Idiopathic Macular Epiretinal Membrane Research Articles

Clinical study of razumab combined with 25G transconjunctival sutureless vitrectomy in the treatment of 29 patients with idiopathic macular anterior membrane

Objective To investigate the effect of razumab combined with 25 G transconjunctival sutureless vitrectomy in patients with idiopathic macular epiretinal membrane (IMEM). Methods 57 cases (57 eyes) of IMEM patients in our hospital were divided into two groups according to random number table. 28 cases in the control group were treated with 25G transconjunctival sutureless vitrectomy, and 29 cases in the observation group were treated with rezumab on the basis of the control group.The improvement of visual acuity, changes of macular fovea thickness (central foveal thickness, CFT), serum levels of vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-1) in the two groups were observed and compared. The changes of intraocular pressure before treatment and at different time points (1 weeks, 1 months, 3 months) after treatment and incidence of complications in two groups were statistically analyzed. Results 3 months after treatment, the improvement rate of visual acuity in the observation group was 75.86% (22/29), higher than that in the control group 50% (14/28) (P 0.05). The incidence of complications in the observation group was 10.34% (3/29), while that in the control group was 7.14% (2/28), with no significant difference between the two groups (P>0.05). Conclusions The combination of rezumab and 25G transconjunctival sutureless vitrectomy can reduce the CFT of IMEM patients, improve their levels of serum ICAM-1 and VEGF, and improve their vision. Besides, it has little influence on intraocular pressure and fewer complications. Key words: Ranibizumab; Conjunctiva; Vitrectomy; Macula lutea; Retina

Macular vascular circulation and retinal oxygen saturation changes for idiopathic macular epiretinal membrane after vitrectomy.

To investigate the postoperative changes in retinal-choroidal blood flow area and retinal vascular oxygen saturation among patients with idiopathic macular epiretinal membranes (iERMs). This study prospectively included 24 eyes of 24 consecutive patients who underwent vitrectomy for iERMs. The flow area of choriocapillary layer, retinal superficial capillary plexuses (SCPs) and retinal deep capillary plexuses (DCPs) were performed using optical coherence tomography angiography with angiovue prototype software, and retinal vascular oxygen saturation was measured using retinal oximeter with the built-in software. The flow area of choriocapillary layers and mean retinal vessel oxygen saturation before and after surgery were compared. Three months after vitrectomy, the foveal flow area of choriocapillary layer increased clinically significantly from 1.5±0.2 to 1.6±0.2mm2 (p=0.02). The retinal vascular changes of SCPs and DCPs were not statistically significant. The mean retinal arterial oxygen saturation was 89.9±11.3% preoperatively and increased to 94.5±9.7% postoperatively (p=0.04). Foveal retinal thickness revealed a clinically significant decrease from 547.8±88.2μm to 403.0±47.5μm after surgery (p<0.05). Postoperative best corrected visual acuity had no statistically significant correlation with foveal flow area of the choriocapillary layer and retinal vascular oxygen saturation. There was a decrease of retinal thickness, an improved flow area of choriocapillary layer in macular region, and an increase of retinal arterial vascular oxygen among iERMs patients after vitrectomy.

Surgical Outcomes of Idiopathic Macular Epiretinal Membrane Peeling.

To evaluate the surgical outcomes of idiopathic macular epiretinal membrane (IERM) peeling in terms of visual acuity and macular thickness. Observational cross-sectional study. Al-Ibrahim Eye Hospital, Karachi, from June 2017 to February 2018. Patients aged >50 years having IERM confirmed with optical coherence tomography (OCT) were included in the study. All patients underwent 3-port pars plana vitrectomy (PPV) followed by epiretinal membrane peeling. Log Mar visual acuity chart was used for documenting visual acuity pre- and postoperatively. OCT was performed for documenting changes in macular thickness pre- and postoperatively. Every patient completed their follow-up of six months. Mean age of the 43 patients was found to be 59.98 ±6.1 years. Mean pre- and postoperative visual acuity of Log Mar showed 0.59 ±0.21 and 0.33 ±0.21, respectively (p<0.001). Mean macular thickness on OCT pre- and postoperatively were 479 ±82.5 and 315 ±82.4 m, respectively (p<0.001). In thirty-one (72.1%) eyes, there was improvement in best corrected visual acuity (BCVA) postoperatively, 9 (20.9%) eyes remained stable; whereas, 3 (7%) eyes had decreased visual acuity at final follow-up of six months. Peeling of IERM is a safe surgical procedure. It is associated with significant improvement in best corrected visual acuity postoperatively along with improvement in anatomical outcomes in terms of decrease macular thickness as measured by OCT.

