Vitrectomy For Idiopathic Epiretinal Membrane Research Articles

PRESENCE OF CRYSTALLINE LENS AS A PROTECTIVE FACTOR FOR THE LATE DEVELOPMENT OF OPEN ANGLE GLAUCOMA AFTER VITRECTOMY

To evaluate the late development of open angle glaucoma (OAG) after vitrectomy and to compare the rate of postvitrectomy OAG development in phakic and pseudophakic eyes. Retrospective case series of 101 eyes of 101 patients who had vitrectomy for idiopathic epiretinal membrane or idiopathic macular hole with a follow-up duration of more than 6 months. Eligible patients were assessed for new development of OAG during the follow-up period. Patients were separated into two groups based on the lens status at the end of the vitrectomy for statistical analysis using Kaplan-Meier survival analysis with log-rank test and Cox regression analysis. The mean follow-up duration was 51 months (range, 6-80 months). Of the 101 eyes, 8 (7.9%) eyes developed OAG during the follow-up period. Phakic eyes were less likely to develop OAG after vitrectomy compared with pseudophakic eyes, with 2% and 13%, respectively (log-rank test, P = 0.025). The result remained statistically significant after adjustment for age, refractive error and the use of gas tamponade (adjusted odds ratio = 0.09, P = 0.038). The presence of the crystalline lens may be protective against the late development of OAG after vitrectomy.

Relationship of Dissociated Optic Nerve Fiber Layer Appearance to Internal Limiting Membrane Peeling

The dissociated optic nerve fiber layer (DONFL) appearance features numerous arcuate striae after vitrectomy for idiopathic epiretinal membrane or macular hole. We studied the relation between the DONFL appearance and internal limiting membrane (ILM) peeling and performed static microperimetry to explore the possible mechanisms underlying the DONFL appearance. Prospective cohort study. Ninety-five eyes of 88 consecutive patients undergoing vitrectomy for idiopathic macular hole. Vitrectomy and gas tamponade were performed with or without ILM peeling. All eyes were examined postoperatively using fundus photography with blue filters. Static microperimetry was performed in 31 eyes with a clearly visible DONFL appearance. The postoperative incidence of the DONFL appearance on blue-filtered fundus photographs. The secondary outcome measure included the microperimetry threshold value in the arcuate striae and the surrounding normal retina within the papillomacular bundle. On blue-filtered photographs, 46 (62.2%) of 74 eyes with ILM peeling exhibited the DONFL appearance, compared with 0 (0%) of 21 eyes without ILM peeling (P = 0.0002). The area of the DONFL appearance was limited to the area of ILM peeling. There was no difference in the microperimetry threshold value between the arcuate striae and the surrounding normal retina (P = 0.9312). The present study indicates that the DONFL appearance might be related to ILM peeling and is not associated with the loss of optic nerve fibers. These results are consistent with the suggestion that the DONFL appearance might be caused by cleavage of the optic nerve fiber bundles due to damage to the Müller cells, which are in close contact with the ILM and act to maintain the close proximity of the nerve fiber bundles.

Optical coherence tomographic findings of dissociated optic nerve fiber layer appearance

PurposeTo examine the features of optical coherence tomographic (OCT) findings of dissociated optic nerve fiber layer (DONFL) appearance. DesignCase–control study. MethodsTwenty-four eyes undergoing vitrectomy for idiopathic epiretinal membrane or macular hole were examined postoperatively using OCT. ResultsThirteen of the 24 eyes exhibited the DONFL appearance. In these 13 eyes, the OCT images indicated dimples in the retinal nerve fiber layer (RNFL) corresponding to each stria. The RNFL thickness (mean ± SD) at the dimple site was 38.1 ± 9.3 μm. The depth of each dimple was 28.6 ± 8.0 μm. The depths of all the dimples were limited to the RNFL thickness. In the other 11 eyes without the DONFL appearance, OCT images showed no distinct dimples. ConclusionsThe DONFL appearance is caused by dimples the depths of which are limited to the RNFL thickness.

Visual field defects after uneventful vitrectomy for epiretinal membrane with indocyanine green–assisted internal limiting membrane peeling

Purpose To report visual field defects after vitrectomy for epiretinal membrane with indocyanine green (ICG)–assisted internal limiting membrane (ILM) peeling. Design Interventional consecutive case series. Methods A retrospective review of 16 eyes of 16 patients who underwent vitrectomy for idiopathic epiretinal membrane. Indocyanine green-assisted ILM peeling was performed in 7 of 16 eyes. The main outcome measure was postoperative visual field. Results Four of seven eyes (57%) with ICG-assisted ILM peeling had visual field defects postoperatively. The field defects identified were nasal in three eyes; in the fourth eye, the visual field was constricted to approximately 30 degrees. None of the nine eyes without ICG-assisted ILM peeling had a visual field defect. Conclusions Peripheral visual field defects may occur after vitrectomy with ICG-assisted ILM peeling. Although the cause of the defects is unclear, the potential role of ICG toxicity requires further investigation.

Scanning Laser Ophthalmoscopic Microperimetry on Idiopathic Epiretinal Membrane and Vitreomacular Traction Syndrome

Purpose: To evaluate visual function before and after vitrectomy for idiopathic epiretinal membrane and vitreomacular traction syndrome. Methods: Microperimetry with scanning laser ophthalmoscope (SLO) was performed in 4 eyes with idiopathic epiretinal membrane (IERM) and 2 eyes with vitreomacular traction syndrome (VMTS), before and at least 3 months after vitrectomy. Results: Five eyes had preoperative scotoma, which disappeared postoperatively. In 1 eye, absolute and relative scotomas developed postoperatively over the areas where the retinal surface was vigorously scratched to peel off an overlying membrane, and in another eye new scatomas appeared over a newly formed epiretinal membrane 8 months after vitrectomy. Conclusions: To our knowledge, the present report is the first to describe preoperative absolute scotoma in IERM, VMTS and also iatrogenic absolute scotoma due to retinal scratching. SLO microperimetry is useful for evaluation of visual function before and after vitrectomy for epiretinal membrane and vitreomacular traction syndrome.

Nuclear Sclerosis After Vitrectomy for Idiopathic Epiretinal Membranes

We performed a retrospective analysis of lens changes occurring after vitrectomy for idiopathic epiretinal membranes causing macular pucker on 75 consecutive phakic eyes. Thirty-five eyes (47%) had appearance or progression of nuclear sclerosis. There were no changes in anterior subcapsular cataracts and three eyes (4%) had minimal changes in posterior subcapsular cataracts. Based on univariate analysis, presence of preoperative nuclear sclerosis, length of follow-up period, and surgeon were found to be associated with the occurrence or progression of nuclear sclerosis. Differences between surgeons were largely accounted for by the difference in proportions with preoperative nuclear sclerosis, and differing lengths of follow-up. Kaplan-Meier life table analysis performed on 53 eyes with examination of fellow eyes and longer follow-up showed significantly more nuclear sclerosis in the operated on eye when compared to the fellow eye (log-rank test, P less than .0001).