Pathophysiology, Classification, Clinical Diagnosis and Treatment of Primary Epiretinal Membrane

2018 ◽  
pp. 262-267
Keyword(s):  
Clinical Examination ◽  
Epiretinal Membrane ◽  
Posterior Vitreous Detachment ◽  
Internal Limiting Membrane ◽  
Non Invasive ◽  
Diagnosis And Classification ◽  
Pars Plana ◽  
Vitreomacular Interface

Epiretinal membrane (ERM), also known as macular pucker, premacular fibroplasia, premacular gliosis, or cellophane maculopathy is a common vitreoretinal interface pathology that can result in mild to moderate visual impairment with an impact on the quality of life. ERM can be classified as primary “idiopathic” or secondary. Most ERMs occur in individuals older than 50 years, and the prevalence of ERM increases as age increases. The pathological mechanisms are not entirely known, however, the posterior vitreous detachment is thought to be key. Diagnosis and classification of ERM are based on clinical examination findings. However, high resolution spectral domain-optic coherence tomographies (SD-OCTs) have proven to be more sensitive than clinical examination for the diagnosis of numerous disorders of the vitreomacular interface, including ERM. SD-OCTs enable the pre-and postoperative comparison of macular structures in a non-invasive examination. In treatment, surgical intervention entails pars plana vitrectomy with ERM removal with or without internal limiting membrane (ILM) removal. Good visual recovery was present in most patients after surgery.

On the creation of a new unified classification of the vitreomacular interface surgical pathology

2021 ◽  
pp. 73-77
Author(s):  
V.V. Miroshnikov ◽  
◽  
Y.A. Ivanishko ◽  
S.A. Kovalev ◽  
◽  
...  
Keyword(s):  
Macular Hole ◽  
Epiretinal Membrane ◽  
Posterior Vitreous Detachment ◽  
Vitreous Body ◽  
Surgical Pathology ◽  
Main Role ◽  
Clinical Classification ◽  
Subsequent Formation ◽  
Vitreomacular Interface

The progress of modern methods the vitreomacular interface (VMI) visualization, clinical and histopathological studies are constantly expanding our understanding of the course of the macular pathological process. At the same time, the diagnostic and classification schemes we use may lose their relevance without reflecting the pathogenesis of the disease, complicating the choice of treatment tactics, and also complicating professional communication when we using various classification approaches. Aim. To offer our views on the possibility of creating a unified clinical classification of primary surgical pathology of VMI. Material and methods. Research papers related to the surgical pathology of VMI were analyzed. Results. The main role in the development of VMI pathology belongs to the vitreous body and the changes that occur in it, leading to posterior vitreous detachment (PVD). Pathological PVD is a variant of vitreomacular adhesion: vitreoschisis or separation of the entire thickness of the posterior cortex with the presence of local vitreoretinal fixation. In the first case, an epiretinal membrane (ERM) develops, which can progress to an ERM with macular pseudohole or to an ERM with foveoschisis. In the second case, pathological PVD is realized in vitreomacular traction (VMT). Depending on various factors, VMT can resolve both asymptomatically and with the formation of a defect in the retinal tissue, leading to outer lamellar macular hole (outer LMH) and the subsequent formation of a full-thickness macular hole (FTMH). If the traction does not cause strong changes, then it, disrupting the architectonics of the retina, triggers the processes leading to the LMH (which was previously called degenerative LMH), and it, in turn, in rare cases, can also become FTMH. Conclusions. We proposed the combined clinical classification scheme of VMI primary surgical pathology, which more fully reflects modern ideas about pathogenesis and allows, based on OCT data, to more clearly differentiate macular changes requiring a various surgical approach. Key words: PPV, vitreomacular interface, classification, VMT, epiretinal membrane, ERM, pseudohole, macular hole.

scholarly journals Risk of newly developing visual field defect and neurodegeneration after pars plana vitrectomy for idiopathic epiretinal membrane

2020 ◽  
pp. bjophthalmol-2020-317478
Author(s):  
Kunihiko Akino ◽  
Norihiro Nagai ◽  
Kazuhiro Watanabe ◽  
Norimitsu Ban ◽  
Toshihide Kurihara ◽  
...  
Keyword(s):  
Visual Field ◽  
Epiretinal Membrane ◽  
Pars Plana Vitrectomy ◽  
Internal Limiting Membrane ◽  
Visual Field Defects ◽  
Automated Perimetry ◽  
Standard Automated Perimetry ◽  
Ilm Peeling ◽  
Idiopathic Epiretinal Membrane ◽  
Pars Plana

