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Qingjian Li,1,&ast; Kunhuan Yang,2– 5,&ast; Qianlin Ji,1,&ast; Jing Jiang,1 Rongrong Zong,2– 5 Yu Zhang,1 Yiwen Qian,1 Xin Che,1 Jinshan Suo,1 Zhiliang Wang1 1Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, Fujian, People’s Republic of China; 3Fujian Engineering and Research Center of Eye Regenerative Medicine, Xiamen, Fujian, People’s Republic of China; 4Eye Institute of Xiamen University, Xiamen, Fujian, People’s Republic of China; 5Xiamen University School of Medicine, Xiamen, Fujian, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jinshan Suo; Zhiliang Wang, Email ammy_suo@163.com; ophwzl@163.comPurpose: To evaluate the efficacy and safety of idiopathic epiretinal membrane (ERM) surgery in patients aged over 80 years.Methods: Consecutive patients who underwent pars plana vitrectomy (PPV) combined with ERM and internal limiting membrane (ILM) peeling with retrobulbar anesthesia were recruited. Based on age, the patients were divided into the elderly group (≥ 80 years of age) and the control group (< 80 years of age). The best-corrected visual acuity (BCVA) and surgical complications were regarded as the main measurement indicators.Results: This study included 43 eyes from 43 patients aged 80 to 91 years and 86 eyes from 86 patients aged 54 to 79 years. Surgical intervention substantially improved BCVA both in the elderly and control groups (p = 0.005 and p < 0.001, respectively). Statistical analyses showed no significant difference in the incidence of surgical complications between the two groups (p = 0.631). The operations in either group were not delayed or canceled for the reason of complications of retrobulbar anesthesia, severe anxiety, or physical discomfort in the perioperative period. Moreover, no patient required a second operation. Also, no stroke, myocardial infarction, or death occurred during the follow-up period. All the surgical complications were treated satisfactorily.Conclusion: Our outcomes indicate that PPV combined with ERM and ILM peeling with retrobulbar anesthesia is effective and safe in elderly patients aged 80 years or older. Based on age alone, we believe that advancing age should not be the risk factor for idiopathic ERM surgery.Keywords: idiopathic epiretinal membrane, elderly, pars plana vitrectomy, complication, safety

Mohammad Abu-Ain,1,2 Raed Shatnawi,1,2 Ibrahim Shehadeh,2 Mohammad Irfan Khan3 1Department of Special Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan; 2Prince Hamzah Hospital, Department of Ophthalmology, Amman, Jordan; 3Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UKCorrespondence: Mohammad Abu-Ain, Department of Special Surgery, Faculty of Medicine, The Hashemite University, P.O.Box 330127, Zarqa, 13133, Jordan, Email abuain@hotmail.co.ukObjective: To evaluate the long-term visual acuity and retinal thickness changes after pars plana vitrectomy (PPV) for idiopathic epiretinal membranes (ERM).Methods: We performed a retrospective analysis of 72 patients who underwent PPV for idiopathic ERM in a tertiary hospital over 5 consecutive years. The main outcome measurement was change in visual acuity and macular thickness as recorded with optical coherence tomography (OCT).Results: Medical records of 239 patients with a diagnosis of ERM who underwent PPV with or without internal limiting membrane (ILM) peeling were reviewed; of these, 72 patients with idiopathic ERM were included in the final analysis. All patients completed at least one year of follow-up, and 23 patients (30%) had 5 or more years of follow-up. The mean preoperative best corrected visual acuity (BCVA) was 20/65, and mean preoperative central macular thickness (CMT) on OCT was 434 microns (μm). Mean postoperative BCVA and CMT at one year were 20/40 and 303 μm, respectively (p< 0.0001). A total of 42 patients (58%) improved by 2 or more lines; BCVA and CMT continued to improve postoperatively for up to 5 years of the follow-up period. There was no significant difference in BCVA or CMT between phakic and pseudophakic patients, and ILM peeling was performed in 67% of patients. Improved BCVA at 1 year was associated with younger age (p< 0.0001) and ILM peeling (p=0.020).Conclusion: PPV is an effective treatment for idiopathic ERM, and ILM peel may be of benefit. BCVA continues to improve up to 2 years and beyond after surgery regardless of the duration of symptoms.Keywords: idiopathic epiretinal membrane, pars plana vitrectomy, optical coherence tomography, central macular thickness

