Surgical Management of Macular Epiretinal Membranes

Purpose: To evaluate the effects of surgical treatment on macular epiretinal membranes.Methods: Vitrectomy and membrane removal were undergone for idopathic or secondary macular epiretinal membrane.Results: Fourteen eyes of 15 patients (93%) had vision improvement after operation in which 8 eyes (57%) increased 3 or more Senellen lines. Only one case suffered from paracentral scotoma. No other complications were noted. Conclusion: Surgical management of macular epiretinal membrane is safe and effective with good visual outcome and few complications. Eye Science 1996; 12:140 -144.

Post-operative visual outcomes based on morphological staging of idiopathic epiretinal membranes on OCT

AIM:To evaluate the recently described optical coherence tomography(OCT)based classification of epiretinal membrane(ERM)and its usefulness in predicting the functional outcome.METHODS:A retrospective observational review of OCT scans of patients with the diagnosis of idiopathic ERM was carried out from January 2016 to June 2021.All consecutive images diagnosed with any stage of idiopathic ERM and fulfilled the eligibility criteria were included in the analysis.ERM was identified on OCT scans as a thin hyperreflective layer over the inner layers of retina.OCT scans of patients with ERM who underwent vitrectomy,were independently staged as per the new classification by two independent retinal surgeons to form a consensus on stage.Best corrected visual acuity(BCVA)in logMAR scale and central subfield thickness(CST)on pre-and post-operative spectral domain OCT scans were the variables noted for all patients at the time of diagnosis and at 6 and 12 mo follow up visit after undergoing intervention.Partial correlation coefficient was computed between BCVA(logMAR)and CST by ERM stage adjusting by baseline measures.RESULTS:Clinical charts of 74 patients with idiopathic ERM were assessed.Clinically significant improvement in BCVA overtime was observed with significant difference in median visual acuity of patients with StageⅡ-ⅣERM with P<0.001.The median CST of all patients with stageⅡ-ⅣERM showed similar consistent improvement with P<0.001 from baseline to 12^(th)month.Our results showed not only gain in visual acuity but also shift from baseline to anatomical normalization of CST in stageⅡ.We found a decrease in CST with difference of 166μm and 151μm in stageⅢand stageⅣrespectively.Our results remained consistent with the hypothesis of improved visual outcomes with all stages of ERM with adjusted moderate linear correlation between visual acuity and CST in stageⅡ-Ⅳ(r>0.3).CONCLUSION:Equally significant visual outcomes of patients with ERM stagedⅡ-Ⅳand therefore can be counselled for improved visual acuity after surgical removal of ERM with improvement up to 5 lines on Snellen's chart from the baseline.

The Preliminary Report of Pathological Changes of Epiretinal Membranes and Internal Limiting Membrane Removed during Idiopathic Macular Hole Surgery

Purpose:To investigate the pathological changes of epiretinal membranes(ERM)and internal limiting membrane (ILM) removed during idiopathic macular hole surgery.Methods:Ten consecutive patients with a unilateral idiopathic macular hole underwent pars plana vitrectomy(PPV) with the surgical removal of the ERMs overlying the hole and ILM surrounding the hole. The pathological features of the excised tissues were examined under the microscope. Results:According to the morphological changes, four ERMs showed cellular elements which looked like glia cells, macrophages, plasma cells, lymphocytes and fibroblast cells. Two of the ILM appeared as transparent membranes without cellular elements. The other eight ILM showed cellular elements on the transparent membranes.Conclusion: Our study supports the hypothesis that the tangential traction of vitreous and proliferative cellular elements on the inner surface of ILM causes idiopathic macular holes. Removal of the posterior cortical vitreous, ILM and proliferative cellular tissue is a valid treatment for IMH.

