm were significantly reduced to 0.21 (0.14-0.29) µm, 0.20 (0.14-0.30) µm, 0.36 (0.21-0.52) µm, 0.15 (1.13-1.41) µm, respectively, after vitrectomy. CONCLUSION: The ocular higher-order aberrations were significantly reduced after vitreomacular surgery for vitreomacular interface diseases.


Assuntos
Membrana Epirretiniana , Vitrectomia , Coma , Topografia da Córnea , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/cirurgia , Humanos , Estudos Prospectivos , Transtornos da Visão , Acuidade Visual
13.
Indian J Ophthalmol ; 70(2): 710, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35086295

RESUMO

BACKGROUND: : "Achoo" is the sound that is correlated with sneezing. A sneeze, in rare occasions, it can cause Valsalva retinopathy. Usually, small bleeding gets absorbed with time. But if the haemorrhage stays for a longer period of time, it can lead to de-hemoglobinization of blood which can cause damage to the photoreceptors. If such a damage occurs over the macula, it can cause irreversible visual loss. Hence, prompt and meticulous treatment is indicated in such cases. One such case is described here where a lady suffered from a sudden bout of sneezing and presented to us after a month later. A large sub-internal limiting membrane (ILM) bleed was noted over the macula. Hence a vitrectomy with ILM peeling with drainage of blood was advised. She recovered 20/40 visual acuity one month following surgery. PURPOSE: This video emphasizes on diagnosis of sub-ILM hemorrhage and the technique in which the sub-ILM bleed can be drained in the modern era of microincision vitreoretinal surgeries. SYNPOSIS: A key aspect in such cases is to distinguish sub-ILM from sub-hyaloid bleed. Subtle differentiating points on imaging are described in the video. In cases of sub-ILM hemorrhage, the most important surgical step after performing a core vitrectomy is a good posterior vitreous detachment (PVD) induction. After that, ILM peeling is carried out with the help of finesse loop and ILM peeling forceps. Using proportional vacuum and aspiration alternatively from the cutter, the hemorrhage is displaced and drained. This step can prevent damage to the underlying retinal tissue. After the macula hemorrhage is completely cleared, an air-fluid exchange is done. HIGHLIGHTS: Teaching points include: 1. Diagnostic markers for sub-ILM hemorrhage; 2.The method of PVD induction in cases of Sub ILM hemorrhage; and 3.Technique of drainage of sub-ILM hemorrhage using proportional vacuum and aspiration function of the cutter. VIDEO LINK: https://youtu.be/hBhfLDy9o-Y.


Assuntos
Membrana Epirretiniana , Macula Lutea , Membrana Basal/cirurgia , Membrana Epirretiniana/cirurgia , Feminino , Humanos , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/etiologia , Hemorragia Retiniana/cirurgia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual , Vitrectomia/métodos
14.
Exp Eye Res ; 217: 108957, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35077755

