Inner Limiting Membrane Peeling Research Articles

Autologous anterior lens capsule flap and serum transplant in managing idiopathic and refractory full-thickness macular holes.

To report the results of pars plana vitrectomy (PPV) with inner limiting membrane (ILM) peeling alongside phacoemulsification and intraocular lens (IOL) implantation with autologous anterior lens capsule flap (ALCF) and autologous serum transplantation (AST) into full-thickness macular holes (FTMH) and 14% perfluoropropane (C3F8) tamponade for idiopathic and refractory FTMHs. Retrospective study involving eleven patients with idiopathic FMTHs and seven with refractory FMTHs after standard surgery with PPV, ILM peeling, and gas tamponade. All eyes underwent a 'combination procedure' of PPV with ILM peeling alongside phacoemulsification and IOL implantation with autologous ALCF and AST into the FTMH and 14% C3F8 tamponade. A face-down position for one week was recommended. The mean preoperative FMTH size was 558.95 ± 186.30 µm. Seven patients aged 64 ± 5 years had a refractory FMTH and eleven patients with a mean age of 63.72 ± 4.97 years had an idiopathic FMTH. The main BCVA improvement six months postoperatively was 0.3 ± 0.29 logMAR. Seventeen macular holes fully closed six months postoperatively, with one FTMH closure failure because of a retinal detachment. ALCF transplantation alongside AST may help to improve the closure rate and visual outcomes in both idiopathic and refractory FMTHs.

Pores of the internal limiting membrane: A common finding in vitreo-maculopathies.

To describe presence and distribution of pores of the inner limiting membrane (ILM) in eyes with vitreo-maculopathies. ILM specimens were harvested from 117 eyes of 117 patients during vitrectomy with membrane peeling from eyes with vitreomacular traction syndrome, idiopathic and secondary epiretinal gliosis, and idiopathic full-thickness macular hole (FTMH). All specimens were processed as flat-mounts for immunocytochemistry and examined by phase-contrast, interference and fluorescence microscopy. Demographic and clinical data were correlated. ILM pores were found in all vitreo-maculopathies. They were identified in 47 (40.2%) of 117 eyes being most evident with anti-laminin. In eyes with FTMH >400μm, pores were seen in more than half of all eyes. They occur as numerous and uniformly distributed defects of the flat mounted ILM with a mean diameter of 9.5 ± 2.4 µm. Edges of ILM pores are round with an irregular contour and no specific cellular pattern. Pores were distinguished from retinal vessel thinning and iatrogenic artefacts. Contrary to previous reports, ILM pores are a common finding in vitreo-maculopathies easily visible with anti-laminin staining. Further studies are needed to clarify whether their presence correlates with differences in disease progression or imaging before and after vitrectomy with ILM peeling.

Postoperative complications after successful primary rhegmatogenous retinal detachment repair

BackgroundTo evaluate the incidence and risk factors for cystoid macular edema (CME) and epiretinal membrane (ERM) development after surgery for primary rhegmatogenous retinal detachment (RRD).MethodsRetrospective observational cohort study involving 62 consecutive patients with primary RRD who underwent RRD repair with either scleral buckling (SB) or pars plana vitrectomy (PPV). SB was used in young phakic patients without posterior vitreous detachment (PVD), high myopic patients, and RRD associated with either anterior or inferior retinal tears. PPV was preferred over SB in pseudophakic patients or those with media opacity and posterior breaks that precluded the SB approach. After surgery, the macular changes, including CME and ERM development, were evaluated 3 and 6 months postoperatively. Phacoemulsification and intraocular lens (IOL) implantation were performed in phakic patients where media opacity or lens bulging did not allow the surgeon to perform surgical maneuvers. The inner limiting membrane (ILM) peeling was randomly performed in the macula-off and the macula-on RRD “pending foveal detachment” subgroup.ResultsSixty-two eyes affected by RRD who underwent SB or PPV were enrolled. CME occurred in 33.3% of the PPV group regardless of the ERM formation. No CME cases were found in the SB group. Macula-off RRD increased the risk of CME by odds ratio (OR) = 4.3 times compared to macula-on RRD regardless of the surgical procedure (p = 0.04). Macula-off status increased the risk of CME of OR = 1.73 times compared to macula-on in the PPV subgroup (p = 0.4). Combined cataract surgery and PPV increased the risk of CME by OR = 3.3 times (p = 0.16) compared to PPV alone, and ILM peeling increased the risk of postoperative CME by OR = 1.8 times (p = 0.37). ERM occurred in 28% of patients who did not undergo ILM peeling, and 29.42% of those who underwent ILM peeling developed ERM (p = 0.6).ConclusionsThe risk of postoperative CME was higher in patients with macula-off than in macula-on RRD and in those with macula-off RRD who underwent PPV. The SB would be advisable in patients with RRD sparing the macula. Furthermore, despite having several advantages, the combined phacoemulsification plus IOL implantation and PPV highly increased the risk of postoperative CME.