Optic Coherence Tomography of Idiopathic Macular Epiretinal Membranes

bjectives: To study the characteristics of optical coherence tomography (OCT)inopathic macular epiretinal membranes (IMEM) and the relationship between thethickness offovea and the vision of affected eyes.Methods:A total of 67 cases (73 eyes) with clinical diagnosis of IMEM using direct,indirect ophthalmoscope, three mirror contact lens, fundus color photography or fundusfluorescein angiography (FFA)were examined with OCTResults: Epiretinal membranes (ERMs) with macular edema were found in 32 eyes,proliferative ERMs in 20 eyes, ERMs with macular pseudoholes in 14 eyes and ERMswith laminar macular holes in 7 eyes. Based on OCT, the ERMs were clearly andpartially seperated from the retinal (27 eyes, 38.36% ), the retinal thickness of thefovea was the thickest in the proliferative ERMs and the thinnest in the ERMs withlaminar macular holes. The statistical analysis showed there was a negative correlationbetween the thickness of fovea and visual acuity ( r ＝ - 0. 454, P ＝ 0. 000).Conclusion:There were four types of images of OCT in IMEM: ERMs with macularedema, proliferative ERMs, ERMs with macular pseudohole and ERMs with laminarmacular hole; and the thicker the fovea under the OCT, the poorer the vision acuity in the affected eyes with ERMs.

Reflectivity and thickness analysis of epiretinal membranes using spectral-domain optical coherence tomography

AIM：To compare thickness and reflectivity spectral domain optical coherence tomography（SD-OCT）findings in patients with idiopathic epiretinal membranes（ERMs）,before and after ERM peeling surgery,with normal controls.·METHODS：A retrospective study analyzing SD-OCTs of eyes with ERMs undergoing ERM peeling surgery by one surgeon from 2008 to 2010 and normal control eyes.SD-OCTs were analyzed using a customized algorithm to measure reflectivity and thickness.The relationship between the SD-OCT findings and best corrected visual acuity（BCVA）outcomes was also studied.·RESULTS：Thirty-four ERM eyes and 12 normal eyes were identified.Preoperative eyes had high reflectivity and thickness of the group of layers from the internal limiting membrane（ILM）to the retinal pigment epithelium（RPE）and the group of layers from the ILM to the external limiting membrane（ELM）.The values of reflectivity of these two groups of layers decreased postoperatively,but were still higher than normal eyes.In contrast,preoperative eyes had lower reflectivity of two10×15 pixel regions of interest（ROIs）incorporating：1）ELM＋outer nuclear layer（ONL）and 2）photoreceptor layer（PRL）＋RPE,compared to controls.The values of reflectivity of these ROIs increased postoperatively,but were still lower than normal controls.A larger improvement in BCVA postoperatively was correlated with a greater degree of abnormal preoperative reflectivity and thickness findings.·C ONCLUSION：Quantitative differences in reflectivity and thickness between preoperative,postoperative,and normal SD-OCTs allow assessment of changes in the retina secondary to ERM.Our study identified hyperreflective inner retina changes and hyporeflective outer retina changes in patients with ERMs.SD-OCT quantitative measures of reflectivity and/or thickness of specific groups of retinal layers and/or ROIs correlate with improvement in BCVA.

An Immunohistochemical Study of IgG, Complement C_3, Collagen Type Ⅲ and Macrophage-Marker Ki-M_7 in Epiretinal Membranes

Purpose: To observe the immunological changes in epiretinal membranes from the patients with proliferative vitreoretinopathy (PVR).Methods: Twelve samples of epiretinal membranes obtained during vitreous surgeries for PVR were examined by direct and indirect immunofluorescein histochem-istry.Results: The cellular membranes in 8 cases were composed of retinal pigment epithelial cells, fibroblast-like cells, macrophages and collagen. Positive stainings of IgG. C3, collagen type 1 and macrophage-marker Ki-M7(CD68) was seen in the membranes.Conclusion : The results indicate that humoral immune components and macrophages may play an important role in the development of epiretinal membrane formation. Eye Science 1996; 12:10-14.

