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

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Wolfgang J. Mayer ◽  
Clara Fazekas ◽  
Ricarda Schumann ◽  
Armin Wolf ◽  
Denise Compera ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Morphological Changes ◽  
Mechanical Trauma ◽  
Retinal Sensitivity ◽  
Ilm Peeling ◽  
Epiretinal Membranes ◽  
Morphological Alterations ◽  
Inner Limiting Membrane ◽  
Before And After ◽  
23 Gauge

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.

scholarly journals Epiretinal membrane surgery outcome in eyes with abnormalities of the central bouquet

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Max P. Brinkmann ◽  
Stephan Michels ◽  
Carolin Brinkmann ◽  
Felix Rommel ◽  
Mahdy Ranjbar ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Internal Limiting Membrane ◽  
Surgical Removal ◽  
Ilm Peeling ◽  
Epiretinal Membranes ◽  
Morphological Appearance ◽  
Surgery Outcome ◽  
Stage 4 ◽  
Before And After ◽  
Stage 1

Abstract Background Clinical studies have shown that epiretinal membranes (ERM) as well as abnormalities of the central foveal bouquet (CB) can be classified in different stages according to their morphological appearance. Furthermore, visual acuity correlates with the different stages of these features. The present study evaluated how these findings change after the surgical removal of the ERM and their impact on functional outcomes. Methods In this retrospective study eyes with ERM were evaluated by SD-OCT scans before and after pars plana vitrectomy (PPV) with macular ERM and internal limiting membrane (ILM) peeling. CB abnormalities were classified according to their morphological appearance from stage 0 (no abnormalities) to stage 3 (acquired vitelliform lesion). ERMs were classified ranging from stage 0 (absence of ERM) to stage 4 (ERM with significant anatomic disruption of macula). Changes in morphology were correlated with visual acuity before and after surgery. Results 151 eyes were included into the study. Before surgery 27.2% (n = 41) of eyes showed CB abnormalities with stage 1 being the most common (11.9%, n = 18). Before surgery ERM was seen in all patients. The most common form was stage 1 (28.5%, n = 43), followed by stage 3 (27.8%, n = 42) and 2 (25.2%, n = 38). Only 18.5% (n = 28) presented with stage 4 ERM. The mean BCVA was 0.42 (logMAR) before and increased to 0.19 (logMAR) 8 weeks after vitrectomy (95% CI 0.20–0.28; p < 0.001). Patients who suffered from CB abnormalities had less increase in BCVA than patients who had no evidence of CB (0.28 vs. 0.14 logMAR; p < 0.001). Of all the patients with CB abnormalities at baseline, 68% had lower CB grading after the surgery (n = 28; 95% CI; p < 0.001). All patients showed an improvement of their ERM grading, with 98.7% reaching stage 0 (n = 151 vs. n = 149; 95% CI; p < 0.001). Conclusions The study indicates that the presence of CB abnormalities correlates with worse visual function. They are furthermore associated with worse visual outcomes after PPV with ERM and ILM peeling. These findings are valuable for deciding on PPV in patients with ERM.

Long-term follow-up of retinal sensitivity assessed by microperimetry in patients with internal limiting membrane peeling

2021 ◽  
pp. 112067212199730
Author(s):  
Benjamin Blautain ◽  
Agnès Glacet-Bernard ◽  
Rocio Blanco-Garavito ◽  
Adélaïde Toutée ◽  
Camille Jung ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Internal Limiting Membrane ◽  
Retinal Sensitivity ◽  
Optical Coherence ◽  
Ilm Peeling ◽  
Epiretinal Membranes ◽  
Fellow Eye ◽  
Vitreomacular Interface

Purpose: To evaluate anatomical and functional changes in patients with vitreomacular interface disease after internal limiting membrane (ILM) peeling, using microperimetry along with usual clinical and multimodal retinal imaging. Methods: Patients with vitreomacular interface disease requiring vitrectomy underwent multimodal retinal evaluation, including visual acuity assessment, fundus color photograph, Spectral-Domain Optical Coherence Tomography, Optical Coherence Tomography-Angiography, and microperimetry. They were examined at baseline (M0), 6 months (M6) and 18 months (M18) after surgery. Retinal sensitivity was subdivided into three concentric polygons: Large, Medium, Small. Results: Eleven eyes of 11 patients were analyzed, including 10 epiretinal membranes (ERMs). Best-corrected visual acuity (BCVA) improved in all patients from 0.51 logarithm of the minimal angle of resolution (logMAR) to 0.067 ( p = 0.0074). Retinal sensitivity improved between M0 and M6 in all polygons and continued to improve between M6 and M18 for polygons Medium (M) and Small (S) with no statistical significance. At M18, BCVA and retinal sensitivity were similar in the operated eye compared with the fellow eye for all patients. Dissociated optic nerve fiber layer appearance was observed in 8 patients at M18. It was not correlated with either retinal sensitivity or BCVA or microscotomas. No recurrence of ERM or macular hole occurred during follow-up. Conclusion: After surgery, the retinal sensitivity assessed by microperimetry gradually improved until the 18th month and was not different from the values of the fellow eye. These results seemed to confirm that ILM peeling can be an effective and safe technique to treat patients with vitreomacular interface disease.