Пилинг внутренней пограничной мембраны сетчатки в хирургическом лечении диабетического макулярного отека (2 клинических случая)

Relevance. Vitreoretinal surgery (VRS) for diabetic macular edema (DME) is the treatment of choice when combined with vitreomacular interface (VMI) anomalies. Peeling of the inner limiting membrane (ILM) of the retina in such patients is a controversial procedure. Purpose. To clinically approve new method of ILM peeling in patients with DME in combination with VMI. Material and methods. The article presents a comparative analysis of two clinical cases. The patients had similar clinical and anamnestic characteristics. In both cases, patients underwent VRS for DME with a large intraretinal cyst in the fovea in combination with epimacular fibrosis (EMF). The operation was combined with intervention for cataract (phacoemulsification with implantation of an elastic intraocular lens). Only the stages of ILM peeling were different: in the first case, the technology with the preservation of the ILM fragment in the fovea was used, in the second, a complete peeling of the ILM was performed. Results. In the course of dynamic observation for 6 months after the operation, observation, examination and, if necessary, additional treatment were carried out. Based on the results of observation and evaluation of the functional and anatomical parameters of the retina within 6 months, an improvement was noted in 1st patient and stabilization in 2nd patient. In the case of 2nd patient, a lamellar macular rupture formed at a period of 3 months, which can be regarded as a complication of the complete ILM peeling technique. Conclusion. Peeling of the ILM with preservation of the fragment in the fovea showed better functional and anatomical results compared to the complete removal of the ILM. Morphofunctional results of this method are to be investigated on the representative patient sample. Key words: diabetes mellitus, diabetic retinopathy, diabetic macular edema, vitrectomy, ILM-peeling, optical coherence tomography

Vitrectomy and ILM peeling in rhesus macaque: pitfalls and tips for success.

The non-human primate (NHP) model is ideal for pre-clinical testing of novel therapies for human retinal diseases due to its similarity to the human visual system. However, intra-ocular delivery of gene therapy or cell transplantation to the retina gets hampered by the sticky vitreous body and poorly permeable inner limiting membrane (ILM) in primates. Although vitrectomy and ILM peeling are commonly performed in patients, many pitfalls exist in carrying out these procedures in the rhesus macaque, which have not been reported previously. We summarised common surgical pitfalls after performing vitrectomy and ILM peeling in four eyes of two rhesus macaques (one male and one female). We provided corresponding hands-on technical tips based on our surgical experience and literature search. Orbital CT scans were compared between adult rhesus macaques and humans. High-resolution surgical videos were recorded to demonstrate each critical surgical step. Due to size difference, poor post-operative compliance, and high-standard requirements of a controlled experiment, there were eleven common surgical pitfalls during vitrectomy and ILM peeling in rhesus macaque. Falling into these pitfalls may produce discomfort, add fatigue, cause surgical complications, or even lead to the exclusion of the NHP from an experimental group. Recognition and circumvention of these pitfalls during vitrectomy and ILM peeling in NHP are essential. By focusing on these surgical pitfalls, we can better carry out preclinical tests of novel therapies for retinal diseases in the NHP model.

Electroretinographic Assessments of Macular Function after Brilliant Blue G Staining for Inner Limiting Membrane Peeling.