RESUMO

Epiretinal membrane (ERM) is a common retinal fibrotic disorder disease causing visual impairment and metamorphopsia. Recently, increasing attention has been devoted to ERM progression after uncomplicated cataract surgery. Cytokines, which play a role in diverse physiological and pathological activities in eyes, are suggested to be involved in these postoperative changes. However, few studies have investigated the post-cataract surgery cytokine expression changes in ERM eyes and their roles in the postoperative changes. The purpose of this study was to evaluate the aqueous levels of cytokines in eyes with idiopathic epiretinal membrane (iERM) both pre- and post-cataract surgery, and their correlations with postoperative iERM progression. In this study, aqueous humor (AH) samples were collected from iERM eyes (n = 25) and non-iERM eyes (n = 23) from 48 patients (48 eyes) undergoing uncomplicated cataract surgery preoperatively and 20 h postoperatively. Samples were analyzed for 48 cytokines with multiplex bead-based immunoassay. Correlations between cytokine level changes (postoperation vs. preoperation) and three-month postoperative best-corrected visual acuity (BCVA) and optical coherence tomography measure changes were evaluated in iERM eyes. We found that in iERM eyes, the levels of 4 cytokines exhibited significant elevations when compared with those in the controls (all p ≤ 0.0015) preoperatively. Postoperatively, the concentrations of 21 cytokines were higher than the preoperative levels in iERM eyes (all p ≤ 0.0015), among which GRO-α, IL-8, and MCP-3 levels showed more pronounced changes than the controls. Additionally, in iERM eyes, IL-4 level changes showed moderate positive correlations with MV (r = 0.492, p = 0.028) and MT (r = 0.481, p = 0.032) changes. LogMAR changes were positively correlated with IL-1α (r = 0.553, p = 0.011), IL-12(P40) (r = 0.544, p = 0.013), and MCP-3 (r = 0.588, p = 0.006) level changes. No significant cytokine-level-change differences were found between eyes with and without postoperative cystoid macular edema development. In conclusion, cataract surgery will bring great alterations to the specific intraocular cytokine microenvironment inherently in eyes with iERM. Many fibrotic and inflammatory cytokines showing elevated levels or relationships with clinical characteristics are suggested to be involved in the pathogenesis and post-cataract surgery progression of iERM; however, further investigations are needed to discern their real roles.


Assuntos
Extração de Catarata , Catarata , Membrana Epirretiniana , Catarata/patologia , Citocinas , Membrana Epirretiniana/cirurgia , Humanos , Estudos Retrospectivos , Tomografia de Coerência Óptica , Vitrectomia/métodos
15.
Retina ; 42(4): 704-711, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-34983900

RESUMO

PURPOSE: To establish an objective and quantitative biomarker of metamorphopsia in epiretinal membranes (ERMs) and determine the optimal timing for ERM surgery. METHODS: Retrospectively, 172 eyes with ERM were reviewed. Retinal folds because of tangential traction by ERM were visualized by en-face optical coherence tomography. The maximum depth of retinal folds (MDRF) within the parafovea was quantified. Metamorphopsia was quantified by M-CHARTS. The change in the distance between the retinal vessels after ERM surgery and the preoperative total depth of retinal folds between the vessels were quantified using en-face optical coherence tomography and optical coherence tomography angiography. RESULTS: Significant correlations were observed between preoperative MDRF and M-CHARTS scores before and at 6 months after surgery (r = 0.617 and 0.460, respectively; P < 0.001) and change in the distance between the retinal vessels after ERM surgery and preoperative total depth of retinal folds between the vessels (r = 0.471; P = 0.013). The preoperative MDRF values at which M-CHARTS scores were 0.5 before and 6 months after the surgery were 69 µm and 118 µm, respectively. CONCLUSION: The MDRF is an objective and quantitative biomarker of metamorphopsia in ERM. To maintain patients' quality of vision, ERM surgery may be performed when the preoperative MDRF ranges between 69 µm and 118 µm.


Assuntos
Membrana Epirretiniana , Biomarcadores , Membrana Epirretiniana/complicações , Membrana Epirretiniana/cirurgia , Humanos , Retina , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Transtornos da Visão/etiologia , Acuidade Visual , Vitrectomia/métodos
16.
Artigo em Inglês | MEDLINE | ID: mdl-34982006

RESUMO

This article reports a case of a 65-year-old woman with recalcitrant recurrent epiretinal membrane (ERM) treated with revision vitrectomy and membrane peeling followed by 12 weekly intravitreal methotrexate injections. Visual acuity and central macular thickness significantly improved, and no ERM recurrence developed 7 months after surgery. This case represents the first documented use of methotrexate to treat surgically resistant ERM reproliferation and indicates a potential for its use in cases that do not respond to standard treatment. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:49-51.].