Correlation between foveal avascular zone size and foveal morphology in patients with idiopathic macular epiretinal membrane

Objective To analyze the correlation between foveal avascular zone (FAZ) size and foveal morphology in patients with idiopathic macular epiretinal membrane (IMEM) using OCT angiography (OCTA). Methods A retrospective case series study contained of 54 eyes of 54 patients affected with IMEM (IEM group) and 50 eyes of 50 normal persons as the control group. The BCVA was measured using the international standard visual acuity chart, and the results were converted to the logMAR visual acuity. The FAZ areas were evaluated with OCTA in both the superficial and deep capillary plexus layers by using 3 mm×3 mm images of the macular. The central macular thickness (CMT), inner retinal layer thickness (IRT), outer retinal layer thickness (ORT), subfoveal choroidal thickness (SFCT), and the status of ellipsoid zone (EZ) were assessed with spectral-domain optical coherence tomography. The differences of FAZ areas between the two groups were analyzed. The correlative analysis was performed to investigate the relationship between areas and foveal morphology. Results Compared with control group, the FAZ area in superficial and deep capillary plexus in the IMEM group were significantly smaller (t=−29.095, −28.743; P<0.001, <0.001); the mean CMT, IRT, ORT and SFCT were significantly thickening in the IMEM group (Z=−8.784, −8.524, −7.709, −7.535; P<0.001,<0.001, <0.001, <0.001). In the IMEM group, the FAZ area in superficial capillary plexus correlated inversely with the CMT, IRT, and the integrity of EZ (r=−0.464, −0.536, −0.293; P<0.001, <0.001, 0.039), no significant correlation of superficial plexus FAZ areas with ORT and SFCT (r=−0.218, −0.165; P=0.172, 0.157). The FAZ area in deep capillary plexus correlated inversely with the CMT, IRT, and the integrity of EZ (r=−0.306, −0.694, −0.468; P=0.037, <0.001, <0.001), no significant correlation with ORT and SFCT (r=−0.242, −0.227; P=0.079, 0.094). Conclusions The FAZ areas is significantly decreased in IMEM eyes compared with normal eyes. Both superficial and deep FAZ area are correlated with the CMT, IRT, and the integrity of EZ. Key words: Macula lutea; Membranes; Tomography, optical coherence; Foveal avascular zone

Macular microvasculature features before and after vitrectomy in idiopathic macular epiretinal membrane: an OCT angiography analysis.

To evaluate pre-operative and post-operative morphologic characteristics in idiopathic macular epiretinal membrane (ERM) by optical coherence tomography angiography (OCTA). Thirty-three subjects with unilateral idiopathic ERM were enrolled and the contralateral eyes served as controls. Vascular parameters including superficial capillary plexus (SCP), deep capillary plexus (DCP), outer capillary plexus (OCP), and choroidal capillary plexus (CCP) were evaluated by OCTA. The superficial foveal avascular zone (FAZ) was significantly smaller in eyes with ERM (P < 0.0001). The vessel densities (VDs) were significantly increased in the fovea but dramatically decreased in the parafovea in SCP and DCP of ERM eyes (all P < 0.0001), in contrast to those in OCP and CCP. The blood flow was augmented in OCP but declined in choroid compared with the controls. In CCP, the mean foveal VD in ERM was significantly smaller (P = 0.023), whereas parafoveal VD did not significantly change (P = 0.66). At 6 months after surgery, flow area was decreased in OCP (P = 0.0007), and foveal and parafoveal VDs were significantly altered in all layers except the foveal VD in OCP and the choroid (all P < 0.05). The total and inner retinal thickness of the fovea and parafovea were correlated with pre-operative and post-operative visual outcomes, respectively. Smaller FAZ and greater interocular differences between post-operative and fellow eyes in FAZ were associated with worse post-operative visual outcomes. OCTA provides a better display of the vascular network of the retina and choroid to evaluate the severity and surgical prognosis of ERM patients.

