Lamellar hole-associated epiretinal membrane is a common feature of macular holes in retinitis pigmentosa

Retinitis pigmentosa (RP) is a rare hereditary disease, yet it is the commonest cause of retinal dystrophy. Although lamellar hole-associated epiretinal membrane (LHEP) is commonly associated with macular holes, the development of macular holes in RP itself is rare. In this article, we report a rare case of bilateral LHEP in RP, and the surgical outcome of LHEP embedding and internal limiting membrane (ILM) flap in repairing a lamellar macular hole (LMH). A 57-year-old woman who had RP with bilateral LHEP underwent a combination of cataract and vitrectomy surgery in her left eye. We preserved LHEP tissue and performed an ILM flap to avoid a iatrogenic full-thickness macular hole (FTMH) and facilitate LMH closure. Her right eye was monitored conservatively. At 2 weeks postoperative, the LMH in her left eye was anatomically repaired. There was limited improvement of visual acuity, which could be justified by disruption of the junction between the photoreceptors’ inner and outer segments (IS/OS junction) as evidenced by spectral-domain optical coherence tomography (SD-OCT). The presence of LHEP in LMH is highly associated with disruption of the IS/OS junction and therefore patients should be counselled regarding guarded visual improvement post-vitrectomy. LHEP, which is derived from a Müller cell-driven process, is closely associated with LMH in RP, likely due to the progressive retinal tissue loss as a result from the disease nature of RP. Therefore, we suggest preserving LHEP tissue and performing an ILM flap as an improvised technique to avoid iatrogenic FTMH and facilitate LMH closure.

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Modified surgical technique for lamellar macular holes with lamellar hole-associated epiretinal proliferation (LHEP)

International Ophthalmology ◽

10.1007/s10792-021-01780-7 ◽

2021 ◽

Author(s):

Kshitiz Kumar ◽

Tushar Kanti Sinha ◽

Debashish Bhattacharya

Keyword(s):

Surgical Technique ◽

Macular Holes ◽

Lamellar Hole

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EPIRETINAL MEMBRANE–INDUCED FULL-THICKNESS MACULAR HOLES

Retina ◽

10.1097/iae.0000000000000999 ◽

2016 ◽

Vol 36 (9) ◽

pp. 1679-1687 ◽

Cited By ~ 11

Author(s):

Chia-Ying Tsai ◽

Yi-Ting Hsieh ◽

Chung-May Yang

Keyword(s):

Epiretinal Membrane ◽

Full Thickness ◽

Macular Holes

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Ocular abnormalities in a large Western China patient cohort with Retinitis Pigmentosa

10.21203/rs.3.rs-63600/v1 ◽

2020 ◽

Author(s):

Lian Tan ◽

Yanling Long ◽

Ziyang Li ◽

Xi Ying ◽

Jiayun Ren ◽

...

Keyword(s):

Visual Acuity ◽

Retinitis Pigmentosa ◽

Macular Oedema ◽

Western China ◽

Vitreomacular Traction ◽

Cystoid Macular Oedema ◽

Epiretinal Membranes ◽

Ocular Abnormalities ◽

Vitreomacular Traction Syndrome ◽

Macular Holes

Abstract Background: To report the prevalence of ocular abnormalities and investigate visual acuity in a large Western China cohort of retinitis pigmentosa (RP) patients.Methods: A retrospective study was performed, reviewing the medical records and ophthalmic examination reports of 2,127 eyes from 1,065 RP patients in one eye hospital. The authors investigated the prevalence of ocular abnormalities and the relationship between best corrected visual acuity (BCVA) and macular abnormalities.Results: Nyctalopia (58.2%) and blurred vision (27.1%) were the leading consultation causes. BCVA measurements in the better eyes at first clinical presentation showed that 304 patients (28.5%) were categorised as blind and 220 patients (20.7%) as low vision. The most common ocular abnormalities were cataracts (43.1%) and macular abnormalities (59.7%), including epiretinal membranes (51.1%), cystoid macular oedema (18.4%), vitreomacular traction syndrome (2.4%), macular holes (2.3%) and choroidal neovascular membranes (0.05%). Glaucoma was found in 35 eyes (1.6%). The proportions of epiretinal membranes (P = 0.001) and macular holes (P = 0.008) increased significantly with age. The proportions of vitreomacular traction syndrome (P = 0.003) and epiretinal membranes (P < 0.001) in pseudophakia and aphakia eyes were significantly higher than in eyes that had not received operations (including cataracts and clear lens). Cystoid macular oedema was significantly associated with poorer visual acuity in RP patients with clear lens (P = 0.002).Conclusion: Cataracts and macular abnormalities are common in RP patients. In the macular abnormalities, cystoid macular oedema may have a negative effect on BCVA in RP patients with clear lens.

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Functional and morphological outcomes after surgery in lamellar macular holes versus epiretinal membrane foveoschisis

European Journal of Ophthalmology ◽

10.1177/1120672120974287 ◽

2020 ◽

pp. 112067212097428

Author(s):

Luigi Caretti ◽

Alvise La Gloria Valerio ◽

Giacomo Verzola ◽

Gloria Badin ◽

Cristina Monterosso ◽

...