Assuntos
Membrana Epirretiniana , Idoso , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/cirurgia , Feminino , Humanos , Metotrexato/uso terapêutico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Vitrectomia/métodos
17.
Tomography ; 8(1): 189-199, 2022 01 12.
Artigo em Inglês | MEDLINE | ID: mdl-35076629

RESUMO

BACKGROUND: The present study examined the relationships among macular microvasculature, retinal structure, and epiretinal membrane (ERM) and explored the utility of optical coherence tomography (OCT) angiography (OCTA) in idiopathic ERM assessment. METHODS: The study sample comprised 276 eyes of 276 patients. A total of 154 eyes with ERM and 122 normal (control) eyes were analyzed. Only one eye of each participant was randomly selected for posterior segment imaging. Each patient underwent OCT and OCTA. Images were analyzed with AngioTool 0.6. RESULTS: Foveal avascular zone was significantly smaller in the ERM group (p = 0.044). Average retinal thickness and foveal thickness were significantly higher in the ERM group (both p = 0.001). Moreover, 64 (41.5%) patients exhibited no metamorphopsia, while 46 (29.8%) and 44 (28.7%) patients exhibited moderate and extensive metamorphopsias, respectively. Meanwhile, FAZ was negatively correlated with central retinal thickness in the ERM group. The vessel area (p = 0.0017) and vessel percentage area (p = 0.044) were significantly greater in the ERM group. CONCLUSIONS: Changes observed in the superficial plexus in OCTA are related to the severity of metamorphopsia and can be further evaluated to support decision making regarding the surgical management of idiopathic ERM.


Assuntos
Membrana Epirretiniana , Membrana Epirretiniana/diagnóstico por imagem , Membrana Epirretiniana/cirurgia , Angiofluoresceinografia/métodos , Humanos , Microvasos/diagnóstico por imagem , Vasos Retinianos/diagnóstico por imagem , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Acuidade Visual
18.
Ophthalmol Retina ; 6(4): 308-317, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34718218

RESUMO

OBJECTIVE: To investigate OCT-based biomarkers of visual acuity (VA) in eyes with idiopathic epiretinal membranes (ERMs) undergoing surgical intervention. PURPOSE: To assess the surgical outcomes of pars plana vitrectomy (PPV) and membrane peel (MP) surgery in eyes with idiopathic ERM and to identify potential imaging-based biomarkers of vision outcomes. METHODS: Retrospective, consecutive case series of eyes with idiopathic ERM that underwent PPV and MP surgery between January 1, 2017, and January 1, 2019. A previously described ERM grading scale was utilized for OCT analysis. The primary outcome was VA at postoperative month 6 and at final follow-up. The secondary outcome was the association of OCT structural features, including ectopic inner foveal layers (EIFLs), inner microcystoid changes, and ellipsoid zone (EZ) disruption, with VA outcomes. RESULTS: A total of 322 eyes with idiopathic ERM were included. The mean (± standard deviation) follow-up was 506.6 ± 324.6 days after MP surgery. VA improved from logarithm of the minimal angle of resolution value of 0.49 ± 0.27 (Snellen 20/61) before MP surgery to 0.41 ± 0.30 (Snellen 20/51, P < 0.001) at 6 months after MP surgery and to 0.31 ± 0.29 (Snellen 20/41, P < 0.001) at the final follow-up. A total of 21 (6.5%) eyes were graded as stage 1, 38 (11.8%) as stage 2, 188 (58.4%) as stage 3, and 75 (23.3%) as stage 4, with higher ERM stages associated with worse pre-MP VA (P < 0.001). The presence of inner microcystoid changes was associated with worse pre-MP VA (P = 0.04). Stage 4 ERM characteristics (P = 0.03), the presence of EZ disruption (P = 0.01) at month 3, and the presence of inner microcystoid changes at month 3 (P = 0.02) were associated with worse VA at 6 months. The presence of EIFL was not associated with the 6-month or final VA on multivariate analysis. When analyzed within defined age groups, patients older than 80 years had worse final VA (P = 0.02) and were more likely to have inner microcystoid changes on OCT (P = 0.01). CONCLUSIONS: VA improvement was noted after surgery in eyes with idiopathic ERM across all stages. Preoperative stage 4 characteristics were associated with worse VA at 6 months. Postoperative inner microcystoid changes and EZ disruption at month 3 were additional OCT biomarkers associated with worse 6-month and final VA outcomes.