scholarly journals Influences of Central Bouquet Alterations on the Visual Outcome in Eyes Receiving Epiretinal Membrane Surgery

2021 ◽  
Vol 11 (3) ◽  
pp. 926
Author(s):  
Max Philipp Brinkmann ◽  
Stephan Michels ◽  
Carolin Brinkmann ◽  
Mario Damiano Toro ◽  
Nicole Graf Johansen ◽  
...  
Keyword(s):  
Visual Outcome ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Epiretinal Membranes ◽  
Staging Systems ◽  
Before And After ◽  
Pars Plana

Background: Previous studies have shown that epiretinal membranes (ERMs) may be associated with abnormal outer retinal anatomy. However, long-term morphological and functional results of pars plana vitrectomy (PPV) with ERM and internal limiting membrane (ILM) peeling in eyes with central bouquet (CB) alterations have not yet been investigated. Methods: In a retrospective, consecutive study all patients underwent best corrected visual acuity (BCVA) testing and spectral domain optical coherence tomography (SD-OCT) before and after a mean of 20 months (range 3–70 months) postoperatively. CB abnormalities and ERMs were classified according to Govetto’s staging systems. Results: Of the 67 eyes, 22 (34%) showed CB abnormalities at baseline. The mean BCVA increased from 0.42 at baseline to 0.20 LogMAR at final follow-up (p < 0.001). Neither ERM stage (p = 0.06) nor CB stage (p = 0.939) at baseline were significant predictors of vision improvement following surgery. Conclusions: Our results show that baseline BCVA, but not classification of CB changes and ERM at baseline, seems to be a useful predictor for functional outcomes following PPV with ERM and ILM peeling in the long-term.

scholarly journals Anatomical and functional significance of ectopic inner foveal layer (EIFL) in epiretinal membrane (ERM)

2021 ◽  
Vol 7 (2) ◽  
pp. 366-371
Author(s):  
Sunil Ganekal ◽  
Varun Ganekal
Keyword(s):  
Visual Acuity ◽  
Epiretinal Membrane ◽  
Visual Outcome ◽  
Surgical Removal ◽  
Chi Square ◽  
Epiretinal Membranes ◽  
Stage 4 ◽  
Before And After ◽  
Chi Square Test ◽  
Stage 1

To compare the visual acuity outcomes after surgical treatment of epiretinal membranes (ERM) in cases with and without ectopic inner foveal layers (EIFL). : A total of 100 eyes of 98 patients with idiopathic ERM were retrospectively staged according to the newer OCT classification and divided into two groups on the basis of presence or absence of EIFL. The two groups were evaluated for various parameters including visual acuity, thickness of the EIFL, re-appearance of the foveal contour, outer retinal changes and complications before and after ERM peeling. Correlation analysis was done using chi square test and p-values were obtained for corresponding variables.: Of 100 eyes with ERM, 20% had stage 1, 29% had stage 2, 42% had stage3 & 9% had stage 4 disease. VA was worse in eyes with EIFL as compared those without it. Correlation of VA with EIFL thickness however was not significant. Surgical removal of ERM didn’t alter EIFL frequency though the thickness decreased. New EIFL appeared in 4% eyes and 35% demonstrated thickened fovea after surgery. Anatomical reappearance of foveal contour was poorer in eyes with EIFL. Outer retinal changes were more common in non EIFL eyes. Lamellar holes and nontractional cysts were more common in EIFL eyes.: EIFL is a significant prognostic tool to predict the visual outcome of surgery in cases of Epiretinal membrane. EIFL eyes did not regain foveal contour, had less outer retinal damage but were associated with poorer visual outcomes.

scholarly journals The Impact of Cataract Surgery on Contrast Visual Acuity and Retinal Sensitivity in Patients with Retinitis Pigmentosa

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Gen Miura ◽  
Takayuki Baba ◽  
Tomoaki Tatsumi ◽  
Hirotaka Yokouchi ◽  
Shuichi Yamamoto
Keyword(s):  
Visual Acuity ◽  
Retinitis Pigmentosa ◽  
Cataract Surgery ◽  
Contrast Sensitivity ◽  
Retinal Sensitivity ◽  
Zone Length ◽  
Ellipsoid Zone ◽  
Postoperative Visual Acuity ◽  
Before And After ◽  
The Impact

