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Idiopathic ERM is a fibrocellular proliferation on the inner surface of vitreomacular interface. Vitrectomy in patients with relatively high preoperative visual acuity is preferable, because it prevents further photoreceptor damage. In the late stages of the disease, patients are not satisfied with the results of the treatment after surgical removal of the ERM due to fibrotic remodeling of the vitreomacular interface. The main reason for this is the incompleteness of the retinal morphology restoration and function. Purpouse . To compare the anatomical and clinical functional results of surgical treatment in patients with different visual acuity at different periods of observation. Material and methods . A clinical and functional assessment of early surgical treatment of idiopathic ERM was performed in 75 patients (75 eyes). It consists in the dynamic observation of the best-corrected visual acuity (BCVA), data of central retinal thickness (CRT) and central retinal sensitivity (CRS). Results . The BCVA of patients from the 1st group was 1.00 (0.80; 1.00) already 6 months after the treatment. Also, as soon as possible, the CRS was restored to 27.25 (26.50; 27.90) dB. In the 2nd group, the BCVA and CRS were revealed by the 12th month of observation 0.80 (0.60; 0.90), RS 26.20 (24.50; 27.00). In the 3rd group, BCVA at the end of the entire observation period did not reach maximum values – 0.50 (0.30; 0.60), CRS 23.70 (22.10; 24.75). Increasing of BCVA correlated with the retinal thickness decreasing. Conclusions . Combined surgical treatment for early symptomatic ERM is effective, safe and appropriate to maintain high anatomical and functional results in the postoperative period, which allows to achieve rapid rehabilitation of patients.

AIM: To evaluate the therapeutic effect of combined phacovitrectomy with membrane peeling and intraocular lens (IOL) implantation in patients with severe idiopathic epiretinal membrane (iERM) and concurrent cataract. METHODS: A total of 34 eyes from 34 patients who underwent phacovitrectomy and epiretinal membrane (ERM) peeling at the First Affiliated Hospital of Zhejiang University between 2015 and 2017. The best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured preoperatively and at 1, 3, 6mo and 1y postoperatively. Temporal changes and bivariate correlations of these parameters were analyzed. RESULTS: Mean logMAR BCVA improved and CFT decreased significantly (P

BACKGROUND: Idiopathic epiretinal membrane (iERM) is an avascular proliferation of different types of cells between the posterior vitreous cortex and the internal limiting membrane. That causes visual impairment including blurry, distortion, scotoma. Many studies of iERM were done to describe the clinical characteristics and investigate the histopathology of this disease. Nonetheless, there has not been a study of iERM histopathology in Vietnam. AIMS: To describe clinical characteristics and histopathological results of idiopathic retinal membrane and the association between them. METHODS: A cross sectional decriptive study of 35 iERMs (33 patients) in Vietnam National Institute of Ophthalmology (VNIO). RESULTS: High morbidity incidence was in group age >50 years (32/35), female gender (26/35), limited movement works (27/35), and high educational levels (28/35). Distortion was the highest (77.14%), scotoma and floater was less frequent (28.5%, 45.7%). Macular edema in all cases and PVD and exudate were high frequent (65.7%, 62.8%). Symptom duration was 8.2 ± 4.7 months, (1-21 months). Mean of central macular thickness was 468.51 ± 97.24 µm (656-274 µm). Six types of cell were detected, including glial cell (35/35), fibroblast (23/35), myofibroblast (23/35), macrophage (13/35), lymphocyte (5/35) and neutrophil (2/35). The number of cell types in one sample ranged from 1-5 types (2.85 ± 1.28 cell types). Number of cell types were correlated to symptom duration (r = 0.47, p = 0.004, Pearson's test) and central macular thickness (r = 0.72, p < 0.001, Pearson's test). CONCLUSION: There were 6 types of cells in iERM. Glial cell was the most frequent cell, inflammatory cells (macrophage, lymphocyte, neutrophil) was also detected. The number of cell types was stastitically correlated to symptom duration and CMT.