Lorenzo Iuliano,1 Giovanni Fogliato,1 Francesca Gorgoni,2 Eleonora Corbelli,1 Francesco Bandello,1 Marco Codenotti11Ospedale San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy; 2Ospedali Riuniti di Ancona, Università Politecnica Delle Marche, Ancona, ItalyAbstract: This review aims to give to the reader an overview selectively oriented on safety and efficacy of surgery, providing concise and direct answers about crucial questions of trainees and experts. Surgery for idiopathic epiretinal membrane (ERM) is a safe and effective procedure that can achieve long-term stable postoperative visual and anatomical improvement, with an overall low recurrence and complication rate. Young patients, with a short onset of symptoms and with better initial visual acuity achieve higher levels of visual outcome. The preoperative degree of metamorphopsia is the prognostic factor for their postoperative degree. Successful results may be obtained in eyes with specific optical coherence tomography criteria, such as thin ganglion cell layers, thin internal plexiform layer, longer photoreceptors outer segment, regular ellipsoid zone and cone outer segment tips line, and without ectopic inner foveal layer. Internal limiting membrane peeling demonstrates positive anatomical and functional outcomes, but final positions about its safety remain controversial.Keywords: idiopathic epiretinal membrane, outcome, safety, efficacy, prognostic factor

Purpose: To report anatomic and logMAR best-corrected visual acuity (BCVA) outcomes with long-term follow-up after pars-plana vitrectomy and epiretinal membrane peeling (PPV-MP)., Design: A retrospective case-series., Participants: Patients with epiretinal membrane (ERM) who underwent PPV-MP performed by one surgeon., Methods: Best-corrected visual acuity (BCVA) was recorded as a logMAR preoperatively and, when available, at 1, 2, 3, 5, 8, 10 years after surgery. The integrity of outer retinal layers was evaluated using spectral domain optical coherence tomography (SD-OCT)., Main Outcome Measures: Postoperative BCVA at different follow-up visits and its correlation with different OCT parameters., Results: Fifty-five eyes of 49 patients were followed postoperatively with a mean of 8.6± 2.6 years (median: 9 years, range 5-16 years). The mean BCVA improved from 0.56±0.29 (20/72) preoperatively to 0.33±0.25 (20/42) at 1 year, 0.29±0.27 (20/38) at 2 years, 0.25±0.28 (20/35) at 3 years, 0.29±0.32 (20/38) at 5 years, 0.28±0.31 (20/38) at 8 years, and 0.28±0.25 (20/38) at 10 years (p<0.001). The BCVA improved at each of the first 3 years postoperatively and remained stable at 5, 8, and 10 years. Postoperative improvement in the integrity of ELM, and EZ, on SD-OCT correlated with improved BCVA., Conclusion: BCVA continues to improve after PPV-MP during the first 3 years postoperatively and remains stable. Improved anatomic integrity of outer retinal layers correlated with improved BCVA., Competing Interests: Dr Harry W Flynn Jr reports grants from National Institutes of Health (NIH), Bethesda, Maryland, during the conduct of the study. The study was supported in part by NIH Center Core Grant P30EY014801 (Bethesda, Maryland) and Research to Prevent Blindness Unrestricted Grant to UM. The Department of Ophthalmology receives grant support from Research to Prevent Blindness and the National Institutes of Health. However, Dr. Flynn has not directly received grant support or research funding for this manuscript. No financial disclosures conflicting relationship exist for any author., (© 2020 Elhusseiny et al.)

Background: The purpose of this study was to investigate postoperative intraocular pressure (IOP) in cases of silicone oil (SO) removal when using 25-gauge transconjunctival sutureless vitrectomy (TSV) with oblique incisions., Methods: We enrolled ten consecutive eyes with SO removal (SO group) and eleven consecutive eyes with idiopathic epiretinal membrane (ERM) as the initial vitrectomy (ERM group) in cases using 25-gauge TSV with oblique incisions. Postoperative IOPs were compared between the two groups at each of the four examination periods., Results: No significant differences were identified in any of the periods examined., Conclusion: The use of 25-gauge TSV with oblique incisions resulted in almost equivalent postoperative IOPs between cases with SO removal and idiopathic ERM as the initial operation. Self-sealing sclerotomy in 25-gauge TSV with oblique incisions may primarily involve the valve architecture, and be complemented by vitreous incarceration.