Correlation between choroidal thickness and intraocular pressure after 23-gauge vitrectomy for idiopathic epiretinal membrane

AIM： To determine the relationship between the subfoveal choroidal thickness（CT） and intraocular pressure（IOP） following idiopathic epiretinal membrane（ERM） surgery.METHODS： Retrospective observational case series of patients who had undergone 23-gauge vitrectomy for an ERM. The measurements of CT and IOP were done at the baseline and 1 d, 1 wk, 1, 3, 6, and 12 mo after the surgery.RESULTS： Forty-four eyes of 43 patients with a mean age of 69.8±9.5 y were studied. The CT was 200.8±86.3 μm at the baseline, 210.1±83.5 μm at 1 d, 213.2±85.4 μm at 1 wk, 203.1±84.0 μm at 1 mo, 197.5±85.5 μm at 3 mo, 197.7±84.0 μm at 6 mo, and 191.2±86.8 μm at 12 mo after surgery. The CT on day 1 and week 1 after the surgery was significantly thicker than that at the baseline CT（P=0.0023 and P〈0.0001）. The CT at 12 mo after surgery was significantly thinner than the baseline（P=0.0062）. The IOP on day 1 and week 1 were significantly lower than the baseline（P〈0.0001 and P=0.0042）. The IOP at 1, 3, 6, and 12 mo after surgery were significantly higher than the baseline IOP（P=0.0087, P=0.0023, P〈0.00051, and P〈0.0001）. The rates of changes in the CT between baseline and day 1 and week 1 were significantly and negatively correlated with the rates of change in the IOP（P〈0.0001 and P=0.046）. In the group with the IOP change rate of-30% or less at 1 d postoperatively, the change rate of CT was-21.1% to 31.2%（9.8%±12.4%） and in the group of-29% or more, it was-8.9% to 28.0%（2.6%±8.9%）. The change rate of CT in the group with the IOP change rate of-30% or less was significantly higher than the group of-29% or more（P=0.016）.CONCLUSION： CT increases soon after the ERM surgery which is probably due to the transient hypotony, showing that IOP may be a significant confounding factor for CT.

Superficial foveal avascular zone area changes before and after idiopathic epiretinal membrane surgery

To investigate the foveal morphological changes and foveal avascular zone（FAZ）area before and after epiretinal membrane（ERM）surgery.Twenty-two eyes with treatmentnaive ERM were included in this retrospective study.The central foveal thickness（CFT）and FAZ area were measured via swept-source optical coherence tomography（SS-OCT）and OCT angiography pre-and postoperatively.The unaffected fellow eyes were used as controls.The preoperative superficial FAZ area was significantly smaller in patients（0.08±0.04 mm^2）than in controls（0.33±0.09 mm^2;P〈0.001）.The postoperative superficial FAZ（0.12±0.06 mm^2）area was significantly greater than the preoperative area（P〈0.001）.The preoperative superficial FAZ area was strongly negatively correlated with CFT（P〈0.001,rho=-0.763）.ERM induced significant foveal morphological changes and reduction of the superficial FAZ area.Foveal thickness was restored and FAZ area increased postoperatively.However,the process is rather slow and the recovery is incomplete.

Anatomic and functional results of idiopathic macular epiretinal membrane surgery

AIM: To assess the impact of macular surgery on the functional and anatomic outcomes in patients with grade 2 epiretinal membrane(ERM), and the effect of internal limiting membrane(ILM) peeling on visual acuity and to analyze the long-term effect of pars plana vitrectomy(PPV) on intraocular pressure(IOP).METHODS: Pseudophakic eyes(62 eyes) diagnosed as idiopathic grade 2 ERM with at least 6 mo postoperative follow-up were included in this retrospective study. The fellow eye was nonvitrectomized. Patients were divided into two groups: group 1(29 eyes) treated with ERM and ILM peeling and group 2(33 eyes) with only ERM peeling. Preoperative and postoperative best corrected visual acuity(BCVA), slit-lamp, and a dilated fundus examination was performed. IOP was measured with Goldman applanation tonometer before, day 1 and first week and each visit after surgery. The incidence of significant IOP elevation was compared between vitrectomized eyes and nonvitrectomized fellow eyes.RESULTS: Visual improvement was statistically significant and similar in both groups(P=0.008 in group 1, P=0.002 in group 2, P=0.09 inter-group). The amount of decrease in central macular thickness was statistically significant and similar in both groups(P=0.005 group 1, P=0.008 group 2, P=0.37 intergroup). At the final follow-up(14.1±9.6 mo) the incidence of significant IOP elevation was 4% in vitrectomized eyes(three eyes) and 3%(two eyes) in the nonvitrectomized fellow eyes(P=0.12). Four eyes(12.1%) had recurrent ERM after a mean follow-up of 8.6±1.1 mo in group 2, there was no recurrence in group 1(P=0.01).CONCLUSION: Recurrence of ERM may be decreased by ILM peeling during ERM surgery. However, it seems that ILM peeling do not affect the functional outcome and 23-gauge PPV alone do not have a significant effect on IOP.