Assuntos
Membrana Epirretiniana , Idoso de 80 Anos ou mais , Biomarcadores , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/cirurgia , Humanos , Estudos Retrospectivos , Tomografia de Coerência Óptica , Vitrectomia
19.
Graefes Arch Clin Exp Ophthalmol ; 260(3): 817-825, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34625846

RESUMO

PURPOSE: To compare visual outcomes, incidence of cystoid macular edema (CME), and rate of repeat epiretinal membrane (ERM) surgery following phacovitrectomy for primary and secondary ERM. METHODS: Retrospective review of 178,856 cataract surgeries from 2003 to 2015. Eyes that underwent cataract surgery combined with ERM peel were included (n = 708). Eyes were divided into primary (n = 538) and secondary (n = 170) ERM groups. Patient demographics, visual acuity (VA), and postoperative CME were recorded. RESULTS: Patients with secondary ERM had worse preoperative VA, 0.9 ± 0.6 logMAR (20/160 Snellen equivalent) as compared to patients with primary ERM, 0.6 ± 0.3 (20/80), respectively (p < 0.0001). There was no difference between the secondary and primary ERM groups in postoperative vision (0.5 ± 0.4 logMAR vs. 0.5 ± 0.3; p = 0.9962) or proportion with VA ≥ 20/40 (46.4% vs. 43.1%; p = 0.6744) at 12-24 weeks. Postoperative CME was twice as likely in the secondary ERM group (16.5%) compared to the primary ERM group (7.8%) (p = 0.0018). There was no difference in the rate of repeat ERM surgery between the secondary ERM group (1.8%) and the primary ERM group (1.5%) (p = 0.7308). CONCLUSION: Eyes with secondary ERM had significant postoperative improvement in VA. They had worse preoperative VA and had a twofold increase in postoperative CME than primary ERM.


Assuntos
Extração de Catarata , Catarata , Membrana Epirretiniana , Catarata/complicações , Membrana Epirretiniana/complicações , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/cirurgia , Humanos , Estudos Retrospectivos , Acuidade Visual , Vitrectomia
20.
Retina ; 42(2): 265-273, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34561406

RESUMO

PURPOSE: To quantify ellipsoid zone (EZ) changes in integrity after epiretinal membrane (ERM) surgery, correlate findings to visual acuity, and determine predictors for prognosis. METHODS: A post hoc analysis of eyes undergoing ERM surgery pooled from the prospective DISCOVER intraoperative optical coherence tomography study and eyes undergoing conventional ERM surgery without intraoperative optical coherence tomography. Quantitative EZ features were extracted using a multilayer machine learning enabled automated segmentation platform after image analyst review/correction for segmentation accuracy. Visual acuity and EZ integrity were quantitatively assessed and correlated before and after ERM surgery. Multiple linear regression was performed to assess preoperative visual acuity and EZ features as predictors for improvement in visual acuity or EZ integrity. RESULTS: There were 177 eyes from 177 subjects that underwent ERM surgery from the DISCOVER and conventional arms. Improvement in visual acuity and multiple EZ integrity features was noted after ERM surgery, including EZ partial attenuation and EZ-retinal pigment epithelium (RPE) volume (P < 0.05). A reduction in EZ partial attenuation and increase in EZ-RPE central subfield thickness (EZ-RPE CST) was significantly correlated with improved visual acuity after ERM surgery (P < 0.05). More robust EZ-RPE CST at baseline predicted visual acuity improvement after ERM peel in regression modeling (ß = 0.005, P < 0.05). CONCLUSIONS: Longitudinal assessment of EZ features demonstrates significant postoperative improvement in multiple EZ integrity metrics after ERM surgery. Improving EZ integrity was correlated to improving the visual acuity. Ellipsoid zone integrity and visual acuity were significant predictors in regression modeling and may have value in clinical prognostication.


Assuntos
Membrana Epirretiniana/cirurgia , Segmento Externo das Células Fotorreceptoras da Retina/fisiologia , Vitrectomia , Idoso , Membrana Epirretiniana/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia
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