Surgical Treatment for Idiopathic Epiretinal Membrane
Authors:
M. Ondrejková 1,2; Martina Gajdošová 2; P. Kyseľová 2
Authors place of work:
FNsP F. D. Roosvelta, Banská Bystrica, prednosta MUDr. Marta Ondrejková, PhD.
1; Oftal s. r. o. – Špecializovaná nemocnica v odbore oftalmológia, Zvolen, primárka MUDr. Monika Gajdošová
2
Published in the journal:
Čes. a slov. Oftal., 71, 2015, No. 4, p. 204-208
Category:
Original Article
Summary
Aim:
To assess effectiveness of surgical treatment for idiopathic epiretinal membrane.
Material and methods:
Retrospective study included on 44 eyes out of 46 patients operated for idiopathic ERM in OFTAL Zvolen with a 20G PPV (32 patients) and posterior vitreous membrane ablation and 23G PPV (14 patients) from August 2008 to December 2014. After the extraction of epiretinal membrane, a peeling of ILM has been implemented following its Blue Membrane identification. Mean follow-up time was 18 months.
Results:
Best corrected visual acuity (BCVA) before the surgery was 0.37 (SD 0.15) whereas post-surgery indicated 0.63 (SD 0.25). In 35 eyes (76.1 %) was BCVA after the surgery 0,5 and better and in 2 eyes (4.3 %) was BCVA 0,16 and worse. 29 eyes (63.0 %) acquired 2 and more rows. BCVA improved in 40 eyes (87.0 %) and remained the same in 3 eyes (6.5 %). Degeneration of BCVA in 3 eyes (6.5 %) was due to retinal detachment in one case, to retinal pigment epithelium (RPE) atrophy in the second case and to ischemic optic nerve head atrophy in the last case. According to OCT, the average mean of foveal thickness before the surgery was 496 (SD 88) µm and decreased to 356 (SD 59) µm after the surgery (thus average reduction of 140 µm). In 30 eyes (65.2 %), we achieved a reduced foveal thickness of more than 100 µm, in comparison to 15 eyes (32.6 %) of less than 100 µm. In no case after the surgery did retinal thickness increase comparing to finding before the surgery. Foveal contour restitution was present in 14 eyes (30.4 %). There were no preoperative/ intraoperative complications. In 3 eyes (10.3 %) a combined cataract surgery with PPV was performed. Cataract progression was seen in 20 phakic eyes (76.9 %) out of 26 where all of them were treated surgically at an average time 13 (3–34) months after the PPV. As postoperative complication shows, a retinal detachment occurred in one eye (2.2 %) 5 months after the surgery and in 1 eye (2.2 %) a cystoid macular edema turned out as the reason of residual posterior vitreous adhesion.
Conclusion:
PPV with membranectomy and internal limiting membrane peeling is a safe and effective method in idiopathic epiretinal membrane treatment. It leads to a function improvement and foveal thickness reduction in most of the patients diagnosed with IEM. Because phakic eyes conduce cataract progression (76.9 %), on older patients with no transparent lens we now perform a combination of surgical operations - pars plana vitrectomy and cataract extraction.
Key words:
idiopathic epiretinal membrane, macular surgery, anatomical and functional changes
Zdroje
1. Alexandrakis, G., Chaudhry, NA., Flynn, HW., Jr, et al.: Combined cataract surgery, intraocular lens insertion and vitrectomy in eyes with idiopathic epiretinal membranes. Ophthalmic Surg Lasers. 1999, 30: 327–328.
2. Boguszaková, J.: Sklivec a sítnice. In Kuchynka, P., Oční lékařství, Praha, Grada, 2007, s. 253-369.
3. Bustros, S., Thompson, JT., Michels, R. et al: Vitrectomy for idiopathic epiretinal membranes causing macular pucker. British Journal of Ophthalmology, 72, 1988, 9: 692–695.
