Удаление идиопатических эпиретинальных мембран с сохранением фовеальной внутренней пограничной мембраны

Abstract

Introduction. The epiretinal membrane (ERM) is a connective tissue structure on the surface of the retina, formed as a result of proliferative and dystrophic processes in the inner layers of the retina and the cortical layers of the vitreous body. ERM has contractile properties and could cause tangential tractions, retinal folding and edema. To ensure the maximum preservation of visual functions, a method of ERM removal with the preservation of foveal inner limiting membrane (ILM) is proposed. Purpose. To present results of a new approach for ERM removal with preservation of foveal ILM on a series of clinical cases. Material and methods. The study included 3 patients with a diagnosis of ERM, with the complaints of metamorphopsia of less than 8 months. In addition to the standard ophthalmological examination, patients underwent optical coherence tomography (CirrusHD-OCT 5000; Carl Zeiss Meditec) and microperimetry (MAIA; CenterVue). Surgical intervention consisted in minimally invasive three-port vitrectomy with removal of ERM and ILM with preservation of foveal ILM. In the postoperative period, patients were examined at the time of 1, 3 and 6 months. Results. The analysis of microperimetric data showed that the degree of functional disorders corresponded to morphological changes: ectopia of the inner layers of the retina, deformation of its normal profile, a pronounced decrease in light sensitivity in the projection area of traction macular edema. In the postoperative period, the indicators of central light sensitivity improved gradually throughout the entire follow-up period. Conclusion. Thus, the proposed low-traumatic method of ERM removal with the preservation of foveal ILM, provides a stable anatomical and functional result, the restoration of both morphological and functional parameters. The data presented in this paper require confirmation in further comparative clinical trials. Key words: epiretinal membrane, surgical treatment, internal limiting membrane