Epiretinal membrane following pars plana vitrectomy for rhegmatogenous retinal detachment repair

AIM: To determine the rate and possible contributors for post-pars plana vitrectomy(PPV) epiretinal membrane(ERM) in patients treated for rhegmatogenous retinal detachment(RRD). METHODS: This prospective, nonrandomized study comprised 47 consecutive patients(47 eyes) with acute RRD treated with 23 G post-PPV. All participants were followed prospectively for 6 mo for the development of ERM using spectral domain optical coherence tomography. Preoperative and intraoperative data were collected by questionnaires to surgeons. Main outcome measure was the percentage of the ERM formation following post-PPV for RRD. RESULTS: ERM developed postoperatively in 23 eyes(48.9%), none necessitated surgical removal. There was a statistically significant difference between patients with and without ERM postoperatively in preoperative best corrected visual acuity(median log MAR 1.9 vs 0.3, respectively;P=0.003) rate of macula-off(69.6% vs 37.5%, respectively, P=0.028), and rate of ≥5 cryo-applications(55.6% and 18.8%, respectively, P=0.039). ERM developed mainly between the 1st and 3rd months of follow-up. Macula-off status increased the risk of ERM, with the odds ratio of 3.81(P=0.031). CONCLUSION: ERM is a frequent post RRD finding, and its development is associated with macula-off RRD.

Inner limiting membrane peeling prevents secondary epiretinal membrane after vitrectomy for proliferative diabetic retinopathy

·AIM:To evaluate the role of internal limiting membrane(ILM)peeling in preventing secondary epiretinal membrane(ERM)formation in pars plana vitrectomy(PPV)for proliferative diabetic retinopathy(PDR).·METHODS:This retrospective study analyzed the medical records of patients who underwent PPV for PDR and were followed up for minimum 3 mo.ILM peeling was performed based on the intraoperative surgeons’judgments.ERM was assessed by optical coherence tomography photography.The relationship between ILM peeling and postoperative ERM was analyzed.·RESULTS:In total,212 eyes from 197 patients were included in this study.The incidence of secondary ERM in the ILM non-peeling group was significantly higher than that in the ILM peeling group(37.0%vs 14.0%;P<0.001).Multivariate logistical regression revealed that ILM peeling was highly associated with the prevention of secondary ERM development[odds ratio 0.38;95%confidence interval0.17-0.86;P<0.05].·CONCLUSION:ILM peeling during PPV for PDRs can effectively reduce the incidence of secondary ERM development and is worth consideration by vitreoretinal surgeons.

The impact of macular surgery in different grades of epiretinal membrane

AIM：To assess the impact of macular surgery on the functional and anatomic outcomes of the patients in different grades of epiretinal membrane（ERM）.METHODS：Seventy-one eyes of 71 patients who underwent 23-gauge transconjunctival sutureless pars plana vitrectomy for primary isolated ERM were evaluated in this study.RESULTS：There were 38 females（53.5%） and 33 males（46.5%）.The average age of the patients was 68.1 y（range 42-89 y）.Mean follow up period was 14 mo（range 6-26 mo）.The cases were divided into two subgroups of cellophane maculopathy（CM） and macular pucker（MP）.An improvement was observed in the postoperative best-corrected visual acuity（BCVA）,as well as a decrement in central foveal thickness（CFT） in both groups（both of these being statistically significant;P=0.001）.In comparison between two groups,it was found that there was a significant improvement on BCVA and CFT in CM group than MP group（P=0.01）.Furthermore,the postoperative fundus findings regarding RPE alterations and macular edema were significantly higher in MP group when compared to the CM group（P=0.01）.CONCLUSION：ERM and internal limiting membrane peeling surgery can lead to a significant reduction of CFT and visual improvements in idiopathic ERM.A long-term ERM persistence will cause unrecoverable retinal damage and visual loss.