Aim. To analyze the clinical and functional results of the combined technology for laser treatment of patients with the initial stages of idiopathic epiretinal membrane.Methods. This study included 3 groups of patients: the main group (32 patients) after the combined laser technology (subthreshold “grid” laser photocoagulation (LP) and subthreshold micropulse LP); control group (30 patients) which did not receive any treatment; comparison group (30 patients) after subthreshold “grid” LP. The assessment uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), central retinal thickness (CRT) and central retinal sensitivity (CRS) was performed. The follow-up period was 5 years.Results. In the control group a slow decrease of UCVA, BCVA, CRS (p < 0.05) and an increasing CRT (p < 0.05) were observed. In the main group maximal UCVA, BCVA, CRS (p < 0.05) were marked from 3 to 6 months after laser treatment and there was a gradual decrease in the CRT indices. In the comparison group, a short-term positive effect was achieved up to 3 months with an increase of UCVA, BCVA, CRS (p < 0.05). 12 months post op there was an increase in CRT with a decrease of UCVA, BCVA, and CRS until the end of study.Conclusion. The technology of combined laser treatment showed high efficiency in control and comparison groups, with stabilization/increase of UCVA, BCVA, CRS and stabilization/improvement of the morphological parameters of the retina – the decrease of CRT with ERM involution.

Purpose: To assess the role of inflammation in the pathogenesis of idiopathic epiretinal membrane (iERM) using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) as indicators of inflammation and to compare these parameter levels between iERM and control subjects. Methods: We retrospectively analyzed the medical records of 36 patients who underwent vitrectomy-ERM peeling and 39 patients who had cataract surgery. We obtained blood samples from all individuals who participated in the study to investigate these parameters. Results: Seventy-five subjects were included in this study: 36 in the iERM group and 39 in the control group. The mean neutrophil and MPV levels were significantly higher in iERM subjects than in control subjects. The mean lymphocyte level was lower in the iERM group. The mean NLR, PLR, and MPV levels were higher in iERM subjects than in control subjects. Conclusion: The higher NLR, PLR, and MPV levels found in patients with iERM may indicate that subclinical systemic inflammation may associate with iERM.

Background The epiretinal membrane (ERM) is a degenerative condition associated with age, which can cause loss of vision and/or metamorphopsia. The treatment of symptomatic ERM involves surgical removal including a vitrectomy followed by peeling of the ERM using a microforceps. As the internal limiting membrane (ILM) is adherent to the ERM, it is sometimes removed with it (spontaneous peeling). If ILM remains in place, it can be removed to reduce ERM recurrence. However, it is important to clarify the safety of ILM peeling, while it increases surgical risks and cause histological disorganization of the retina that can lead to microscotomas, may be responsible for definitive visual discomfort. Methods PEELING is a prospective, randomized, controlled, single-blind, and multicentered trial with two parallel arms. This study investigates the benefit/risk ratio of active ILM peeling among individuals undergoing ERM surgery without spontaneous ILM peeling. Randomization is done in the operating room after ERM removal if ILM remains in place. After randomization, the two groups—“active peeling of the ILM” and “no peeling of the ILM”—are compared during a total of three follow-up visits scheduled at month 1, month 6, and month 12. Primary endpoint is the difference in microscotomas before surgery and 6 months after surgery. Patients with spontaneous peeling are not randomized and are included in the ancillary study with the same follow-up visits and the same examinations as the principal study. Relevant inclusion criteria involve individuals aged > 18 years living with idiopathic symptomatic ERM, including pseudophakic patients with transparent posterior capsule or open capsule or lensed patients with age-related cataracts. The calculated sample size corresponds to 53 randomized eyes (one eye/patient) per arm that means 106 randomized eyes (106 randomized patients) in total and a maximum of 222 included patients (116 spontaneous peeling). Discussion ILM peeling is often practiced in ERM surgery to reduce ERM recurrence. It does not impair postoperative visual acuity, but it increases the surgical risks and causes anatomical damages. If active ILM peeling is significantly associated with more microscotomas, it may contraindicate the ILM peeling during primitive idiopathic ERM surgery. Trial registration ClinicalTrials.gov, NCT02146144. Registered on 22 May 2014. Recruitment is still ongoing.