Background/AimsPars plana vitrectomy (PPV) is widely performed in patients with idiopathic epiretinal membrane (iERM) to improve vision. Postoperative visual field defects (VFDs) have been previously reported. However, whether they occur when using the most recent PPV system, and the frequency of VFDs as measured by standard automated perimetry, remain poorly documented and were examined in this study.MethodsData of 30 eyes (30 patients; mean age, 66.1 years; 15 men) who underwent PPV for iERM during February 2016–June 2019 and had preoperative and postoperative visual field measurements using standard automated perimetry (Humphrey visual field analyser 30-2 program) were retrospectively analysed. Eyes with diseases other than iERM, including moderate-to-severe cataract or preoperative VFDs were excluded.ResultsVFD, defined by the Anderson and Patella’s criteria, was found in 73.3% of the eyes 1 month after PPV. After age adjustment, internal limiting membrane (ILM) peeling was identified as a risk factor for postoperative VFD (p=0.035; 95% CI 1.173 to 92.8). Postoperative VFD was frequently observed nasally (86.4%, p=0.002), and on optical coherence tomography measurements, ganglion cell layer (GCL) thinning was found temporal to the fovea (p=0.008). Thinning of the superior and inferior retinal nerve fibre layers and of the GCL temporal to the fovea were significant in eyes after ILM peeling (all p<0.05).ConclusionILM peeling may cause inner retinal degeneration and lead to the development of VFDs after PPV, which should be further examined.

Hematopathological Concepts and Controversies in the Diagnosis and Classification of Myelodysplastic Syndromes

Hematology ◽  
2006 ◽  
Vol 2006 (1) ◽  
pp. 199-204 ◽  
Author(s):  
James W. Vardiman
Keyword(s):  
Bone Marrow ◽  
Myelodysplastic Syndromes ◽  
Who Classification ◽  
Diagnostic Dilemma ◽  
Genetic Studies ◽  
Diagnostic Uncertainty ◽  
Diagnostic Problems ◽  
Diagnosis And Classification

Abstract Although the diagnosis and classification of most cases of the myelodysplastic syndromes (MDS) is usually accomplished without difficulty, a minority of cases may pose diagnostic problems. In many cases the diagnostic dilemma can be solved by adhering to basic guidelines recommended for evaluation of patients suspected of having MDS, and in particular to the quality of the blood and bone marrow specimens submitted for morphologic, immunophenotypic and genetic studies. In other cases, such as patients who have hypocellular MDS or MDS with fibrosis, the criteria for making a diagnosis may be difficult if not impossible to apply, and in still others the diagnostic uncertainty is because the minimal criteria necessary to establish the diagnosis of MDS are not always clearly stated. In this review, some of these diagnostic problems are addressed and some general guidelines for resolving them are suggested. In addition, data are presented that illustrate that the WHO classification offers a valuable tool in the diagnosis and classification of MDS.

Automated Brain Imaging Diagnosis and Classification Model using Rat Swarm Optimization with Deep Learning based Capsule Network

2021 ◽  
pp. 2240001
Author(s):  
A. Vasantharaj ◽  
Pacha Shoba Rani ◽  
Sirajul Huque ◽  
K. S. Raghuram ◽  
R. Ganeshkumar ◽  
...  
Keyword(s):  
Deep Learning ◽  
Classification Model ◽  
Swarm Optimization ◽  
Diagnosis And Classification ◽  
Enhance Efficiency ◽  
Magnetic Resonance Imaging Mri ◽  
Learning Machine ◽  
The Brain

Earlier identification of brain tumor (BT) is essential to increase the survival rate of the patients. The commonly used imaging technique for BT diagnosis is magnetic resonance imaging (MRI). Automated BT classification model is required for assisting the radiologists to save time and enhance efficiency. The classification of BT is difficult owing to the non-uniform shapes of tumors and location of tumors in the brain. Therefore, deep learning (DL) models can be employed for the effective identification, prediction, and diagnosis of diseases. In this view, this paper presents an automated BT diagnosis using rat swarm optimization (RSO) with deep learning based capsule network (DLCN) model, named RSO-DLCN model. The presented RSO-DLCN model involves bilateral filtering (BF) based preprocessing to enhance the quality of the MRI. Besides, non-iterative grabcut based segmentation (NIGCS) technique is applied to detect the affected tumor regions. In addition, DLCN model based feature extractor with RSO algorithm based parameter optimization processes takes place. Finally, extreme learning machine with stacked autoencoder (ELM-SA) based classifier is employed for the effective classification of BT. For validating the BT diagnostic performance of the presented RSO-DLCN model, an extensive set of simulations were carried out and the results are inspected under diverse dimensions. The simulation outcome demonstrated the promising results of the RSO-DLCN model on BT diagnosis with the sensitivity of 98.4%, specificity of 99%, and accuracy of 98.7%.

scholarly journals ILM removal in vitreomacular interface disorders: for or against?