Microstructural morphology and visual acuity outcome in eyes with epiretinal membrane before,during,and after membrane peeling in intraoperative optical coherence tomography assisted macular surgery

AIM:To measure the difference of intraoperative central macular thickness(CMT)before,during,and after membrane peeling and investigate the influence of intraoperative macular stretching on postoperative best corrected visual acuity(BCVA)outcome and postoperative CMT development.METHODS:A total of 59 eyes of 59 patients who underwent vitreoretinal surgery for epiretinal membrane was analyzed.Videos with intraoperative optical coherence tomography(OCT)were recorded.Difference of intraoperative CMT before,during,and after peeling was measured.Pre-and postoperatively obtained BCVA and spectral-domain OCT images were analyzed.RESULTS:Mean age of the patients was 70±8.13y(range 46-86y).Mean baseline BCVA was 0.49±0.27 log MAR(range 0.1-1.3).Three and six months postoperatively the mean BCVA was 0.36±0.25(P=0.01 vs baseline)and 0.38±0.35(P=0.08 vs baseline)log MAR respectively.Mean stretch of the macula during surgery was 29%from baseline(range 2%-159%).Intraoperative findings of macular stretching did not correlate with visual acuity outcome within 6mo after surgery(r=-0.06,P=0.72).However,extent of macular stretching during surgery significantly correlated with less reduction of CMT at the fovea centralis(r=-0.43,P<0.01)and 1 mm nasal and temporal from the fovea(r=-0.37,P=0.02 and r=-0.50,P<0.01 respectively)3mo postoperatively.CONCLUSION:The extent of retinal stretching during membrane peeling may predict the development of postoperative central retinal thickness,though there is no correlation with visual acuity development within the first 6mo postoperatively.

Potential role of Müller cells in the pathogenesis of macropsia associated with epiretinal membrane:a hypothesis revisited

Pathophysiological explanations for metamorphopsia associated with retinal pathologies generally focus on photoreceptor organization disruption. However, the retinal microarchitecture is complicated, and we hypothesize that other retinal cells may also be involved. Metamorphopsia has been widely studied in eyes with epiretinal membranes and we revisit the idea that Müller cell displacement causes retinal macropsia. A Pub Med query and related article search for the macula ultrastructure under normal and pathological conditions revealed an enormous amount of information, particularly ultrahigh definition optical coherence tomography and other retinal imaging modality studies. Findings of these imaging studies support our hypothesis that Müller cells, and not cone photoreceptors, are primarily responsible for macropsia in eyes with epiretinal membranes. More specifically, we conclude that displacement of Müller cell endfeet, and not photoreceptor cones, is a more likely the explanation for retinal macropsia associated with epiretinal membranes.

Predictive factors of epiretinal membrane in complicated rhegmatogenous retinal detachment tamponaded with silicone oil

AIM:To determine the incidence and predictive factors for epiretinal membrane(ERM)formation in eyes with complicated primary rhegmatogenous retinal detachment(RRD)tamponaded with silicone oil(SO).METHODS:This retrospective case-control study included 141 consecutive patients with(51 eyes)and without(90 eyes)ERM formation after primary pars plana vitrectomy(PPV)and SO tamponade for complicated RRD.The risk factors for ERM were assessed using logistic regression analysis.RESULTS:The prevalence of postoperative ERM was 36.2%(51/141).Multivariate logistic regression analysis showed that the risk factors for ERM in SO-tamponaded eyes included preoperative proliferative vitreoretinopathy[PVR;odds ratio(OR),2.578;95%confidence interval(CI)1.580–4.205,P<0.001],preoperative choroidal detachment(OR,4.454;95%CI 1.369–14.498,P=0.013),and photocoagulation energy(OR,2.700;95%CI 1.047–6.962,P=0.040).The duration of the preoperative symptoms,intraocular SO tamponade time,giant retinal tear,preoperative vitreous hemorrhage,preoperative bestcorrected visual acuity,number of breaks,quadrants of RRD,axial length,and photocoagulation points were not predictive factors for ERM formation.CONCLUSION:Preoperative PVR,choroidal detachment,and photocoagulation energy are risk factors of ERM formation after complicated RRD repair.Better ophthalmic care as well as patient education are necessary for such patients with risk factors.