The purpose of this study was to determine the effect of brilliant blue G (BBG) staining of the inner limiting membrane (ILM) on macular function. Fourteen eyes of 14 patients consisting of 9 men and 5 women who underwent vitreous surgery with ILM peeling were studied. The mean age of the patients was 68.8 ± 9.14 years. Three eyes had a macular hole and eleven eyes had an epiretinal membrane. The ILM was made more visible by spraying 0.25% BBG into the vitreous cavity. The macular function was assessed by recording intraoperative focal macular electroretinograms (iFMERGs) before and after the intravitreal spraying of the BBG dye. The iFMERGs were recorded three times after core vitrectomy. The first recording was performed before the BBG injection (Phase 1, baseline), the second recording was performed after the spraying of the BBG and washing out the excess BBG (Phase 2), and the third recording was performed after the ILM peeling (Phase 3). All recordings were performed after 5 min of light-adaptation and stabilization of the intraocular conditions. The iFMERGs were recorded twice at each phase. The implicit times and amplitudes of the a- and b-wave, the PhNR, and the d-wave were measured. Wilcoxon signed-rank test were used to determine the significance of differences of the findings at Phase 2 vs. Phase 1 and Phase 3 vs. Phase 1. A p value < 0.05 was taken to be statistically significant. The average implicit times of the a-wave, b-wave, PhNR, and d-wave were not significantly different in Phase 1, 2, and 3. The average a-wave, b-wave, PhNR, and d-wave amplitudes at Phase 1 did not differ significantly from that at Phase 2 and at Phase 3. The results indicated that the intravitreal injection of BBG does not alter the physiology of the macula, and we conclude that BBG is safe. We also conclude that iFMERGs can be used to monitor the macular function safely during intraocular surgery.

A force measurement platform for a vitreoretinal surgical simulator using an artificial eye module integrated with a quartz crystal resonator

To provide quantitative feedback on surgical progress to ophthalmologists practicing inner limiting membrane (ILM) peeling, we developed an artificial eye module comprising a quartz crystal resonator (QCR) force sensor and a strain body that serves as a uniform force transmitter beneath a retinal model. Although a sufficiently large initial force must be loaded onto the QCR force sensor assembly to achieve stable contact with the strain body, the highly sensitive and wide dynamic-range property of this sensor enables the eye module to detect the slight forceps contact force. A parallel-plate strain body is used to achieve a uniform force sensitivity over the 4-mm-diameter ILM peeling region. Combining these two components allowed for a measurable force range of 0.22 mN to 29.6 N with a sensitivity error within −11.3 to 4.2% over the ILM peeling area. Using this eye module, we measured the applied force during a simulation involving artificial ILM peeling by an untrained individual and compensated for the long-term drift of the obtained force data using a newly developed algorithm. The compensated force data clearly captured the characteristics of several types of motion sequences observed from video recordings of the eye bottom using an ophthalmological microscope. As a result, we succeeded in extracting feature values that can be potentially related to trainee skill level, such as the mean and standard deviation of the pushing and peeling forces, corresponding, in the case of an untrained operator, to 122.6 ± 95.2 and 20.4 ± 13.2 mN, respectively.

Сравнение ранних результатов и безопасности различных способов пилинга внутренней пограничной мембраны сетчатки в хирургическом лечении диабетической ретинопатии

Relevance. Surgical treatment (VRS) of diabetic retinopathy (DR) is the method of choice in the development of its complications and in combination of DR with other vitreoretinal diseases. The procedure of the retinal inner limiting membrane (ILM) peeling is a debatable stage of the VRS, there is no single concept for its application, and the analysis of its results provides conflicting data. The purpose of the study was a comparative analysis of various methods of retinal ILM peeling in terms of safety, functional and anatomical results in the early postoperative period (up to 3 months). Material and methods. A randomized study was conducted on three comparable groups of patients with proliferative DR (PDR). All patients underwent comparable VRS treatment, the groups differed only in the stage of ILM peeling: in group 1, ILM peeling was not performed, in group 2, it was performed within the inter-arcade space, in group 3, dosed center-sparing ILM peeling was performed. Results. ILM peeling methods were comparable in terms of safety. However, in group 2, a lamellar macular hole (LMH) formation was noted in two cases. Also intraoperatively among patients of group 2, five cases of transient retinal neuroepithelial detachment (tNED) associated with ILM peeling were detected. Functional and anatomical results in the groups were comparable and did not differ significantly. A possible predictive role of the central macular volume in the prognosis of postoperative diabetic macular edema (DME) was revealed. A relationship between tNED and the risks of developing DME and LMH after surgery has been established. Conclusion. In the early postoperative period, the results of treatment using different methods of ILM peeling are comparable. Their further study and analysis of long-term results are required. Keywords: diabetic retinopathy, diabetic macular edema, vitreoretinal surgery, ILM peeling, dosed center-sparing ILM peeling, optical coherence tomography, lamellar macular hole.