Long term clinical observation on postoperative microstructural change of macula lutea in treatment of idiopathic macular epiretinal membrane

Objective: To evaluate the relationship between the structure of macular region and prognosis after vitrectomy in idiopathic macular epiretinal membrane patients. Methods: Retrospective case series study. The cases of 74 idiopathic macular epiretinal membrane patients (31 female patients, 43 male patients, aged 68.1±6.9) who received surgery treatment in our hospital during January 2013 and December were collected and analyzed. Ophthalmic routine examination and optical coherence tomography (OCT) have been conducted for all patients prior to operation. All eyes underwent vitecrtomy and macular epiretinal membrane peeling. During the 12 months follow up, the preoperative and postoperative data including best corrected visual acuity (BCVA), foveal thickness, changes of morphology in ellipsoid zone were observed and analyzed. All the patients were divided into two groups, continuous group (52 patients) and discontinuous group (22 patients), based on the preoperative continuity status of ellipsoid zone. The data of preoperative macular retinal thickness, the relationship between age and course of the disease, preoperative BCVA and postoperative BCVA were analyzed statistically with repeated ANOVA method. The postoperative BCVA were analyzed statistically with t test mtehod, based on the different grouping of continuity status of ellipsoid zone. Results: The preoperative LogMar BCVA, and the postoperative LogMAR BCVA of 1 month, 3 month, 6 month and 12 month after operation were 0.59±0.26, 0.63±0.34, 0.46±0.22, 0.45±0.23, 0.41±0.23 (F=25.122, P<0.05) respectively. The preoperative foveal thickness, and the postoperative foveal thickness of 1 month, 3 month, 6 month and 12 month after operation were (468.12±73.07), (371.57±57.09), (320.57±65.88), (294.85±69.36), (283.5±66.56)μm (F=8.802, P<0.05), the difference between the figures are of statistical significance. The postoperative BCVA of continuous group (0.34±0.27) improved significantly, as compared to the BCVA of discontinuous group (0.62±0.24) (t=-4.209, P<0.05). There is no obvious relationship between the degree of preoperative macular edema and postoperative visual function (r=0.015, P> 0.015). Seven patients still have macular edema one year after surgery. Conclusion: The postoperative visual function in patients with idiopathic macular epiretinal membrane has negative correlation with preoperative thickness of fovea, and has positive correlation with continuity of ellipsoid zone. (Chin J Ophthalmol, 2018, 54: 258-262).

Relationship between choroidal thickness and idiopathic macular epiretinal membrane

Relationship between choroidal thickness and idiopathic macular epiretinal membrane

Research on accuracy of different IOL power calculation following the combination of phacoemulsification and vitrectomy in eyes with idiopathic macular epiretinal membrane

