Functional and Morphological Correlations before and after Video-Documented 23-Gauge Pars Plana Vitrectomy with Membrane and ILM Peeling in Patients with Macular Pucker.

Wolfgang J Mayer,Christos Haritoglou,Ricarda Schumann,Denise Compera,Armin Wolf,Clara Fazekas,Anselm Kampik

doi:10.1155/2015/297239

Wolfgang J Mayer, Christos Haritoglou + Show 5 more

Open Access

https://doi.org/10.1155/2015/297239

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Abstract

Purpose. To assess functional and morphological alterations following video-documented surgery for epiretinal membranes. Methods. Forty-two patients underwent video-documented 23-gauge vitrectomy with peeling of epiretinal (ERM) and inner limiting membrane (ILM). Patient assessment was performed before and 3 and 6 months including best corrected visual acuity (BCVA), slit lamp biomicroscopy, SD-OCT, and central 2° and 18° microperimetry. In addition, all video-documented areas of peeling on the retinal surface were evaluated postoperatively using an additional focal 2° microperimetry. Retinal sensitivity and BCVA were correlated with morphological changes (EZ and ELM) in the foveal region and in regions of membrane peeling. Results. Overall, BCVA increased from 0.6 (±0.2) to 0.2 (±0.2) logMAR after 6 months with an increase in retinal sensitivity (17.9 ± 2.7 dB to 26.8 ± 3.1 dB, p < 0.01). We observed a significant correlation between the integrity of the EZ but not of the ELM and the retinal sensitivity, overall and in peeling areas (p < 0.05). However, no significant correlation between alterations in the area of peeling and overall retinal sensitivity regarding visual acuity gain could be observed after 6 months (p > 0.05). In contrast, overall postoperative retinal sensitivity was significantly decreased in patients with a visual acuity gain lower than 2 lines (p < 0.05) correlating with EZ defects seen in OCT. Conclusions. Mechanical trauma of epiretinal membrane and ILM peeling due to the use of intraocular forceps may affect the outer retinal structure. Nevertheless, these changes seem to have no significant impact on postoperative functional outcome.

Highlights

Epiretinal membrane (ERM) formation reflects a number of pathological changes occurring in vitreoretinal junctions
The aim of the present study was to analyze the correlation between morphological changes of the outer retina, such as EZ and ELM, and functional parameters, such as retinal sensitivity and visual acuity in the fovea and in the area of ERM and internal limiting membrane (ILM) peeling, whether the manual peeling using forceps during surgery has an influence on postoperative functional outcome or not
The video documentation of all surgical procedures revealed that the surgeon made 3 to 8 grasps with the endgripping forceps at the retinal surface to remove epiretinal membranes and the ILM

Summary

Introduction

Epiretinal membrane (ERM) formation reflects a number of pathological changes occurring in vitreoretinal junctions. Fibrous astrocytes, and Muller cells proliferate and migrate from neurosensory retina, through surface and breaks of the internal limiting membrane (ILM). The epiretinal membrane itself is defined as a fine, semitranslucent, nonvascular, fibrocellular membrane on the inner retinal surface along the ILM [1, 2, 5]. Pars plana vitrectomy with membrane peeling is the current standard treatment for surgical removal of ERM, with reported rates of visual improvement ranging between 67% and 82%. Removing the ILM has been suggested as a measure to prevent cellular reproliferation. Disruptions of the photoreceptor inner and outer segment band seem to be a potential predictor for poor visual recovery in eyes having undergone

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