PURPOSE: To evaluate the vitreous concentration of different nonsteroidal anti-inflammatory drugs (NSAIDs) after topical administration and the related prostaglandin E2 (PGE2) levels in patients undergoing pars plana vitrectomy. METHODS: A prospective, randomized, investigator-masked study was performed. One hundred four patients scheduled for a pars plana vitrectomy for an epiretinal membrane or a macular hole were randomized to receive topical diclofenac 0.1%, indomethacin 0.5%, nepafenac 0.3%, bromfenac 0.09%, or placebo 3 days before surgery. At the beginning of surgery, a sample of undiluted vitreous was collected in each patient to assess NSAIDs concentration and PGE2 levels. RESULTS: The median vitreous concentrations were 203.35 (interquartile range 146.54-264.18) pg/mL for diclofenac, 243.45 (interquartile range 156.96-365.37) pg/mL for nepafenac, 438.21 pg/mL (interquartile range, 282.52-645.87) for its active metabolite amfenac, 350.14 (interquartile range, 290.88-481.95) pg/mL for indomethacin, and 274.59 (245.43-358.25) pg/mL for bromfenac. Vitreous PGE2 levels were significantly lower for all the NSAIDs groups compared with the control group (P < 0.001). A statistically significant higher vitreous PGE2 level was found in the diclofenac group compared with the other NSAIDs groups (P < 0.05). CONCLUSION: Topical NSAIDs achieve sufficient vitreous concentration to decrease vitreous PGE2 levels compared with the control group. The different efficacy in reducing PGE2 concentration may affect the management of posterior segment inflammation.

Background This study compared the postoperative outcomes of 27-gauge (G) and 25-G vitrectomy performed for the treatment of idiopathic epiretinal membrane (ERM). Methods The study design was single center, retrospective, interventional case series. Two hundred consecutive eyes that underwent primary vitrectomy for ERM (27-G vitrectomy in 100 eyes and 25-G vitrectomy in 100 eyes) were studied for 6 months. In all eyes, scleral tunnels were made using angle incisions, and air or gas exchange was performed. Results There were no significant differences in age, spherical diopter power, as well as preoperative Early Treatment Diabetic Retinopathy Study (ETDRS) score, central retinal thickness (CRT), and intraocular pressure between the 27-G and 25-G groups. The proportions of simultaneous cataract surgery (27-G vs. 25-G: 82% vs. 90%), air-filled eyes (99% vs. 98%), and scleral wound suture at the end of surgery (0% vs. 0%) were not significantly different between two groups. The mean operation time for vitrectomy was significantly (P = 0.0322) longer by 4 min for 27-G (37 min) compared to 25-G (33 min) vitrectomy. Gain in ETDRS score was significantly (P = 0.0421) better in 27-G group (4.7 ± 8.1 letters) compared to 25-G group (1.1 ± 13.6 letters) at 1 month post-vitrectomy, but not significantly different at 3 and 6 months (P = 0.0835 and 0.0569, respectively). Decrease in CRT was significantly (P = 0.0354) greater in 27-G group (−24.2 ± 50.0 μm) compared to 25-G group (−8.0 ± 48.6 μm) at 1 month post-vitrectomy, but not significantly different at 3 and 6 months (P = 0.6059 and 0.1725, respectively). On postoperative day 1, hypotony (≤ 6 mmHg) was observed in 2 eyes in 27-G group and 6 eyes in 25-G group, while ocular hypertension (≥ 25 mmHg) was found in 4 eyes in 27-G group and 11 eyes in 25-G group, with no significant differences between two groups. Postoperative complications requiring treatment occurred in one eye (vitreous hemorrhage) in 27-G group, and in two eyes (vitreous hemorrhage and retinal detachment in one eye each) in 25-G group. Conclusions Although 27-G vitrectomy requires operation time of 4 min longer compared to 25-G vitrectomy for ERM surgery, using the 27-G system results in earlier recovery of visual acuity, CRT improvement and stabilized ocular pressure.