Objective To evaluate the accuracy of intraocular lens (IOL) power calculation using IOL-Master in patients underwent phacoemulsification and vitrectomy for idiopathic macular epiretinal membrane (IMEM) concurrent with age-related cataract (ARC). Methods A prospective study was designed.A total of 32 patients (32 eyes) with ARC (ARC group) and 30 patients (30 eyes) with ARC and IMEM (ARC+ IMEM group) were enrolled from March 2013 to July 2015 in the Hangzhou District of Eye Hospital of Wenzhou Medical University.All the surgeries were performed by the same experienced surgeon and the same IOL (Adapt-AO) was implanted.IOL power was calculated by both SRK-T and Haigis formulas.The central macular thickness was measured by OCT preoperatively and postoperatively.The mean postoperative refractive prediction error (ME), mean absolute postoperative prediction error (MAE) and percentage of eyes achieved target refraction within ±0.25, ±0.50 and ±1.00 D were compared between the 2 groups.The correlation between the refractive error and macular thickness change was evaluated. Results The ME and MAE calculated by Haigis were (-0.47±0.66)D and (0.63±0.44)D in ARC+ IMEM group, and (-0.18±0.74)D and (0.68±0.65)D in ARC group.The ME and MAE calculated by SRK-T were (-0.60±0.59)D and (0.73±0.41)D in ARC+ IMEM group, and (-0.23±0.85)D and (0.75±0.69)D in ARC group.No significant differences were found between the two groups in each formula (all at P>0.05). There was no significant difference of MAE distribution between the two groups in Haigis formula.In SRK-T formula, the percentage of MAE≤0.25 D in the ARC+ IMEM group was significantly higher than that in the ARC group (χ2=7.114, P=0.007). In the ARC+ IMEM group, the change of the macular thickness was (-97.4±115.3)μm, which was statistically correlated with the ME of Haigis and SRK-T formulas (r=0.369, P=0.045; r=0.421, P=0.021). Conclusions There is a tendency toward myopia shift in patients underwent phacoemulsification and vitrectomy compared with conventional phacoemulsification.The myopia shift shows a significant correlation with macular thickness changes.Haigis formula performs better than SRK-T formula with the condition of un-optimized parameters. Key words: Idiopathic macular epiretinal membrane; Cataract; Refraction; Bio-measurement; Phacoemulsification; Vitrectomy

Assessment of macular function in patients with idiopathic Epiretinal membrane by multifocal Electroretinography: correlation with visual acuity and optical coherence tomography

BackgroundThis study evaluates the macular function changes in patients with idiopathic macular epiretinal membrane (ERM) by multifocal electroretinography (mfERG) and their correlations with visual acuity and central macular thickness (CMT) by optical coherence tomography (OCT).MethodsTwenty eyes of 20 patients with ERM underwent OCT and mfERG examinations. The response amplitude densities and implicit times of mfERG were compared to the control fellow eyes. Correlation analyses among visual acuity, central macular thickness and mfERG values in the central two concentric rings were performed.ResultsThe mfERG P1 response amplitude densities in ring 1–2 and P1 implicit time in ring1 were significantly changed in epiretinal membrane eyes compared with controls (P < 0.05). Multivariate stepwise linear regression analyses showed LogMAR visual acuity was significantly correlated with CMT (P = 0.004), and also with the P1 amplitude density in ring 1 (P = 0.002). CMT showed significant correlation with P1 implicit time in ring 2 (P = 0.013).ConclusionsThe mfERG abnormalities show macular function changes and correlate with visual acuity and central macular thickness in eyes with ERM. In first-order mfERG responses, P1 wave changes may be a sensitive functional measurement for ERM patients.

Correlation of visual acuity and metamorphopsia with foveal morphology before and after vitrectomy with internal limiting membrane peeling in idiopathic macular epiretinal membrane eyes

Objective To analyze the correlation of visual acuity and metamorphopsia with foveal morphology before and after vitrectomy with internal limiting membrane peeling (ILMP) in idiopathic macular epiretinal membrane (IMEM) eyes. Methods This is a retrospective case series of 47 IMEM patients (49 eyes). All the patients underwent 25G pars plana vitrectomy with IMEM removal and ILMP. The best corrected visual acuity (BCVA) was measured using the international standard visual acuity chart, and the results were converted to the logarithm of the minimum angle of resolution (logMAR) visual acuity. The severity of metamorphopsia was measured using M-charts. The central macular thickness (CMT), inner nuclear layer thickness (INT), inner retinal layer thickness (IRT), outer retinal layer thickness (ORT), the status of ellipsoid zone (EZ) were assessed with spectral-domain optical coherence tomography at baseline and each month postoperatively. The differences in BCVA, CMT, INT, IRT, ORT and status of EZ before and after surgery were analyzed, so did the correlations between these indexes at the same time. Results Compared with baseline, the postoperative BCVA was significantly increased (F=6.133, P<0.001), but the M value, CMT, INT, IRT, ORT were significantly decreased (F=12.481, 10.565, 15.739, 6.046, 10.569; P<0.001);the integrity of EZ was improved significantly (χ2=12.309, P<0.001). Preoperative BCVA was positively related to the CMT (r=0.720) and ORT (r=0.720, 0.887; P<0.05), while negatively related to preoperative integrity of EZ (r=−0.295, P<0.05). The postoperative BCVA was positively related to the preoperative BCVA and postoperative CMT, ORT (r=0.774, 0.754, 0.842; P<0.05), while negatively related to postoperative integrity of EZ (r=−0.676, P<0.05). The preoperative M value was positively related to the preoperative CMT, INT, IRT, and ORT (r=0.931, 0.668, 0.840, 0.637; P<0.05). The postoperative M value was positively related to the preoperative M value and postoperative CMT, INT, IRT, and ORT (r=0.723, 0.722, 0.767, 0.825, 0.387; P<0.05). Conclusions Vitrectomy with ILMP for IMEM can improve the visual acuity, metamorphopsia and foveal morphology. Both visual acuity and metamorphopsia correlate with foveal morphology. Key words: Macula lutea; Membranes; Vitrectomy; Tomography, optical coherence