Rates of Reoperation in 10 114 Patients with Epiretinal Membranes Treated by Vitrectomy with or without Inner Limiting Membrane Peeling

To compare rates of reoperation in patients with idiopathic epiretinal membrane (ERM) who received pars plana vitrectomy (PPV) with or without inner limiting membrane (ILM) peeling and to assess trends in the overall use of ILM peeling over time. Retrospective cohort study. Patients included in the IBM Marketscan database between January 1, 2008, and December 31, 2016, who underwent surgery for idiopathic ERM. Procedure claims with laterality codes were used to determine patients with idiopathic ERM who received PPV with or without ILM peel between 2008 and 2016, and to identify cases of reoperation and subsequent retinal detachment within 1 year of index surgery. The primary outcome was rate of reoperation for recurrent ERM according to whether or not patients receive an ILM peel during their index ERM surgery. We also assessed trends for index ERM surgery (ILM peel or no ILM peel) between 2008 and 2016, and the risk of developing retinal detachment within 1 year of the index ERM surgery. A total of 10 114 patients received ERM surgery and met inclusion criteria (5310 without ILM peel and 4804 with ILM peel). The reoperation rate was significantly lower among patients who received PPV with ILM peel (0.88%) compared with patients without ILM peel (1.48%; P= 0.007). In 2008, PPV without ILM peel represented 70% of ERM procedures, but PPV with ILM peeling accounted for 52% and 70% of ERM procedures in 2013 (P < 0.001) and 2016 (P < 0.001), respectively. The rates of retinal detachment were similar between patients who received an ILM peel (0.79%) and patients who did not receive an ILM peel (0.92%) during their primary ERM surgery (P= 0.474). The increasing use of PPV with ILM peeling to address ERM removal is associated with significantly reduced reoperation rates within 1 year. Future studies are needed to determine the cost-effectiveness of performing an ILM peel for initial idiopathic ERM repairs and evaluate long-term visual and structural changes related to ILM peeling.

Efficacy of macular massage combined with negative pressure suction for giant idiopathic macular hole

Objective To evaluate the efficacy of 25 G vitrectomy combined with macular massage and negative pressure suction for the treatment of giant idiopathic macular hole. Methods Clinical data of 27 eyes of 27 patients with giant idiopathic macular hole, of which the diameter was 500-800 μm, from Apr.2016 to Dec.2018 in Hanyang Eyegood Ophthalmic Hospital was analyzed retrospectively. Macular massage and negative pressure suction with flute needle were performed after 25 G vitrectomy and peeling of the inner limiting membrane. Results Macular hole closure at 3-5 days postoperatively occurred in 25 eyes(92.6%). Best corrected visual acuity (BCVA, logMAR) at 3-5 days postoperatively were ameliorated from 1.28±0.30 to 1.04±0.37(t=3.860, P=0.032). The postoperative intraocular pressure (IOP) was similar to the preoperative IOP within normal limits(t=2.147, P=0.226). No complication such as iatrogenic injury of macular, bleeding, retinal detachment or secondary glaucoma was recorded in the intra-operative and the follow-up period. Conclusion 25 G vitrectomy combined with macular massage and negative pressure suction contributes to the anatomical repair and visual function recovery of patients with giant idiopathic macular hole. Key words: Vitrectomy; Massage, macular; Suction, negative pressure; Hole, macular, idiopathic, giant

Efficacy of vitrectomy and air tamponade for idiopathic macular hole

Objective To evaluate the clinical efficacy of 25 G vitrectomy combined with air tamponade in the treatment of idiopathic macular hole. Methods A retrospective study. The data of 62 eyes of 62 patients with idiopathic macular hole were analyzed. All patients were randomly divided into two groups, with each group of 31 cases. All cases received 25 G vitrectomy combined with peeling of the inner limiting membrane. After gas fluid exchange, the control group received perfluoropropane(C3F8) tamponade in vitrectomy and the observation group received air tamponade in vitrectomy.The follow-up time was 3 months. Results The difference in the rate of hole closing was not statistically significant between the two groups (P=0.895). In observation group, the time of keeping face-down positioning was significant shorter than that of control group (P=0.011). The difference in visual acuity at 3 months postoperatively was not stastically significant (P=0.487). The difference of rate of complication was not stastistically significant between the two groups (P=0.688). Conclusion Vitrectomy and air tamponade for the treatment of idiopathic macular hole, the absorption of air is faster than that of C3F8 tamponade, which is effective to reduce the time of face-down posture. Key words: Vitrectomy, 25 G; Hole, idiopathic, macular; Tamponade, air