Objective: Comparative morphological characteristic and evaluation of cytokine profile of idiopathic epiretinal membrane (ERM), complicated lamellar macular hole. Materials and Methods: Immunohistochemical study of 15 ERM removed during vitrectomy included the definition of responses to antigens fibronectin, laminin, glial fibrillary acidic protein. All membrane samples were divided into two groups: I group consisted of 8 ERM, which wasn’t clinically combined with retina defects, the II group included 7 ERM complicated lamellar macular hole. Results: ERM in group I were a collagen-membrane with a thickness from 2,1±0,7 to 4,4±1,4 µm, infiltrated radial glial cells, isolated fibroblastic cells. For membranes was characterized by a positive reaction to GFAP and largely negative reaction (62.7%) on fibronectin, laminin. ERM in group II were more thick, which was in the range from 6,03±1,6 to 7.56±1,02 µm, high cell density: radial glial cells, cells of fibroblast series (fibroblasts laminocity, myofibroblasts) and hyalocity. Immunohistochemistry complicated ERM had a positive immunophenotyping antigens against adhesion protein fibronectin, laminin, of GFAP along with a pronounced fibroblastic and macrophage infiltration. Conclusion: ERM complicated lamellar macular hole, characterized by an increased thickness, marked infiltration of radial glial cells, cells of fibroblast series (fibroblasts laminocity, myofibroblasts) and hyalocity. The positive response comparable ERM complicated lamellar macular hole on fibronectin, laminin and GFAP could mean cytokines involved into development and progression of neurodegenerative process. The accumulation of collagen fibers and myofibroblasts may help to strengthen the contractions and reduce the elastic properties of ERM, with the subsequent development of the tangential tractions and retinal tear.Objective: Comparative morphological characteristic and evaluation of cytokine profile of idiopathic epiretinal membrane (ERM), complicated lamellar macular hole. Materials and Methods: Immunohistochemical study of 15 ERM removed during vitrectomy included the definition of responses to antigens fibronectin, laminin, glial fibrillary acidic protein. All membrane samples were divided into two groups: I group consisted of 8 ERM, which wasn’t clinically combined with retina defects, the II group included 7 ERM complicated lamellar macular hole. Results: ERM in group I were a collagen-membrane with a thickness from 2,1±0,7 to 4,4±1,4 µm, infiltrated radial glial cells, isolated fibroblastic cells. For membranes was characterized by a positive reaction to GFAP and largely negative reaction (62.7%) on fibronectin, laminin. ERM in group II were more thick, which was in the range from 6,03±1,6 to 7.56±1,02 µm, high cell density: radial glial cells, cells of fibroblast series (fibroblasts laminocity, myofibroblasts) and hyalocity. Immunohistochemistry complicated ERM had a positive immunophenotyping antigens against adhesion protein fibronectin, laminin, of GFAP along with a pronounced fibroblastic and macrophage infiltration. Conclusion: ERM complicated lamellar macular hole, characterized by an increased thickness, marked infiltration of radial glial cells, cells of fibroblast series (fibroblasts laminocity, myofibroblasts) and hyalocity. The positive response comparable ERM complicated lamellar macular hole on fibronectin, laminin and GFAP could mean cytokines involved into development and progression of neurodegenerative process. The accumulation of collagen fibers and myofibroblasts may help to strengthen the contractions and reduce the elastic properties of ERM, with the subsequent development of the tangential tractions and retinal tear.

The article presents comparative morphological analysis and assessment of response to antigens of fibronectin, laminin, glial fibrillary acidic protein (GFAP) in idiopathic epiretinal membranes (iERM). Authors found a comparable positive iERM reaction to fibronectin and GFAP, which indicates the involvement of these cytokines in the development and progression of the posterior segment neurodegenerative process. Cellular elements in the vitreous gel responsible for iERM formation were fibroblasts, myofibroblasts, hyalocytes, and retinal radial glial cells. Retinal radial glial cells play the main role in the recurrent iERM formation.Conclusion. Due to its hemodynamic, nootropic, neurotrophic action, the investigated bioregulatory complex increases the optic nerve tolerance to the stress effect of IOP, SBP, and DBP asynchronous fluctuations, and improves the ocular blood perfusion.