Visual quality assessment of TCM warm-reinforcing method in early idiopathic macular epiretinal membrane

Visual quality assessment of TCM warm-reinforcing method in early idiopathic macular epiretinal membrane

The efficacy of vitrectomy combined with membrane peeling for the treatment of idiopathic epiretinal membrane

Objective To evaluate the efficacy of 25-gauge vitrectomy combined with membrane peeling for the treatment of idiopathic macular epiretinal membrane. Methods The clinical data of 23 eyes of 23 patients with idiopathic macular epiretinal membrane were analyzed retrospectively. Results The visual acuity after surgery was improved in 19 eyes, and unchanged in 4 eyes. Before surgery the metamorphopsia was in 11 eyes, among them the metamorphopsia relieved, but did not completely disappeared in 9 eyes. According to the different forms of idiopathic epiretinal membrane, these patients were divided into 4 groups: the group of epiretinal membrane associated with macular edema, 14 eyes, underwent vitrectomy combined with membrane peeling, there were 7 eyes with retinal internal limiting membrane peeling during surgery; after surgery, the visual acuity improved in 12 eyes, and remained unchanged in 2 eyes. The group of proliferative epiretinal membrane, 6 eyes, among them 1 eye treated with epiretinal membrane peeling only.The other 5 eyes received vitrectomy combined with membrane peeling, during surgery 2 eyes combined with ILM peeling, the visual acuity improved in 4 eyes and unchanged in 2 eyes after operation. The group of macular pseudohole induced by macular epiretinal membrane, 2 eyes, underwent vitrectomy combined with membrane peeling, the vision acuity improved in all cases after surgery. The group of lamellar macular hole leaded by epiretinal membrane, 1 eye, underwent comined surgery with ILM peeling, the postoperative visual acuity improved. Conclusion Vitrectomy combined membrane peeling can effectively treat for idiopathic macular membrane. Key words: Epiretinal membrane, macular, idiopathic; Vitrectomy, combined membrane peeling

Levels of Interleukin 27 and Interleukin 35 in the Serum and Vitreous of Patients with Proliferative Diabetic Retinopathy

ABSTRACTPurpose: To examine the role of interleukin 27(IL-27) and interleukin 35 (IL-35) in diabetic retinopathy (DR).Methods: Patients with diabetes mellitus were divided into three groups: diabetes without retinopathy (DWR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR). Patients with idiopathic macular epiretinal membrane (IMEM) were included as a control group. The serum and vitreous levels of IL-27 and IL-35 were measured using ELISA.Results: The serum levels of IL-27 (median 240.900 pg/mL, range 42.224 – 617.810 pg/mL; p < 0.001) and IL-35 (median 11.875 ng/mL, range 8.640 – 19.340 ng/mL; p < 0.001) were significantly decreased in PDR patients compared to controls (median 2712.310 pg/mL, range 1005.375–5786.877 pg/mL and median 25.185 ng/mL, range 22.845 – 29.590 ng/mL, respectively). The vitreous levels of IL-35 were significantly decreased in PDR patients (16.32 ± 3.24 ng/mL) compared to controls (24.54 ± 5.86 ng/mL, p < 0.001).Conclusions: Serum and vitreous levels of IL-35 and serum level of IL-27 may be associated with the pathogenesis of PDR.

