Clinical outcomes of idiopathic macular epiretinal membrane removal by 23G vitrectomy with or without internal limiting membrane peeling_Chinese Journal of Ocular Fundus Diseases

Authors：

WangHong , ZhangPing , ChenFeng-e , 邱庆华 ,  孙涛

Department of Ophthalmology, Affiliated First People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080, China;

Corresponding author：

孙涛, Email: drsuntao@yeah.net

Keywords：

Macula lutea; Membranes; Surgical procedures, minimally invasive; Vitrectomy

DOI：

10.3760/cma.j.issn.1005-1015.2014.04.007

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Objective To evaluate the clinical outcomes of idiopathic macular epiretinal membrane (IMEM) by 23G vitrectomy with or without internal limiting membrane peeling. Methods A total of 40 eyes in 40 patients diagnosed as IMEM underwent 23G pars plana three-port vitrectomy (23G PPV). The macular ERM alone was removed in 20 eyes (non-ILM peeling group). Both ERM and ILM peeling were performed in another 20 eyes (ILM peeling group). All patients underwent removal of ERM with assistance of triamcinolone acetonide. For patients who underwent ILM peeling, indocyanine green dye was used to stain the ILM. ILM was peeled off up to the marginal of macular vessels arch. The patients in ILM peeling group and non-ILM peeling group had postsurgical follow-up for (15.85±3.79) months and (16.45±3.72) months respectively. There were no significant differences in gender, age, OD/OS, preoperative best-corrected visual acuity (BCVA), preoperative central macular thickness (CMT), preoperative total macular volume (TMV) and follow-up time between the two groups (P > 0.05). Intraoperative or postoperative complication was recorded during the follow-up period. At the final visit, the differences in BCVA, CMT and TMV between the two groups were analyzed, so did the correlations between BCVA and CMT or TMV in each group at the same time. Results There was no recurrence of an ERM or severe complications, such as retinal detachment and endophthalmitis in either group. The mean BCVA of ILM peeling group and non-ILM peeling group was 0.53±0.27 and 0.54±0.26 respectively at the final visit. Postoperative BCVA improved significantly in both groups with significant difference (t=5.035, 4.964; P < 0.05). The was no difference of postoperative BCVA between two groups (t=0.176, P > 0.05). The mean CMT was (343.55±48.74) μm and (311.70±42.48) μm, and the mean TMV was (7.78±0.40) mm³ and (7.88±0.43) mm³. CMT (t=9.508, 8.549) and TMV (t=11.098、15.372) revealed a significant decrease in both groups with significant difference (P < 0.05).The postoperative CMT in the ILM peeling group was significantly higher than that in the non-ILM peeling group (t=-2.203, P < 0.05). No difference was found between the two groups in terms of TMV (t=0.755, P > 0.05). Furthermore, no correlation was observed between postoperative BCVA and CMT (r=0.244, 0.266; P > 0.05) or TMV (r=-0.096, 0.157; P > 0.05). Conclusions 23G PPV combined with or without ILM peeling is an efficient and safe treatment for IMEM. ILM peeling appears to have similar effect on the long-term visual outcomes comparing with non-ILM peeling, combined with much thicker postoperative CMT.

Citation： WangHong, ZhangPing, ChenFeng-e. Clinical outcomes of idiopathic macular epiretinal membrane removal by 23G vitrectomy with or without internal limiting membrane peeling. Chinese Journal of Ocular Fundus Diseases, 2014, 30(4): 361-365. doi: 10.3760/cma.j.issn.1005-1015.2014.04.007 Copy