4. Donati, G., Kapetanios, AD., Pournaras, CJ.: Complications of surgery for epiretinal membranes, Graefes Arch Clin Exp Ophthalmol, 236, 1998, 10: 739–46.
5. Goldberg, RA., Waheed, NK., Duker, JS: Optical coherence tomography in the preoperative and postoperative management of macular hole and epiretinal membrane. Br J Ophtalmol. [online]. Marec 2014 [cit. 16. apríl 2014]. Dostupné na WWW: <http://bjo.bmj.com/content/early/2014/03/13/bjophthalmol-2013-304447.abstract>
6. Gupta, V., Gupta, A., Dogra, MR.: Atlas optical coherence tomography of macular diseases and glaucoma, New Delhi, Jaypee brothers, 2006, s. 155-168. ISBN 81-8061-653-3.
7. Chaudhry, NA., Cohen, KA., Flynn, HW Jr. et al: Combined pars plana vitrectomy and lens management in complex vitreoretinal disease, Semin Ophthalmol, 18, 2003, 3: 132–41.
8. Kim, J., Rhee, KM., Woo, SJ. et al.: Long-term temporal changes of macular thickness and visual outcome after vitrectomy for idiopathic epiretinal membrane, Am J Ophthalmol, 150, 2010, 5: 701–709.
9. Krásnik, V., Strmeň, P., Vavrová, K. et al.: Naše skúsenosti s chirurgickou liečbou vitreomakulárneho trakčného syndrómu. Čes. a slov. Oftal., 56, 2000, 4: 218–222.
10. Kwon, Sl., Ko, SJ., Park, IW.: The Clinical Course of the Idiopathic Epiretinal Membrane after Surgery, Korean Journal of Ophthalmology, 23, 2009, 4: 249–252.
11. Margherio, RR., Cox, MS. Jr, Trese, MT. et al.: Removal of epimacular membranes, Ophthalmology, 92, 1985; 8: 1075–83.
12. Massin, P. et al: Optical Coherence Tomography of Idiopathic Macular Epiretinal Membranes Before and After Surgery, Am J Ophthalmol, 130, 2000, 6: 732–739.
13. Nakashizuka, H. et al.: Short-Term Surgical Outcomes of 25- Gauge Vitrectomy for Epiretinal Membrane with Good Visual Acuity. J Clin Exp Ophthalmol. . [online]. Máj 2013 [cit. apríl 2014]. Dostupné na WWW: <http://omicsonline.org/vitrectomy-for-epiretinal-membrane-with-good-visual-acuity-2155-9570.1000280.php?aid=15333>
14. Pesin, SR., Olk, RJ., Grand, MG. et al.: Vitrectomy for premacular fibroplasia. Prognostic factors, long-term follow-up, and time course of visual improvement, Ophthalmology, 98, 1991; 7: 1109–14.
15. Saxena, S.: Clinical Ophtalmology: Medical and Surgical Approach, New Delhi, Jaypee – Highlights Medical Publishers, 2011, 881 p.
16. Spaeth, G.: Ophtalmic Surgery: Principles and practice, Philadelphia, Saunders, 2003, 799 p.
17. Thompson, JT.: Vitrectomy for epiretinal membranes with good visual acuity, Trans Am Ophthalmol Soc, 2004, 102: 97–105.
18. Ting, FS., Kwok, AK.: Treatment of epiretinal membrane: an update, Hong Kong Med J, 11, 2005, 6: 496–502.
Štítky
OphthalmologyČlánok vyšiel v časopise
Czech and Slovak Ophthalmology
2015 Číslo 4
Najčítanejšie v tomto čísle
- Surgical Treatment for Idiopathic Epiretinal Membrane
- Treatment of Macular Oedema due to retinal vein occlusion with OZURDEX
-
Treatment of Unilateral Amblyopia.
Comparison of Methods CAM and CRCS Color Reversal Checkerboard Stimulation of Retina - Exenteration of the Orbit for Basal Cell Carcinoma