Purpose. To determine the effects of cataract surgery on contrast visual acuity and retinal sensitivity in patients with retinitis pigmentosa. Methods. Retinal sensitivity and contrast visual acuity were determined by microperimetry (MAIA) and contrast sensitivity acuity tester (CAT-CP), respectively, before and after cataract surgery. The significance of the correlations between visual acuity, retinal sensitivity, contrast visual acuity, improvements after surgery, and macular structure before and after cataract surgery was determined. Results. Retinal sensitivity and contrast visual acuity were significantly improved after cataract surgery. The correlations among postoperative visual acuity, postoperative retinal sensitivities, and preoperative ellipsoid zone length were significant. The postoperative retinal sensitivity of the central 10° and the ellipsoid zone length was particularly significantly correlated. Preoperative contrast visual acuity and the amount of improvement and preoperative retinal sensitivity and the amount of improvement were significantly negatively correlated. The contrast visual acuity under both the 100% and 10% photopic and mesopic conditions improved significantly after cataract surgery. Conclusions. Cataract surgery in retinitis pigmentosa patients with preserved ellipsoid zones significantly improved retinal sensitivity and contrast visual acuity. Cataract surgery can be expected to improve retinal sensitivity and contrast visual acuity under various conditions, even if preoperative visual parameters are low, as long as the ellipsoid zone is preserved.

scholarly journals Eccentric Macular Hole after Pars Plana Vitrectomy for Idiopathic Macular Hole: A Case Report

2017 ◽  
Vol 8 (1) ◽  
pp. 116-119 ◽  
Author(s):  
Irini Chatziralli ◽  
George Theodossiadis ◽  
Maria Douvali ◽  
Alexandros A. Rouvas ◽  
Panagiotis Theodossiadis
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Pars Plana Vitrectomy ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Pars Plana ◽  
23 Gauge ◽  
Retinal Hole ◽  
The Right

Introduction: Postoperative eccentric macular hole (MH) formation is an uncommon complication after pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for epiretinal membrane or MH treatment. Herein, we present a case of eccentric MH formation after PPV with ILM peeling for MH. Case Description: A 72-year-old female patient underwent 23-gauge PPV with ILM peeling for idiopathic MH in her right eye. The visual acuity was 6/24 in the right eye. One week postoperatively the retina was attached and the MH seemed to be closed, while visual acuity was 6/12. One month after PPV, there was a single eccentric retinal hole below the macula, which was detected at the fundoscopy and was confirmed by OCT. The visual acuity was 6/9 and the patient referred no symptoms. No further intervention was attempted, and at the 6-month follow-up the visual acuity and the size of the eccentric MH remained stable. Conclusions: Eccentric MHs can develop after PPV and are usually managed conservatively by observation.

scholarly journals Morphological Changes and Prognostic Factors before and after Photodynamic Therapy for Central Serous Chorioretinopathy

2021 ◽  
Vol 14 (1) ◽  
pp. 53
Author(s):  
Yu Wakatsuki ◽  
Koji Tanaka ◽  
Ryusaburo Mori ◽  
Koichi Furuya ◽  
Akiyuki Kawamura ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Photodynamic Therapy ◽  
Prognostic Factors ◽  
Central Serous Chorioretinopathy ◽  
Disease Duration ◽  
Morphological Changes ◽  
Factors Associated ◽  
Before And After ◽  
The Mean ◽  
Mean Luminance

Central serous chorioretinopathy (CSC) is a disease of unknown etiology, but half-dose photodynamic therapy (hPDT) is well known to be effective for CSC. Infrared reflectance (IR) has been shown to be effective for detecting retinal pigmented epithelial and choroidal lesions, but no reports have focused on chorioretinal changes using IR images after as compared to before hPDT. This study aimed to clarify the features of IR images as well as retinal and choroidal morphological changes before and after treatment with verteporfin hPDT for CSC. We also examined prognostic factors associated with CSC treatment. This was a retrospective study that included 140 eyes of 140 patients (male/female ratio 122:18, mean age 53.4 ± 10.8 years) diagnosed with CSC who underwent hPDT in our hospital during the period from April 2015 to December 2018. We determined changes in visual acuity, therapeutic efficacy, central retinal thickness (CRT), central choroidal thickness (CCT), and IR images at one and three months after hPDT as compared to before treatment. Dry macula was defined as a complete resolution of serous retinal detachment after hPDT. History of smoking, disease duration, presence of drusen, presence of retinal pigment epithelium abnormalities, type of fluorescein angiographic leakage, and presence of choroidal vascular hyperpermeability were investigated as prognostic factors associated with treatment efficacy. CRT and CCT were measured using optical coherence tomography (Spectralis HRA-2; Heidelberg Engineering), and IR images after versus before treatment were compared using ImageJ software (version 1.52) to calculate the mean luminance for a 3 × 3 mm area in the macula. Compared with the values before treatment, CCT, CRT, and visual acuity showed significant improvements at one and three months after treatment, and the mean luminance of IR images was also significantly increased. Furthermore, the luminance on IR images tended to rise, though the values at one month and three months after treatment did not differ significantly. Disease duration was significantly associated with dry macula one month after treatment, and visual acuity and CRT before hPDT were both significantly related to dry macula three months after treatment. IR images tended to improve over time, from before treatment through one and three months after hPDT.