Morphologic and functional outcomes of different optical coherence tomography patterns of myopic foveoschisis after vitrectomy and inner limiting membrane peeling.

To evaluate the morphologic and functional outcomes of different optical coherence tomography (OCT) patterns of myopic foveoschisis after vitrectomy with Inner Limiting Membrane (ILM) peeling. In this prospective non-randomised study, 62 consecutive eyes with Myopic Foveoschisis were categorised into three groups according to OCT pattern: retinoschisis type (Rt) Group (23/62), foveal detachment type (FDt) Group (20/62) and macular hole type (MHt) Group (19/62). All patients underwent 25-Gauge vitrectomy and ILM peeling. Air or gas tamponade was used. All patients were observed at month 1, 2, 4 and 6 after surgery. surgical success as resolution of myopic foveoschisis, central retinal thickness (CRT), IS/OS junction recovery and best-corrected visual acuity (BCVA) measurement. Any complication was reported. In all eyes OCT showed a resolution of the retinoschisis, foveal detachment and macular hole pattern, respectively. CRT significantly decreased in all Groups (p < .001), mainly in MHt. IS/OS junction recovery was mainly observed in MHt. BCVA significantly increased in all Groups (p < .01). A functional gain ≥2 Snellen lines occurred in 70, 85 and 68% in the Rt, FDt and MHt Group, respectively. Final BCVA was correlated with preoperative BCVA (R 0.74, p < 0.0001), postoperative CRT (R -0.49, p < 0.0001), and the recovery of IS/OS junction at 6 months (R 0.76, p < 0.0001). Few postoperative complications occurred. Vitrectomy with ILM peeling results in favourable anatomic and functional outcomes for different patterns of myopic foveoschisis.

Results of pars plana vitrectomy with peeling of the inner limiting membrane in patients with laser-induced macular hole

Objective: To evaluate the results of pars plana vitrectomy (PPV) with peeling of the inner limiting membrane (ILM) in patients with laser-induced macular hole. Methods: The clinical data of 11 patients (12 eyes) with decreased visual acuity due to laser-induced macular hole from January 2014 to December 2017 were retrospectively studied.All patients underwent routine examination, fundus photography and optical coherence tomography (OCT). Patients were observed every two weeks. PPV with ILM peeling was performed when macular hole was enlarged. Closure of macular hole, pre- and post-operation visual acuity were observed. Results: A total of 11 male patients (12 eyes)aged (18±4) years were included in the study.Laser instruments which lead to macular hole consisted of laser toy (3 eye), laser pen (4 eye), laser torch (1 eye) and cosmetic laser instrument (4 eyes). All patients were followed up every two weeks and evaluated by OCT. None of the macular hole was spontaneously closed in this study. All Macular holes were enlarged in 1-3 months of follow-up and underwent PPV with ILM peeling immediately. All of the macular hole with PPV and ILM peeling were completely closed. During follow-up, the best-corrected visual acuity(BCVA) of 10 eyes (10/12) were found to increase above 3 lines and BCVA of 7 eyes(7/12) were found to be more than 0.5. Only 1 eye maintained the same visual acuity after the surgery which might be due to long course, large macular hole diameter (850 μm) and serious retinal pigment epithelium (RPE) damage. Conclusion: Early PPV with ILM peeling for laser induced macular hole might benefit for the closure rate of macular hole and better visual acuity prognosis.