2021 ◽  
pp. 83-88
Author(s):  
S.V. Kolesnik ◽  
◽  
A.I. Kolesnik ◽  
A.V. Miridonova ◽  
F.A. Avakyan ◽  
...  
Keyword(s):  
Macular Hole ◽  
Epiretinal Membrane ◽  
Functional Outcomes ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Review Literature ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
Vitreomacular Interface

Purpose. To provide data on efficacy and safety of internal limiting membrane (ILM) removal in various pathologies of the vitreomacular interface. Material and methods. To perform the review, literature sources were searched through the PubMed and Scopus databases up to year 2021 using the keywords "internal limiting membrane peeling", "macular hole", "epiretinal membrane". A total of 38 articles relevant to the topic of the review were selected. Results. Numerous studies have confirmed the efficacy of internal limiting peeling in improving anatomical and functional outcomes of treatment of various pathologies. However, even a flawlessly performed peeling can cause both anatomical and functional effects on the retina. Various studies have demonstrated that the anatomical complications of ILM peeling did not correlate with the functional outcomes of surgery. Conclusion. Available evidence supports ILM peeling as an intervention that improves anatomical and functional results of treatment and reduces rate of reoperation. However, in order to evaluate the safety of this procedure, further studies with an assessment of the visual function with a long follow-up period are required. Key words: internal limiting membrane, peeling, macular hole, epiretinal membrane

scholarly journals Inverted ILM flap technique in Optic Disc Pit Maculopathy: An Iranian experience with review of the literature

2021 ◽  
Author(s):  
Ali Tavallali ◽  
Yasaman Sadeghi ◽  
Seyed-Hossein Abtahi ◽  
Hosein Nouri ◽  
Mitra Rezaei ◽  
...  
Keyword(s):  
Optic Disc ◽  
Posterior Vitreous Detachment ◽  
Surgical Techniques ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Optic Disc Pit ◽  
Review Of The Literature ◽  
Pars Plana ◽  
Optic Disc Pit Maculopathy ◽  
Prospective Case Series

Abstract Purpose To present the outcome of optic disc pit maculopathy (ODPM) managed successfully with inverted internal limiting membrane (ILM) flap over the optic disc. Methods This prospective case series included three patients with ODPM who underwent pars plana vitrectomy with posterior vitreous detachment induction, followed by inverted ILM flap over the optic disc and gas tamponade. Patients were followed for 7-16 weeks as regards their functional and anatomical findings. A narrative review is also provided about Pathology, Pathogenesis, and surgical techniques in the treatment of ODPM Results Three adult patients (25–39 years old) were evaluated, with a mean duration of decreased visual acuity of 7.33 ± 2.40 months (4-12 months). Postoperatively, BCVA improved dramatically in one patient from 2/200 to 20/25. BCVA in the other two improved two and three lines, to 20/50 and 20/30, respectively. Significant anatomic improvement was achieved in all patients. Conclusion Vitrectomy with inverted ILM flap insertion over the optic disc can yield favorable anatomical improvement in patients with ODPM.

scholarly journals Epidemiology of Vitreomacular Interface Disorders

2018 ◽  
pp. 220-223
Keyword(s):  
Macular Hole ◽  
Epiretinal Membrane ◽  
Visual Loss ◽  
Disease Duration ◽  
Posterior Vitreous Detachment ◽  
Vitreomacular Adhesion ◽  
Membrane Formation ◽  
Vitreous Detachment ◽  
Vitreomacular Interface ◽  
Epidemiological Characteristics

Vitreomacular interface disorders consist of a series of diseases including vitreomacular adhesion, vitreomacular traction, macular hole, and epiretinal membrane formation. They occur due to the failed progression of normal posterior vitreous detachment. Affected patients may present with metamorphopsia and varying degrees of visual loss depending on the severity of foveal disturbance and disease duration. The aim of this review is to define the epidemiological characteristics of these groups of disorders which show an increased incidence and prevalence with age in parallel with the occurrence of posterior vitreous detachment.

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