Postoperative eccentric macular holes after vitrectomy and internal limiting membrane peeling.

The purpose of this study was to describe the incidence, clinical characteristics, and outcome of eccentric macular holes presenting after vitrectomy and internal limiting membrane (ILM) peeling for the treatment of macular pathology and discuss the pathogenesis of holes formation. A retrospective, noncomparative, interventional case-series study of five patients who developed eccentric macular holes postoperatively following vitrectomy in 198 consecutive patients who underwent ILM peeling for idiopathic macular hole and epiretinal membrane formation between 2008 and 2015. Five patients (2.5%) developed full-thickness eccentric macular holes postoperatively. Three patients presented with a single eccentric macular hole, one patient had an eccentric hole after a failed idiopathic macular hole surgery and one patient developed four eccentric macular holes. The mean diameter of the holes was 584μm (range 206-1317μm) and the average time of holes formation after vitrectomy was 27.7weeks (range 1-140weeks). Postoperative best-corrected visual acuity ranged from "counting fingers" to 20/25. The eyes with the holes distant from the fovea had the best final visual acuity. No further intervention was attempted and no complications occurred. The mean follow-up time was 26.8months. The postoperative macular holes after vitrectomy and ILM peeling were variable in number, size, and time of appearance but remained stable and were not associated with any complications. The pathogenesis of macular holes is most consistent with contraction of the residual ILM or secondary epimacular proliferation probably stimulated by ILM peeling.

To investigate the safety and efficacy of indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling for treatment of idiopathic macular epiretinal membranes

To observe the efficacy of indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling for treatment of idiopathic macular epiretinal membranes(IMEM). Retrospectively studied 60 patients with IMEM who all underwent the surgery of vitrectomy combined with internal limiting membrane peeling from 2011 to 2013. Best corrected visual acuity (BCVA), intraocular pressure(NCT), slit-lamp examination, fundus photography, optical coherence tomography (OCT) were committed. Patients were followed for 6 months. They were divided into two groups according to whether indocyanine green(ICG) was used or not with 32 members in ICG group and 28 members in none ICG group. They were divided into two groups according to the intergrity or disruption of the ellipsoid zone (EZ band) with 26 members in EZ band intergrity group and 34 members in EZ band disruption group. Age ranged from 28 to 79 years and the average age was 60.3 ± 10.9. Twenty-five males and 35 females were included. Twenty-five left eyes and 35 right eyes were incorporate. Among the 60 patients, 38 cases (63.33%) underwent visual acuity improvement after operation(BCVA improved at least 2 rows) and 21 (35%)patients' vision remained the same(BCVA changes less than 2 rows), while only one patient(1.67%) experienced decreased visual acuity(BCVA decline at least 2 rows). Average best corrected visual acuity (BCVA) (LogMar)and central retina thickness(CRT) (μm)of all patients preoperationwere 0.85 ± 0.44 and 578.45±144.61 respectively, which were 0.57±0.40 , 466.31±87.80 for one month and 0.54±0.42, 442.33± 98.92 three and six months postoperation(P<0.05). Compared to group of disruption EZ band, the BCVA of group of integral EZ band was better(P<0.05). 15 of 26 members in group of integral EZ band came up with EZ band cells loss in one month after operation and recovered by three or six months later. There was no statistical significance in BCVA and CRT between ICG group and none ICG group(P<0.05). Indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling in the treatment of IMEM is safe and effective. The symptoms of decreased vision, metamorphopsia were greatly ameliorated. Besides, retinal organization structures showed a certain extent of improvement. The transient occurrence of EZ band disruption postoperation could recovery 3 to 6 months later. And internal limiting membrane peeling assisted with ICG is a promising approach to the accomplishment of surgery without obvious toxicity. (Chin J Ophthalmol, 2016, 52:366-372).