One-year follow-up evaluation of combined phacovitrectomy for idiopathic epiretinal membrane

AIM:To evaluate the therapeutic effect of combined phacovitrectomy with membrane peeling and intraocular lens(IOL)implantation in patients with severe idiopathic epiretinal membrane(iERM)and concurrent cataract.METHODS:A total of 34 eyes from 34 patients who underwent phacovitrectomy and epiretinal membrane(ERM)peeling at the First Affiliated Hospital of Zhejiang University between 2015 and 2017.The best-corrected visual acuity(BCVA)and central foveal thickness(CFT)were measured preoperatively and at 1,3,6 mo and 1 y postoperatively.Temporal changes and bivariate correlations of these parameters were analyzed.RESULTS:Mean logMAR BCVA improved and CFT decreased significantly(P<0.001)until 6 mo after surgery.Correlation analysis revealed a positive correlation between preoperative and postoperative logMAR BCVA(r=0.716,P<0.001 at 1 mo,r=0.417,P=0.014 at 3 mo,r=0.359,P=0.037 at 6 mo,and r=0.369,P=0.032 at 12 mo post-op respectively),but preoperative CFT was neither associated with postoperative CFT nor with postoperative logMAR BCVA.There was a positive correlation between CFT and logMAR BCVA at 1 mo(r=0.346,P=0.045),6 mo(r=0.347,P=0.045),and 12 mo(r=0.342,P=0.048)post-operatively.The intraand postoperative complications were relatively mild,and the incidences were generally low.CONCLUSION:For severe iERM patients with significant visual symptoms,combined phacovitrectomy with membrane peeling and IOL implantation is safe and effective in improving BCVA and decreasing CFT.Early surgery in selected patients may help preserving better visual function.

Epiretinal membrane related vascular changes in diabetic eyes evaluated with optical coherence tomography angiography

AIM:To evaluate the retinochoroidal microvascular circulation and anatomical structure of diabetic and nondiabetic patients with epiretinal membrane(ERM)with the help of optical coherence tomography angiography(OCT-A)and compare them with healthy control subjects.METHODS:In this prospective,cross-sectional study,a total of 165 eyes were evaluated,including 50 eyes of patients with diabetic ERM,54 eyes of idiopathic ERM(iERM)patients,and 61 eyes of healthy controls.Macula and disc angiography was performed by OCT-A.Macular vessel density(VD)ratio was evaluated by dividing the VD of the foveal region by the VD of the parafoveal region.Statistical calculations were evaluated at the 95%confidence interval.RESULTS:Macula superficial VD values of ERM cases were lower than that in the control group,while foveal VD was higher in ERM cases.Macula deep VD values of ERM cases were lower in all quadrants,except the fovea.The width of the foveal avascular zone(FAZ)area was significantly lower in the ERM groups,and the FAZ width was lowest in iERM group.Macula superficial VD ratio was significantly higher in the ERM groups,but there was no significant difference between ERM groups.Macula deep VD ratio was significantly higher in the iERM group than in the control group.CONCLUSION:Diabetic and idiopathic ERMs differ in their mechanism of formation and clinical presentation,as well as their effect on retinal vascular structures.If the relationship of increase of retinal thickness with vascular integrity can be demonstrated with OCT-A,then,OCT-A can be used as a guide for ERM prognosis.