Keyword(s):

Epiretinal Membrane ◽

Clinical Findings ◽

Functional Improvement ◽

Foveal Thickness ◽

Central Foveal Thickness ◽

Macular Holes ◽

Full Thickness Macular Hole ◽

Anatomical Success ◽

Sd Oct

Purpose: To compare the clinical findings and outcomes of vitrectomy for lamellar macular holes (LMH) versus epiretinal membrane foveoschisis (ERMF). Materials and methods: This retrospective study enrolled 36 eyes of 35 patients with a minimum follow-up of 6 months. Spectral domain optical coherence tomography (SD-OCT) parameters and best-corrected visual acuity (BCVA) were analyzed preoperatively and postoperatively. Results: The 19 (52.8%) ERMF and 17 (47.2%) LMH were included. Preoperatively, eyes with LMH were characterized by a lower central foveal thickness (CFT) (102.18 ± 31.44 µm vs 159.37 ± 25.25 µm, p < 0.001) and a greater incidence of outer retinal disruption ( p < 0.001). Primary anatomical success was achieved in 34/36 eyes (94.4%). Preoperative BCVA was better in ERMF (0.16 – IQR 0.09 – logarithm of the minimal angle of resolution (LogMAR) – 20/28 Snellen) than LMH (0.40 – IQR 0.30 – LogMAR, 20/50 Snellen) ( p = 0.008). At 6 months after surgery, BCVA significantly improved in the ERMF group ( p < 0.001), but showed insignificant change in LMH ( p = 0.125). Two cases, both in the LMH group, developed full thickness macular hole after surgery. Conclusion: Eyes with LMH showed visual stabilization after surgery, whereas the eyes in the ERMF group were susceptible to functional improvement. These differences in BCVA outcomes may be the consequence of a higher damage in the outer retina in the LMH group; an accurate SD-OCT examination is a fundamental step when deciding to proceed or not to the surgery.

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25 vs. 27-gauge micro-incision vitrectomy surgery for visually significant macular membranes and full-thickness macular holes: a retrospective study

International Journal of Retina and Vitreous ◽

10.1186/s40942-020-00259-4 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Gordon T. Brown ◽

Sangeethabalasri Pugazhendhi ◽

Robert M. Beardsley ◽

John W. Karth ◽

Peter A. Karth ◽

...

Keyword(s):

Visual Acuity ◽

Retrospective Study ◽

Retrospective Analysis ◽

Epiretinal Membrane ◽

Internal Limiting Membrane ◽

Full Thickness ◽

Eligibility Criteria ◽

Macular Holes ◽

Corrected Distance Visual Acuity ◽

Vitrectomy Surgery

Abstract Background To evaluate visual and safety outcomes for 25-gauge (25G) and 27-gauge (27G) micro-incision vitrectomy platforms (MIVS) for the treatment of epiretinal membrane and full-thickness macular holes. Methods Retrospective analysis of all patients who underwent internal limiting membrane (ILM) peel surgery from January 2017 through December 2018. 207 cases met the eligibility criteria for inclusion. Primary endpoint was post-operative Best-Corrected Distance Visual Acuity (BCVA) at 6 months. Results For all patients combined, mean logMAR BCVA improved from 0.57 (± 0.40) to 0.37 (± 0.36) post-operatively (p < 0.001). For 25G ERMs, logMAR BCVA improved from 0.51 (± 0.28) to 0.30 (± 0.25) post-operatively (p < 0.001). For 27G ERMs, logMAR BCVA improved from 0.33 (± 0.28) to 0.28 (± 0.27) post- operatively (p = 0.15). For 25G FTMHs, logMAR BCVA improved from 0.87 (± 0.48) to 0.51 (± 0.44) post-operatively (p < 0.001). For 27G FTMHs, logMAR BCVA changed from 0.89 (± 0.47) to 0.96 (± 0.60). Conclusion Final visual outcomes improved for both 25G and 27G ERM groups and the 25G FTMH group. Both 25G and 27G were safe and well tolerated MIVS platforms for the treatment of ERM and FTMH.

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Prevalence of cystoid macular oedema, epiretinal membrane and cataract in retinitis pigmentosa

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-311964 ◽

2018 ◽

Vol 103 (8) ◽

pp. 1163-1166 ◽

Cited By ~ 5

Author(s):

Gerald Liew ◽

Stacey Strong ◽

Patrick Bradley ◽

Philip Severn ◽

Anthony T Moore ◽

...

Keyword(s):

Retinitis Pigmentosa ◽

Macular Oedema ◽

Epiretinal Membrane ◽

Autosomal Recessive ◽

Autosomal Dominant ◽

Cystoid Macular Oedema ◽

Dominant Inheritance ◽

Younger Age ◽

Multivariable Analyses ◽

Eye Clinic

Background/AimsTo report the prevalence of treatable complications (cystoid macular oedema, CME; epiretinal membrane, ERM and cataract) in patients with retinitis pigmentosa (RP).MethodsConsecutive patients with RP attending a tertiary eye clinic in 2012. Spectral domain-optical coherence tomography was used to determine presence of CME and ERM. Clinic records were reviewed to identify cataract and pseudophakia. Multivariable analyses adjusted for age, gender and other confounders.ResultsData are presented for 338 eyes from 169 patients. CME was present in 58.6% of patients and 50.9% of eyes and was bilateral in 73.7%. ERM, cataract and pseudophakia were present in 22.8%, 23.4% and 11.2% eyes, respectively. In multivariable analyses, CME was associated with younger age (OR 0.81, 95% CI 0.67 to 0.98) but not with gender. Patients with ERM and cataract/pseudophakia were less likely to also have CME (OR 0.19, 95% CI 0.09 to 0.40 and OR 0.37, 95% CI 0.16 to 0.84, respectively). CME was most prevalent in patients with autosomal-dominant inheritance (71.4%), followed by autosomal recessive/sporadic inheritance (58.9%) and least likely in persons with X linked inheritance (12.5%, p<0.001).ConclusionsThe prevalence of treatable RP complications is high and suggests it may be clinically beneficial to screen patients with RP to identify those who may benefit from current or future interventions.

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