Focal Nonperfusion of Deep Retinal Capillary Plexus in Eyes With Epiretinal Membranes Revealed by Optical Coherence Tomography Angiography.

To evaluate the leakage pattern in eyes with idiopathic epiretinal membranes (ERM) using fluorescein angiography (FA) and the structure of the retinal capillary plexus with optical coherence tomography angiography (OCTA). The authors enrolled patients with idiopathic macular ERM in the consecutive case series study. All patients were evaluated using FA at the central macula area and OCTA at the central 3 mm × 3 mm. Six patients (seven eyes) with ERM completed this preliminary study. The authors examined five eyes that showed increased macular thickness without a lamellar hole and two eyes that showed combined ERM with a lamellar hole. In the five eyes with ERM alone, the irregular focal hypofluorescent areas in FA corresponded to the locations of absent or low flow signals within vasculatures in the deep retinal capillary plexus seen in OCTA, whereas most of the superficial retinal capillary plexus was not affected, except vascular tortuosity in OCTA. In the two eyes combined with lamellar hole, OCTA showed central cystic lesions without vasculatures, but no low flow signals within vasculatures in the deep retinal capillary plexus beyond the hole. These focal irregular, absent, or low flow signals within vasculatures in the deep retinal plexus improved 1 month after surgical removal of the ERM in one eye. Mechanical stress exerted from the ERM might affect deep retinal capillary flow more profoundly than the superficial capillary flow, which would account for the fluorescence changes seen in FA. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:404-409.].

Comparison between 20-, 23-, and 25-G transconjunctival sutureless vitrectomy in the surgical treatment of idiopathic macular hole and idiopathic epiretinal membrane

Aim The aim of the present study was to compare 20, 23, and 25-G transconjunctival sutureless vitrectomy (TSV) systems in the management of idiopathic macular hole and idiopathic epiretinal membrane (EMM) as regards the operative time and postoperative complications such as hypotony (as shown by intraocular pressure Patients and methods This prospective, comparative, randomized clinical study was carried out on 60 consecutive patients undergoing TSV at a single center and by the same surgeon. Included patients were with preoperative diagnoses of idiopathic macular hole (group A) and idiopathic EMM (group B). Ten patients of each group were randomly allocated to 25-, 23-, or 20-G TSV subgroups using a table of random numbers. Three-port pars plana vitrectomy with internal limiting membrane peeling in group A with gas tamponade and EMM peeling in group B was carried out. Results In group A, the mean duration of surgery in the 20-G TSV subgroup was 43.7 ± 1.89 min compared with 42.5 ± 2.01 min in the 23-G subgroup and 43.5 ± 1.84 min in the 25-G subgroup. There was no statistically significant difference between the three subgroups. In group B, there was no statistically significant difference between the three subgroups, with a mean time of surgery of 35.8 ± 1.81 min in the 20-G subgroup versus a mean time of 37.9 ± 2.33 and 37.3 ± 1.98 min in the 23-G and the 25-G subgroups, respectively. In group A, the intraocular pressure was within the normal range in all follow-up periods in the three subgroups and no reported cases of hypotony either in the early or late follow-up periods. In group B, there was a statistically significant difference only in the first follow-up period between the three subgroups, as two cases of hypotony in the 20-G subgroup and two cases in the 25-G subgroup were reported, all of which resolved without sequelae. There were no cases of postoperative endophthalmitis in any case of either group A or group B. There were no cases of postoperative retinal detachment in any case of either group A or group B in all follow-up periods. Conclusion The current study indicated no increased risk of postoperative complications such as hypotony, endophthalmitis, or retinal detachment during sutureless vitrectomy.

Protective effects of SIRT1 in patients with proliferative diabetic retinopathy via the inhibition of IL-17 expression.