(1) Background: The aim of this observational cross-sectional work was to investigate early retinal vascular changes in patients undergoing idiopathic epiretinal membrane (iERM) surgery using swept source optical coherence tomography angiography (SS-OCTA), (2) Methods: 24 eyes of 24 patients who underwent vitrectomy with internal limiting membrane (ILM) peeling were evaluated pre- and postoperatively using SS-OCTA system (PLEX Elite 9000, Carl Zeiss Meditec Inc., Dublin, CA, USA). For each eye, five 6x6-mm OCTA volume scans were acquired by two observers independently. The en face images of superficial capillary plexus (SCP) were then exported to imageJ and a semi-automated algorithm was used for subsequent quantitative analysis. Perfusion density (PD), vessel length density (VLD), vessel diameter index (VDI) and vessel tortuosity (VT) of SCP were evaluated in both the parafoveal (2.5 mm diameter) and perifoveal areas (5.5 mm diameter), (3) Results: At OCTA analysis statistically significant differences were found between controls and diseased eyes for all parameters in parafoveal and perifoveal regions (p&lt, 0.001, p&lt, 0.05) except for perifoveal VLD. During 6-month follow up, both anatomical/perfusion and functional parameters showed a statistically significant improvement if compared to preoperative values. In detail, at one month post vitrectomy, VLD and VT significantly changed in parafoveal region (p=0.043, p=0.045), while PD and VDI showed a trend of increase in both parafoveal and perifoveal region. At 6 months after surgery, PD, VLD and VT of parafoveal region significantly improved (p=0.021, p=0.018, p=0.047 respectively). (4) Conclusions: SS-OCTA provides a quantitative and qualitative analysis of the superficial capillary plexus allowing for early vascular changes assessment after vitrectomy with iERM and ILM peeling.

The present study aimed to assess the feasibility and safety of 27G core-pars plana vitrectomy (PPV) for idiopathic epiretinal membrane (IERM). A retrospective analysis was performed on 38 eyes from 38 patients with IERM with a mean age of 62.73±5.61 years. 27G core-PPV was combined with IERM and internal limiting membrane (ILM) peeling. Pre-operative and post-operative best-corrected visual acuity (BCVA) and lens density were measured. Optical coherence tomography (OCT) and OCT angiography were performed to determine the patients' macular area. Ultrasound biomicroscopy and B-mode ultrasound were subsequently performed to observe any complications and the follow-up period ranged from 1 week to 12 months post-operatively. A total of 36 patients achieved visual improvement of ≥2 Snellen lines, of which 33 patients exhibited improvements within 1 week and the lens density remained unchanged. The mean central macular thickness significantly decreased at 12 months post-operatively (P≤0.05); however, it was not observed to be correlated with BCVA (r=0.41; P>0.05). The foveal avascular zone of the affected eye was significantly smaller than that of the healthy fellow eye (P≤0.05) and negatively correlated with post-operative BCVA (r=-0.72; P≤0.05). Superficial retinal capillary density and deep retinal capillary density decreased post-operatively (both P≤0.05) and no complications were observed. Taken together, the results of the present study indicate that application of 27G core-PPV with ILM peeling is minimally invasive for IERM and facilitates rapid post-operative BCVA recovery.