Evaluating inner retinal dimples after inner limiting membrane removal using multimodal imaging of optical coherence tomography

BackgroundTo evaluate inner retinal dimples after peeling of the inner limiting membrane (ILM) for macular holes (lamellar macular hole [LMH] and full-thickness macular hole [FTMH]) via multiple imaging modes of spectral-domain optical coherence tomography (OCT) and to assess their relationship with preoperative vitreoretinal interface conditions.MethodsThe data of 38 eyes in 35 patients who underwent surgery for LMH, and FTMH were retrospectively studied. The presence of postoperative inner retinal dimples was judged by a combination of en face OCT layer images and cross-sectional images. The demographic and clinical characteristics of eyes with and without inner retinal defects were compared to identify factors involved in the formation of the defects.ResultsInner retinal defects were found in 26 eyes (68%) after surgery. They appeared on the en face OCT ILM layer images as multiple dark spots limited to the ILM peeling area, and corresponded to dimples or pitting of inner retinal layers on cross-sectional OCT images. In 5 cases (19%), apparent progression of inner retinal defects was observed on the en face OCT images as increasing numbers and sizes of the dark spots, which seemed to follow an eccentric growth pattern starting from the central macula. In addition, highly myopic eyes were found to be associated with the formation of more severe inner retinal defects.ConclusionsMultiple imaging modes of en face spectral-domain OCT provide comprehensive information about the appearance of inner retinal dimples. High myopic eyes seem to develop more severe inner retinal defects after ILM peeling.

Photothermal optical coherence tomography of indocyanine green in ex vivo eyes.

Indocyanine green (ICG) is routinely used during surgery to stain the inner limiting membrane (ILM) and provide contrast on white light surgical microscopy. While translation of optical coherence tomography (OCT) for intraoperative imaging during ophthalmic surgery has enhanced visualization, the ILM remains difficult to distinguish from underlying retinal structures and ICG does not provide additional OCT contrast. We present photothermal OCT (PT-OCT) for high-specificity detection of ICG on retinal OCT images. We demonstrate our technique by performing an ILM peel in ex vivo eyes using low ICG concentrations and laser powers. These results establish the feasibility of PT-OCT for intraoperative guidance during retinal surgery.

Perioperative nursing of inner limiting membrane peeling silicone oil plombage on curing yellow spot retinal detachment of high myopia

Objective To discuss about the perioperative nursing method of inner limiting membrane peeling silicone oil plombage on curing yellow spot retinal detachment of high myopia. Methods Preoperative mental nursing, article preparation, intraoperative patient's condition monitoring, postoperative position, prevention and complication nursing were conducted to 60 cases of yellow spot retinal detachment of high myopia by applying inner limiting membrane peeling silicone oil plombage. Results After silicone oil was taken out, the retina of 55 patients(91.67%) was still in place.After silicone oil of 5 patients (8.33%) was taken out, there was retinal detachment, and reoperation was conducted to reset.6 months after operation, there were 15 cases(25.00%) that the vision was recovered to be ≥0.1, 14 cases(23.33%) recovered to be 0.05~0.09, 13 cases(21.67%)recovered to be 0.02~0.04 and 8 cases(13.33%)had index light sensation. Conclusions Give appropriate preoperative psychological nursing, and patients with sufficient preoperative preparation, intraoperative monitoring vital signs, precise surgery and postoperative observation, body position nursing care, prevention of complications, nursing is the guarantee of successful operation, it is also the key to promote the patient choosing. Key words: High myopia; Retinal detachment; Impending macular hole; Silicone oil tamponade; Perioperative nursing

Foveal Microstructure Analysis in Eyes with Diabetic Macular Edema Treated with Vitrectomy.