Diabetic retinopathy (DR) is a chronic microvascular complication of diabetes that may lead to loss of vision. The pathogenesis of DR is complex and elevated expression levels of T helper (Th)17 cells and interleukin (IL)-17 have been suggested to be associated with the development and progression of DR. Sirtuin 1 (SIRT1) is a nicotinamide-adenine dinucleotide+-dependent histone deacetylase that is downregulated in patients with DR. Previous studies have demonstrated that SIRT1 is capable of inhibiting the production of IL-17. In the present study, 19 patients with proliferative diabetic retinopathy (PDR) and 20 non-diabetic controls with idiopathic macular epiretinal membranes were recruited and the SIRT1 expression levels of excised specimens were analyzed using immunohistochemistry. IL-17 expression levels in the sera from patients with PDR and controls were determined by enzyme-linked immunosorbent assay (ELISA). Furthermore, SIRT1 mRNA and protein expression levels in peripheral blood mononuclear cells (PBMCs) from the two groups were analyzed following culture with or without a SIRT1 activator, resveratrol. IL-17 expression levels in the supernatants of PBMCs were determined using ELISA and the results demonstrated that IL-17 expression levels were increased in the sera of patients with PDR, as compared with the controls. Furthermore, increased expression levels of SIRT1 and IL-17 were detected in fibrovascular membranes and PBMCs harvested from patients with PDR, respectively. Notably, SIRT1 mRNA and protein expression levels were decreased in the PBMCs of patients with PDR and IL-17 production was inhibited following SIRT1 activation. The results of the present study indicated that imbalanced IL-17 and SIRT1 expression levels may contribute to the pathogenesis of DR, and SIRT1 may have a protective role in PDR by inhibiting the production of IL-17.

Interleukin-1β Level Is Increased in Vitreous of Patients with Neovascular Age-Related Macular Degeneration (nAMD) and Polypoidal Choroidal Vasculopathy (PCV).

PurposeTo examine the expression of pro-interleukin-1β (pro-IL-1β) and interleukin-1β (IL-1β) in the vitreous body of patients with neovascular age-related macular degeneration(nAMD), polypoidal choroidal vasculopathy (PCV), proliferative diabetic retinopathy (PDR), retinal vein occlusion (RVO) or Eales’ disease to further elucidate the role of IL-1β and inflammation in the pathogenesis of neovascular retinal disease.DesignProspective clinical laboratory investigation study.MethodsAll patients enrolled had vitreous hemorrhage due to nAMD, PCV, PDR, RVO or Eales’ disease that required vitrectomy. Patients were excluded for any history of active intraocular inflammation, or other ophthalmic surgery besides vitrectomy. Control samples were obtained from patients with idiopathic macular epiretinal membrane. A total of fifty vitreous samples were collected from patient during vitrectomy. Pro-IL-1β and IL-1β expression were measured by enzyme-linked immunosorbent assay (ELISA). Results were analyzed statistically using nonparametric tests.ResultsExpression of pro-IL-1β protein was increased by 2.83-fold and 9.19-fold in PCV and nAMD vitreous samples relative to control, respectively. Expression of IL-β protein was increased by 10-fold and 4.83-fold in PCV and nAMD vitreous samples relative to control, respectively.ConclusionsOur results demonstrate that expression of pro-IL-1β and IL-1β proteins is higher in PCV and nAMD. The roles of pro-IL-1β and IL-1β as inflammatory mediators in the development of PCV and nAMD may be associated with photoreceptor degeneration and neovascularization which necessitates further study.

Correlation between macular structural changes and functional outcomes in idiopathic macular epiretinal membranes

Objective To investigate the correlation between macular structural changes and functional outcomes in idiopathic macular epiretinal membranes (IMEM). Methods Clinical data of 85 patients with monocular IMEM admitted from April 2013 to April 2014 were retrospectively analyzed. The diseased eyes(85 eyes)were studied as observation group and the normal eyes(85 eyes)served as control group. The results of routine eye examinations, optical coherence tomography (OCT) and multifocal electroretinography (mfERG) were compared between observation and control groups. Results The preoperative best corrected visual acuity (BCVA) in observation group was lower than that in control group (0.55±0.17 vs. 0.92±0.14, P 0.05). BCVA in observation group was negatively correlated with CRT(r=-2.16, P<0.05). Conclusions The central retinal thickness is negatively correlated with the best corrected visual acuity, but not correlated with center mfERG in patients with IMEM. Key words: Macular degeneration; Tomography, optical coherence; Electroretinography