Purpose: To investigate the changes of the vitreomacular interface during a 1-year follow-up after idiopathic epiretinal membrane (iERM) surgery. Methods: Six patients affected by fovea-attached iERM were recruited in this pilot study. Pars plana vitrectomy associated with epiretinal membrane peeling was performed uneventfully in all cases. In four cases, the inner limiting membrane was removed using Brilliant blue G. En face high-resolution adaptive optics and cross-sectional spectral domain optical coherence tomography retinal imaging were performed before and at 1, 3, 6, and 12 months after surgery. The microstructures of vitreomacular interface in high-resolution adaptive optics images were correlated to the cross-sectional spectral domain optical coherence tomography data. Results: Preoperatively, adaptive optics images showed multiple abnormalities of the vitreomacular interface, such as macrofolds, microfolds, and hyperreflective microstructures. We identified two subtypes of iERM according to the distribution of microfolds over the foveal area, which included the radial-type and the grid-type iERM. After surgery, the morphology of the vitreomacular interface changed compared with the preoperative state. The number of both macrofolds and microfolds was reduced in all cases. The hyperreflective structures were still resolvable in all cases, however presenting different shape and morphology than preoperatively. In addition, they showed marked differences between eyes that had internal limiting membrane removal and eyes that did not. Conclusion: Adaptive optics imaging gives new insight into the changes of vitreomacular interface after iERM surgery. Enhanced multimodal imaging of the vitreomacular interface and retinal structures can be valuable to monitor treatment outcome of iERM.

Background: Idiopathic epiretinal membrane (iERM) is a common eye disease, which can be treated by surgical removal of the fibrotic tissue. Morphological outcome is generally evaluated by optical coherence tomography (OCT). Here, we investigate the impact of surgery on hemodynamics of the posterior pole, using OCT angiography (OCTA). Methods: Patients with unilateral iERM and indication for treatment were included. OCT and OCTA images of the posterior pole were obtained preoperatively and 3-months after 23G vitrectomy with membrane peeling. Parameters of interest included full retinal perfusion, choriocapillaris perfusion (CCP), Sattler&rsquo, s layer perfusion (SLP), and Haller&rsquo, s layer perfusion, which were evaluated longitudinally and also compared to unaffected fellow eyes. Using these parameters, multiple regression analyses were used to predict visual outcomes. Results: Sixty-three iERM eyes were recruited, which initially showed a significant bigger central retinal thickness (p &lt, 0.001) and total macular volume (TMV) (p &lt, 0.001) compared to fellow eyes, while perfusion parameters were alike. Three months later, treated eyes had a statistically significant thicker subfoveal choroid (p = 0.006) and showed an increase of CCP (p = 0.003), while SLP decreased (p = 0.014). Lower preoperative TMV and higher SLP were associated with better postoperative visual outcome. Conclusion: In this OCTA study, iERM itself does not affect the choroidal circulation. However, preoperative choroidal circulation will be a biomarker to know the influence on the choroidal circulation after ERM surgery and may be considered as a predictor for visual outcome.

Background To compare the ciliary body changes associated with the use of 23-gauge (23G) and 20-gauge (20G) systems for pars plana vitrectomy. Methods A total of 60 patients (60 eyes) with idiopathic epiretinal membrane who were scheduled for surgical treatment were selected and randomly assigned to 20G group or 23G group. Time required for incision making, vitrectomy, and incision closure was compared between the two groups. Changes in ciliary body were evaluated by ultrasound microscopy (UBM). Anterior chamber inflammation was assessed with laser flare meter instrument. Results Incision-making time (4.5 ± 0.9 min) and incision-closure time (2.8 ± 0.7 min) in the 23G group were significantly shorter than those in the 20G group (10.1 ± 1.5 min and 11.3 ± 2.2 min, respectively). No significant intergroup difference was observed with respect to time required for vitrectomy (21.6 ± 3.3 min and 20.7 ± 3.2 min, respectively). Ciliary body thickness in the 23G group recovered back to preoperative levels after 4 weeks, as against 8 weeks in the 20G group. Postoperative ciliary body thickness in the 20G group was significantly higher than that in the 23G group (p