18 MHz彩色多普勒超声检查对黄斑前膜的临床诊断价值

目的:探讨18 MHz彩色多普勒超声对黄斑前膜的诊断价值。方法:收集2020-01/2022-01期间在我院经眼底检查拟诊白内障和玻璃体混浊的患者44例80眼,分别通过光学相干断层扫描法(OCT)与18 MHz彩色多普勒超声对患眼进行检查,比较18 MHz彩色多普勒超声与OCT对黄斑前膜诊断敏感度、特异性、准确度的差异。结果:经18 MHz彩色多普勒超声检测80眼中,62眼为黄斑前膜,18眼为非黄斑前膜;经OCT确诊确实为黄斑前膜的54眼,非黄斑前膜的13眼,漏诊5眼,误诊8眼;18 MHz彩色多普勒超声与OCT诊断一致性较高(Kappa=0.892,P<0.05);18 MHz彩色多普勒超声检测黄斑前膜敏感性为92%,特异性为62%,漏诊率为8%,误诊率为38%,正确率为84%;与OCT检测相比,18 MHz彩色多普勒超声检测特异性、正确率、阳性预测准确率、阴性预测准确率降低,误诊率升高(均P<0.05),诊断敏感性与漏诊率比较无差异(均P>0.05)。结论:18 MHz彩色多普勒超声对黄斑前膜病变具有一定鉴定价值,与OCT检验具有一致性。

3D手术视频系统及术中OCT在特发性黄斑前膜玻璃体切除术中的应用

目的:评价3D手术视频系统及术中光学相干断层扫描(OCT)在特发性黄斑前膜玻璃体切除术中的应用效果。方法:回顾性临床研究。选取2023-01/10在新疆四七四医院眼科治疗的特发性黄斑前膜患者61例61眼,按手术方式分为两组:3D组31例31眼采用3D手术视频系统及术中OCT技术,传统手术组30例30眼采用Resight非接触广角镜系统手术。记录两组患者手术时间及剥膜时间,随访6 mo,分析两组术后最佳矫正视力(BCVA)、眼压(IOP)、黄斑区视网膜厚度(CMT)、并发症。结果:所有患者均顺利完善手术,术中均未发生视网膜大出血、视网膜裂孔、视网膜脱离等严重并发症,术后均未出现眼内炎、继发性青光眼等并发症。3D组手术时间和剥膜时间明显短于传统手术组(20.13±1.59vs 25.97±2.09 min;3.74±0.89vs 8.13±1.72 min,均P<0.001)。两组患者术后1 mo BCVA、CMT与术前比较均无差异(均P>0.008),术后3、6 mo BCVA、CMT均较术前改善(均P<0.008)。术后6 mo,3D组BCVA较传统手术组明显改善(P=0.007)。术后各时间点两组间CMT和眼压比较均无差异(均P>0.05)。结论:3D手术视频系统及传统手术组均可治疗特发性黄斑前膜,但3D手术视频系统术中OCT在缩短手术时间,提高手术效率,改善精细手术步骤方面更有优势。

Prognostic factors of short-term outcomes of intravitreal ranibizumab in diabetic macular edema

AIM：To evaluate the prognostic factors for short-term visual and anatomical improvement of intravitreal ranibizumab（IVR） for diabetic macular edema（DME）.METHODS：Fifty-one eyes from 35 patients that received three consecutive monthly IVR for DME with moderate visual loss were retrospectively recruited; all cases had their baseline best-corrected visual acuity（BCVA） between 20/400 and 20/40. BCVA and central subfield thickness（CST） at baseline and month 3 were collected. Linear mixed models were used to evaluate the prognostic factors for visual and anatomical improvement at month 3.RESULTS：Younger age, poorer baseline BCVA and proliferative diabetic retinopathy（PDR） were correlated with better visual improvement at month 3（P=0.002, 0.0001 and 0.007, respectively）. Thicker CST and the presence of subretinal fluid at baseline were correlated with a greater reduction in CST（P〈0.0001 and P=0.018, respectively）. The presence of epiretinal membrane or previous posterior subtenon injection of triamcinolone acetonide（PSTA） were associated with a smaller reduction in CST（P=0.029 and 0.018, respectively）, but had no significant effects in visual improvement at month 3（P〉0.05 for both）.CONCLUSION：For eyes with DME and moderate visual loss, those with younger age, poorer baseline BCVA or PDR tend to have better visual improvement after three consecutive monthly IVR. Epiretinal membrane or previous PSTA result in less resolution of CST, but do not significantly affect visual improvement.