The purpose of this study was to evaluate baseline and postoperative factors affecting outcomes after vitrectomy for diabetic macular edema (DME) using optical coherence tomography (OCT). Vitrectomy combined with inner limiting membrane (ILM) peeling and additional laser photocoagulation therapy was performed on 36 eyes of 30 DME patients. Evaluations included the logarithm of the minimal angle of resolution (logMAR), best-corrected visual acuity (BCVA) and OCT parameters at baseline and 1, 3, 6, and 12months postoperatively. Correlations between OCT parameters and BCVA were assessed at each follow-up visit. Correlations among postoperative BCVA and preoperative BCVA, foveal macular thickness (FMT), outer foveal thickness (OFT), and photoreceptor outer segment (PROS) length were evaluated using multiple regression analysis. BCVA significantly improved from 0.50±0.25 to 0.34±0.26 at 12months postoperatively (P<0.001). Mean FMT improved significantly from 526.4±120.4 to 384.6±120.5 at 1month, 325.2±100.3 at 3months, 304.1±102.5 at 6months and 274.2±86.6μm at 12months postoperatively (P<0.001, respectively). OFT 1month after surgery was significantly decreased 46.5±14.7-40.2±14.4μm (P=0.017), although at 3, 6, and 12months it did not differ from the baseline value. PROS length 1month after surgery significantly decreased from 31.7±6.9-28.8±6.8μm (P=0.015) and that at 3months and 6months recovered to the baseline value. PROS length 12months after surgery was significantly increased to 34.3±7.2μm from baseline (P=0.023). Mean FMT was not correlated with BCVA at any time point. Mean OFT and PROS length at 3, 6, and 12months were correlated with BCVA. In multiple regression analysis, PROS length had the greatest effect on VA 12months postoperatively (P=0.0262, standard regression coefficient=-0.366). Current surgery helps DME patients to maintain VA and foveal structures. The results suggest that PROS length predicts visual outcome in DME patients following vitrectomy with ILM peeling and additional laser photocoagulation.

Comparison of different measure methods of macular hole closure index for predicting the anatomical prognosis of idiopathic macular hole surgery

Objective To compare the predicted efficiency of macular hole closure index (MHCI) calculated by 2 different methods for postoperative anatomical outcomes after idiopathic macular hole (MH) surgery. Methods This is a prospective exploratory clinical study. A total of 63 patients (63 eyes) with idiopathic MH, who received vitrectomy, inner limiting membrane peeling and gas tamponade, were enrolled in this study. All the patients received optical coherence tomography (OCT) examination at each visit to measure the MHCI using the formula MHCI= (M+N) /BASE, M and N is the distance from outer limiting membrane break points to the beginning points of detached photoreceptor from retinal pigment epithelium of both side of the hole, respectively. BASE is the length of MH base. MHCI1 was measured by built-in caliper of OCT software, MHCI2 was measured by ImageJ software. The minimum macular diameter (MHD) was measured by built-in caliper of OCT software. Based on the OCT images, the anatomical outcomes were classified grade A (bridge-like shape closure), grade B (complete closure) and grade C (poor closure). Grade A and B are considered as good closure, grade C as poor closure. Patients were followed up at 3, 6 and 12 months after surgery. The closure grades at last visit were the final outcome. The relationship between MHCI1, MHCI2 and closure grades was analyzed. And the predicted efficiency of MHD, MHCI1 and MHCI2 for anatomical outcomes after the surgery was studied. Results The mean MHCI1 was 0.68±0.21 (0.30-1.35), MHCI2 was 0.95±0.26 (0.41-1.55), and MHD was (476.24±210.18) μm (127-956 μm). MHCI1 and MHCI2 were both negative correlated with the closure grades (r=−0.665, −0.691; P<0.001). The receiver operating characteristic (ROC) curve analysis of MHCI1, MHCI2 and MHD for the prediction of good or poor closure showed that area under the curve (AUC) was 0.928, 0.957 and 0.916 respectively, and 0.505, 0.67 and 559 μm were set as the lower cut-off value. The sensitivity was 96.2%, 92.3% and 90.9% respectively, and specificity was 81.8%, 72.7% and 76.9% respectively. Accordingly, the ROC curve analysis for the prediction of grade A or B closure showed that AUC was 0.840, 0.847 and 0.653 respectively, and 0.705, 0.965 and 364 μm were set as the upper cut-off value. The sensitivity was 80.0%, 82.9%, 63.4% respectively and specificity was 75.0%, 85.7%, 65.9%. Conclusion MHCI1 and MHCI2, measured by built-in caliper of OCT software or ImageJ software, both have good predictive efficiency for the anatomical outcomes of MH surgery. Key words: Retinal perforations/surgery; Tomography, optical coherence; Forecasting

Analysis of Retinal Architectural Changes Using Intraoperative OCT Following Surgical Manipulations With Membrane Flex Loop in the DISCOVER Study.