1.	惠延年.黄斑部视网膜前膜[M]//李凤鸣.中华眼科学. 2版.北京:人民卫生出版社, 2005:2276-2279.
2.	Smiddy WE, Maguire AM, Green WR, et al. Idiopathic epiretinal membranes: ultrastructural characteristics and clinicopathologic correlation[J]. Ophthalmology, 1989, 96:811-820.
3.	Park DW, Dugel PU, Garda J, et al. Macular pucker removal with and without internal limiting membrane peeling: pilot study[J]. Ophthalmology, 2003, 110:62-64.
4.	Kwok AK, Lai TY, Li WW, et al. Indocyanine green assisted internal limiting membrane removal in epiretinal membrane surgery: a clinical and histologic study[J]. Am J Ophthalmol, 2004, 138:194-199.
5.	Terasaki H, Miyake Y, Nomura R, et al. Focal macular ERGs in eyes after removal of macular ILM during macular hole surgery[J]. Invest Ophthalmol Vis Sci, 2001, 42:229-234.
6.	Uemura A, Kanda S, Sakamoto Y, et al. Visual field defects after uneventful vitrectomy for epiretinal membrane with indocyanine green-assisted internal limiting membrane peeling[J]. Am J Ophthalmol, 2003, 136:252-257.
7.	Pournaras CJ, Donati G, Brazitikos PD, et al. Macular epiretinal membranes[J]. Semin Ophthalmol, 2000, 15:100-107.
8.	Dell'omo R, Cifariello F, Dell'omo E, et al. Influence of retinal vessel printings on metamorphopsia and retinal architectural abnormalities in eyes with idiopathic macular epiretinal membrane[J]. Invest Ophthalmol Vis Sci, 2013, 54:7803-7811.
9.	Mitchell P, Smith W, Chey T, et al. Prevalence and associations of epiretinal membranes: the Blue Mountain Eye Study, Australia[J]. Ophthalmology, 1997, 104:1033-1040.
10.	de Bustros S, Thompson JT, Michels RG, et al. Vitrectomy for idiopathic epiretinal membranes causing macular pucker[J]. Br J Ophthalmol, 1988, 72:692-695.
11.	朱秀安.视网膜[M]//李凤鸣.中华眼科学.2版.北京:人民卫生出版社, 2005:89-120.
12.	Smiddy WE, Michels RG, Green WR. Morphology, pathology and surgery of idiopathic vitreoretinal macular disorders: a review[J]. Retina, 1990, 10:288-296.
13.	Rahman R, Stephenson J. Early surgery for epiretinal membrane preserves more vision for patients[J]. Eye (Lond), 2014, 28:410-414.
14.	Gandorfer A, Haritoglou C, Gass CA, et al. ICG assisted peeling of the internal limiting membrane may cause retinal damage[J]. Am J Ophthalmol, 2001, 132:431-433.
15.	Lim JW, Cho JH, Kim HK. Assessment of macular function by multifocal electroretinography following epiretinal membrane surgery with internal limiting membrane peeling[J]. Clin Ophthalmol, 2010, 4:689-694.
16.	Guigou S, Courjaret JC, Marc C, et al. Anatomical and functional repercussions of internal limiting membrane peeling in epiretinal membrane surgery[J]. J Fr Ophtalmol, 2013, 36:151-159.
17.	Balducci N, Morara M, Veronese C, et al. Retinal nerve fiber layer thickness modification after internal limiting membrane peeling[J]. Retina, 2014, 34:655-663.
18.	Clark A, Balducci N, Pichi F, et al. Swelling of the arcuate nerve fiber layer after internal limiting membrane peeling[J]. Retina, 2012, 32:1608-1613.
19.	Hillenkamp J, Saikia P, Gora F, et al. Macular function and morphology after peeling of idiopathic epiretinal membrane with and without the assistance of indocyanine green[J]. Br J Ophthalmol, 2005, 89:437-443.
20.	Enaida H, Sakamoto T, Hisatomi T, et al. Morphological and functional damage of the retina caused by intravitreous indocyanine green in rat eyes[J]. Graefe's Arch Clin Exp Ophthalmol, 2002, 240:209-213.
21.	Sandali O, El Sanharawi M, Basli E, et al. Epiretinal membrane recurrence: incidence, characteristics, evolution, and preventive and risk factors[J]. Retina, 2013, 33:2032-2038.