Purpose: To compare the clinical outcomes and the rate of complications of 27-gauge transconjunctival nonvitrectomizing vitreous surgery (NVS) and of 25-gauge transconjunctival sutureless vitrectomy surgery for idiopathic epiretinal membrane removal. Methods: In this prospective randomized study, 83 phakic eyes of 83 consecutive patients with an idiopathic epiretinal membrane were randomized to receive 27-gauge NVS (NVS-group) or 25-gauge vitrectomy (Standard-group). Main outcome measures were best-corrected visual acuity, central retinal thickness, nuclear density units' changes, and rate of complications. Results: Thirty-nine eyes of the Standard-group and 40 of the NVS-group were considered in final analysis. Mean best-corrected visual acuity improved significantly in both groups, with a significant better result at 12 months in NVS-group (P 0.039; t-test). Central retinal thickness decreased significantly in both groups (P < 0.001, Tukey test), without significant difference between the two groups at any time point. At 12 months, nuclear density increased significantly in the Standard-group (analysis of variance, P < 0.001), and it did not change in the NVS-group (analysis of variance, P 0.537). Epiretinal membrane recurred in 5.1% of eyes in the Standard-group and in 7.5% of eyes in the NVS-group (Fisher's exact test, P 1.000). Conclusion: The 27-gauge NVS is an effective surgical procedure in eyes with epiretinal membrane and it induces less progression of nuclear sclerosis than 25-gauge vitrectomy.

Background: Idiopathic epiretinal membrane (iERM) is a fibrocellular membrane that proliferates on the inner surface of the retina at the macular area. Membrane contraction is an important sight-threatening event and is due to fibrotic remodeling. Methods: Analysis of the current literature regarding the epidemiology, clinical features, and pathogenesis of iERM and fibrotic tissue contraction. Results: Epidemiologic studies report a relationship between iERM prevalence, increasing age, and posterior vitreous detachment. Clinically, iERM progresses through different stages characterized by an increased thickness and wrinkling of the membrane. Pathophysiologically, iERM formation is a fibrotic process in which myofibroblast formation and the deposition of newly formed collagens play key roles. Anomalous posterior vitreous detachment may be a key event initiating the formation of iERM. The age-related accumulation of advanced glycation end products may contribute to anomalous posterior vitreous detachment formation and may also influence the mechanical properties of the iERM. Conclusion: Remodeling of the extracellular matrix at the vitreoretinal interface by aging and fibrotic changes, plays a significant role in the pathogenesis of iERM. A better understanding of molecular mechanisms underlying this process may eventually lead to the development of effective and nonsurgical approaches to treat and prevent vitreoretinal fibrotic diseases.

WOS: 000439166500005 PubMed ID: 28608032 To assess the levels of neutrophil-to-lymphocyte ratio (NLR) in patients with idiopathic epiretinal membrane (iERM) and to compare the NLR results of patients with iERM and healthy controls. This retrospective study enrolled 43 patients with iERM and 40 healthy subjects. Complete ophthalmologic examination and complete blood count measurements were performed of all subjects. Complete blood counts were performed within 2 h of blood collection. There was a significant difference in NLR between iERM and control groups (p < 0.01). The receiver operating characteristics analysis revealed that the value of NLR to distinguish patients with iERM and controls was found to be 0.832. The best cutoff value was 1.90, with a sensitivity of 72% and specificity 70%. Our study for the first time provides evidence that subclinical systemic inflammation may cause or at least accompanies iERM using a novel biomarker NLR.

Purpose: This study aimed to evaluate choroidal thickness modifications before and after vitrectomy with or without phacoemulsification for idiopathic epiretinal membrane in the operated eye and in the unaffected fellow eye. Methods: In total, 53 eyes of 53 patients underwent 25-gauge pars plana vitrectomy plus internal limiting membrane peeling and air tamponade. Twenty-seven eyes underwent combined surgery with phacoemulsification and intraocular lens implantation. Choroidal thickness was measured using enhanced deep image spectral-domain optical coherence tomography at the fovea and at 500 and 2,500 µm from the fovea. Fellow eyes without any previous ocular surgery history served as controls. Results: Baseline comparison did not show significant differences between study and fellow eyes (p > 0.05). Choroidal thickness significantly decreased in the subfoveal area (p = 0.004) as well as at 500 µm (p = 0.026) and 2,500 µm nasally (p = 0.019) and at 500 µm (p = 0.039) and 2,500 µm (p = 0.005) temporally to the fovea. No significant changes were observed postoperatively in the superior and inferior areas (p > 0.05). No differences were found between eyes which underwent combined surgery and those which underwent vitrectomy alone (p > 0.05). The unaffected eyes did not show any significant changes (p > 0.05). Conclusions: Comparison of baseline values did not show any differences between affected and unaffected eyes, meaning that choroidal thickness was not influenced by the development of epiretinal membrane. Vitrectomy plus epiretinal and inner limiting membrane removal may influence choroidal homeostasis, leading to a decrease in choroidal thickness in the subfoveal, nasal, and temporal areas. Combined surgery did not show significant differences when compared to vitrectomy alone.