PurposeWe investigate acute retinal alterations identified on intraoperative optical coherence tomography (iOCT) immediately following surgical intervention with the Finesse Flex Loop for vitreoretinal interface disorders.MethodsThe Determination of feasibility of Intraoperative Spectral domain microscope Combined/integrated OCT Visualization during En face Retinal and ophthalmic surgery (DISCOVER) study is a prospective multisurgeon intraoperative OCT clinical study. Subjects who had participated in the DISCOVER study and had undergone macular surgery with the membrane flex loop from August 2014 to July 2016 were identified. iOCT images and video sequences were evaluated at various surgical time points. Subjects were excluded if iOCT images were not obtained over the area of membrane peeling performed with the membrane flex loop. Qualitative characteristics of intraoperative changes in retinal images were analyzed, with particular focus on the retinal layers within the bed of membrane peeling performed specifically with the membrane flex loop.ResultsWe studied 34 eyes of 34 patients, with a mean age of 72.7 (± 6.4) years, 25 of whom were women. The intraoperative diagnosis was full thickness macular hole in 21 eyes (62%) and epiretinal membrane in 13 (38%). All eyes had successful indocyanine green–assisted inner limiting membrane (ILM) flap initiation using the membrane loop. Intraoperative OCT demonstrated expansion of the ellipsoid zone-to-RPE distance in 3 eyes (9%), definitive subretinal fluid accumulation in 1 eye (3%), and hyperreflectivity of the inner retinal layers associated with retinal hemorrhage in 10 eyes (29%). Retinal breaks were not observed in any eye.ConclusionsAcute retinal alterations after ILM peeling with the membrane flex loop were visualized at a frequency of less than 10%. Additional research is needed to understand the clinical impact, if any, of these architectural alterations.

Foveal contour as a significant predictor of surgical outcome in idiopathic epiretinal membrane

Objective To observe the foveal contour characteristic of idiopathic epiretinal membrane (iERM). Methods A total of 53 eyes in 52 patients with iERM who underwent pars plana vitrectomy with epiretinal membrane and inner limiting membrane peeling were enrolled in this retrospective study. All eyes received the examination of optical coherence tomography (OCT) and minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA). Foveal contour grading was according to the ratio of central macular thickness (CMT) to the thickness of the retina 1 mm away on OCT line scan: Grade 0, depressed; Grade 1, flat; Grade 2, elevated. Baseline foveal contour grade was as follows: 28 eyes with Grade 1 (Group 1), and 25 eyes with Grade 2 (Group 2). The mean logMAR BCVA was 0.40±0.26 in Group 1, and 0.60±0.27 in Group 2 respectively. The mean CMT was (433.52±133.05) μm and (571.70±85.40) μm respectively. The logMAR BCVA and CMT both demonstrated significant difference between the two groups (t=-2.825, -4.512; P<0.05). OCT images and BCVA at 1, 3 months after surgery were collected and analyzed. The change in foveal contour, BCVA and CMT were evaluated. The relationship between surgical outcome and different preoperative grading was analyzed. Results Foveal contour grade at 3 months after surgery was as follows: 15 eyes with Grade 0, 21 eyes with Grade 1, and 17 eyes with Grade 2, demonstrating significant difference compared with baseline (Z=-3.588, P<0.05). In Group 1, there were 12 eyes with Grade 0, 10 eyes with Grade 1, and 6 eyes with Grade 2 postoperatively. In Group 2, there were 3 eyes with Grade 0, 11 eyes with Grade 1, and 11 eyes with Grade 2 postoperatively. The postoperative foveal contour grade was significantly different between the two groups (Z=-2.466, P<0.05). The logMAR BCVA at 1, 3 months after surgery both improved significantly compared with baseline (P<0.05) in Group 1 (t=-3.226, -5.439) and Group 2 (t=-4.137, -5.919). The logMAR BCVA at 1, 3 months after surgery demonstrated significant difference between the two groups (t=-2.231, -2.291; P<0.05). The CMT decreased significantly at 1, 3 months after surgery in Group 1 (t=-2.674, -4.090) and Group 2 (t=-9.663, -9.865) compared with baseline (P<0.05). The CMT at 1, 3 months after surgery demonstrated significant difference between the two groups (t=-2.825, -3.003; P<0.05). The improvement of logMAR BCVA 3 months after surgery was negatively correlated (P<0.05) with preoperative logMAR BCVA (r=-0.758) and preoperative CMT (r=-0.359). Conclusion In iERM eyes, flat foveal contour had better surgical prognosis than elevated ones. Key words: Macula lutea; Membranes; Vitreoretinal surgery; Tomography, optical coherence