1. 惠延年.黄斑部视网膜前膜[M]//李凤鸣.中华眼科学. 2版.北京:人民卫生出版社, 2005:2276-2279.
2. Smiddy WE, Maguire AM, Green WR, et al. Idiopathic epiretinal membranes: ultrastructural characteristics and clinicopathologic correlation[J]. Ophthalmology, 1989, 96:811-820.
3. Park DW, Dugel PU, Garda J, et al. Macular pucker removal with and without internal limiting membrane peeling: pilot study[J]. Ophthalmology, 2003, 110:62-64.
4. Kwok AK, Lai TY, Li WW, et al. Indocyanine green assisted internal limiting membrane removal in epiretinal membrane surgery: a clinical and histologic study[J]. Am J Ophthalmol, 2004, 138:194-199.
5. Terasaki H, Miyake Y, Nomura R, et al. Focal macular ERGs in eyes after removal of macular ILM during macular hole surgery[J]. Invest Ophthalmol Vis Sci, 2001, 42:229-234.
6. Uemura A, Kanda S, Sakamoto Y, et al. Visual field defects after uneventful vitrectomy for epiretinal membrane with indocyanine green-assisted internal limiting membrane peeling[J]. Am J Ophthalmol, 2003, 136:252-257.
7. Pournaras CJ, Donati G, Brazitikos PD, et al. Macular epiretinal membranes[J]. Semin Ophthalmol, 2000, 15:100-107.
8. Dell'omo R, Cifariello F, Dell'omo E, et al. Influence of retinal vessel printings on metamorphopsia and retinal architectural abnormalities in eyes with idiopathic macular epiretinal membrane[J]. Invest Ophthalmol Vis Sci, 2013, 54:7803-7811.
9. Mitchell P, Smith W, Chey T, et al. Prevalence and associations of epiretinal membranes: the Blue Mountain Eye Study, Australia[J]. Ophthalmology, 1997, 104:1033-1040.
10. de Bustros S, Thompson JT, Michels RG, et al. Vitrectomy for idiopathic epiretinal membranes causing macular pucker[J]. Br J Ophthalmol, 1988, 72:692-695.
11. 朱秀安.视网膜[M]//李凤鸣.中华眼科学.2版.北京:人民卫生出版社, 2005:89-120.
12. Smiddy WE, Michels RG, Green WR. Morphology, pathology and surgery of idiopathic vitreoretinal macular disorders: a review[J]. Retina, 1990, 10:288-296.
13. Rahman R, Stephenson J. Early surgery for epiretinal membrane preserves more vision for patients[J]. Eye (Lond), 2014, 28:410-414.
14. Gandorfer A, Haritoglou C, Gass CA, et al. ICG assisted peeling of the internal limiting membrane may cause retinal damage[J]. Am J Ophthalmol, 2001, 132:431-433.
15. Lim JW, Cho JH, Kim HK. Assessment of macular function by multifocal electroretinography following epiretinal membrane surgery with internal limiting membrane peeling[J]. Clin Ophthalmol, 2010, 4:689-694.
16. Guigou S, Courjaret JC, Marc C, et al. Anatomical and functional repercussions of internal limiting membrane peeling in epiretinal membrane surgery[J]. J Fr Ophtalmol, 2013, 36:151-159.
17. Balducci N, Morara M, Veronese C, et al. Retinal nerve fiber layer thickness modification after internal limiting membrane peeling[J]. Retina, 2014, 34:655-663.
18. Clark A, Balducci N, Pichi F, et al. Swelling of the arcuate nerve fiber layer after internal limiting membrane peeling[J]. Retina, 2012, 32:1608-1613.
19. Hillenkamp J, Saikia P, Gora F, et al. Macular function and morphology after peeling of idiopathic epiretinal membrane with and without the assistance of indocyanine green[J]. Br J Ophthalmol, 2005, 89:437-443.
20. Enaida H, Sakamoto T, Hisatomi T, et al. Morphological and functional damage of the retina caused by intravitreous indocyanine green in rat eyes[J]. Graefe's Arch Clin Exp Ophthalmol, 2002, 240:209-213.
21. Sandali O, El Sanharawi M, Basli E, et al. Epiretinal membrane recurrence: incidence, characteristics, evolution, and preventive and risk factors[J]. Retina, 2013, 33:2032-2038.

Chinese Journal of Ocular Fundus Diseases

Clinical outcomes of idiopathic macular epiretinal membrane removal by 23G vitrectomy with or without internal limiting membrane peeling

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