scholarly journals Internal Limiting Membrane Peeling and Flap Inverting under Air in Large Idiopathic Macular Hole Surgery

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Yuan Zong ◽  
Kaicheng Wu ◽  
Jian Yu ◽  
Changbo Zhou ◽  
Chunhui Jiang
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Idiopathic Macular Hole ◽  
Ilm Peeling ◽  
Minimum Diameter ◽  
Measurement Results ◽  
Pars Plana ◽  
23 Gauge

Purpose. To evaluate the efficacy of internal limiting membrane (ILM) peeling combined with modified flap inverting under air in the treatment of large idiopathic macular hole (MH). Methods. Eyes with a large idiopathic MH (minimum diameter >550 μm) were included in this study. The surgical procedure included standard 23-gauge pars plana vitrectomy (PPV), ILM peeling, complete fluid-gas exchange, and ILM flap inversion under air. The patients underwent follow-up exam including optical coherence tomography (OCT) and best-corrected visual acuity (BCVA) measurement. Results. Sixteen eyes from 16 patients were included. Mean MH diameter was 681.43 ± 112.12 μm. After a mean follow-up time of 6.25 ± 2.65 months, in all cases, the MH was closed, and the ILM flap could be seen at the inner surface of the fovea. U-shaped and V-shaped MH closure was achieved in 11 and 5 cases, respectively. The BCVA improved significantly from 1.49 ± 0.35 logMAR to 0.89 ± 0.35 logMAR ( p < 0.05 ), and visual acuity of 20/100 or better was achieved in 8 eyes. Conclusion. ILM flap inverting under air was helpful in improving the functional and anatomic outcomes of vitrectomy for large idiopathic MH.

scholarly journals Current Trends about Inner Limiting Membrane Peeling in Surgery for Epiretinal Membranes

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Francesco Semeraro ◽  
Francesco Morescalchi ◽  
Sarah Duse ◽  
Elena Gambicorti ◽  
Andrea Russo ◽  
...  
Keyword(s):  
Basement Membrane ◽  
Adverse Effects ◽  
Surgical Procedure ◽  
Cellular Proliferation ◽  
Routine Practice ◽  
Ilm Peeling ◽  
Epiretinal Membranes ◽  
Current Trends ◽  
Inner Limiting Membrane ◽  
Vitreomacular Interface

The inner limiting membrane (ILM) is the basement membrane of the Müller cells and can act as a scaffold for cellular proliferation in the pathophysiology of disorders affecting the vitreomacular interface. The atraumatic removal of the macular ILM has been proposed for treating various forms of tractional maculopathy in particular for macular pucker. In the last decade, the removal of ILM has become a routine practice in the surgery of the epiretinal membranes (ERMs), with good anatomical results. However many recent studies showed that ILM peeling is a procedure that can cause immediate traumatic effects and progressive modification on the underlying inner retinal layers. Moreover, it is unclear whether ILM peeling is helpful to improve vision after surgery for ERM. In this review, we describe the current understanding about ILM peeling and highlight the beneficial and adverse effects associated with this surgical procedure.

Internal limiting membrane peeling without vitrectomy for laser-induced macular holes in two children

2021 ◽  
pp. 112067212199063
Author(s):  
Nan Chen ◽  
Kunkun Zheng
Keyword(s):  
Visual Acuity ◽  
Surgical Procedure ◽  
Pediatric Patients ◽  
Internal Limiting Membrane ◽  
Optical Coherence ◽  
Slit Lamp ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Before And After

Purpose: To describe a technique of internal limiting membrane (ILM) peeling without vitrectomy for the treatment of laser-induced macular holes in two children. Methods: ILM peeling was performed under the vitreous hyaloid, and the vitreous was retained. Slit lamp and optical coherence tomographic examinations were performed before and after surgery. Results: Macular holes were closed with different patterns at different time in the two patients, while visual acuity improved significantly in both of them eventually. Conclusion: The technique of ILM peeling in the absence of vitrectomy can promote the closure of laser-induced macular holes and minimize the surgical procedure, with few vitrectomy complications in pediatric patients. The closure pattern may vary on account of different injury sources and extents.

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