Hirotsugu Takashina,1,2 Akira Watanabe,2 Hiroshi Tsuneoka2 1Department of Ophthalmology, National Hospital Organization Sagamihara Hospital, Sagamihara, Kanagawa, Japan; 2Department of Ophthalmology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan 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. Keywords: sclerotomy leakage, self-sealing, silicone oil tamponade, remnant vitreous, hypotony, idiopathic epiretinal membrane

Background Characterization of the neuro-glial profile of cells growing out of human idiopathic epiretinal membranes (iERMs) and testing their proliferative and pluripotent properties ex vivo is needed to better understand the pathogenesis of their formation. Methods iERMs obtained during uneventful vitrectomies were cultivated ex vivo under adherent conditions and assessed by standard morphological and immunocytochemical methods. The intracellular calcium dynamics of the outgrowing cells was assessed by fluorescent dye Fura-2 in response to acetylcholine (ACh)- or mechano- stimulation. Results The cells from the iERMs formed sphere-like structures when cultured ex vivo. The diameter of the spheres increased by 5% at day 6 and kept an increasing tendency over a month time. The outgrowing cells from the iERM spheres had mainly glial- and some neuronal- like morphology. ACh- or mechano- stimulation of these cells induced intracellular calcium propagation in both cell types; in the neuronal-like cells resembling action potential from the soma to the dendrites. Immunocytochemistry confirmed presence of glial- and neuronal cell phenotype (GFAP and Nestin-1 positivity, respectively) in the iERMs, as well as presence of pluripotency marker (Sox2). Conclusion iERMs contain cells of neuronal- and glial- like origin which have proliferative and pluripotent potential, show functionality reflected through calcium dynamics upon ACh and mechano- stimulation, and a corresponding molecular phenotype.

The aim of this study was to review the literature on predictive factors for postoperative visual acuity (VA) in surgery for idiopathic epiretinal membrane (ERM). A systematic review of the literature in the databases of PubMed and Embase was performed. The risk of bias was assessed based on predefined criteria and the results were summarized. In total, 1927 studies were retrieved of which 35 were potentially eligible. Nineteen studies were of adequate quality in terms of bias. Preoperative VA, central foveal thickness (CFT) and inner segment/outer segment (IS/OS) integrity on optical coherence tomography (OCT) were most extensively studied. Other preoperative factors studied were severity of metamorphopsia, several OCT parameters, fundus autofluorescence and multifocal electroretinogram. In the current literature, preoperative VA is the only variable consistently associated with postoperative VA. IS/OS integrity on OCT is probably associated, and the severity of metamorphopsia, cone outer segment tips integrity and fundus autofluorescence are possibly associated with postoperative VA. CFT is not associated with postoperative VA. Further studies with adequate methodological quality are needed to confirm these findings. Therefore, an overall prediction model, including different parameters, is still awaited.

PURPOSE:: To compare the incident rates of sustained elevation of intraocular pressure (IOP) after uncomplicated pars plana vitrectomy for idiopathic epiretinal membrane and the unoperated fellow eye. METHODS:: Retrospective multicenter study of 198 patients who underwent pars plana vitrectomy for an idiopathic epiretinal membrane that was followed for at least 12 months. The diagnosis of sustained IOP elevation was defined as an elevation of IOP ? 24 mmHg or an increase of ? 5 mmHg in the IOP from baseline on 2 separate visits that warranted the initiation of ocular hypotensive therapy. The main outcome measured was the development of sustained IOP elevation as defined above. RESULTS:: Patients were followed for an average of 47.3 ± 24 months (range, 12-106 months). In the vitrectomized eyes, 38 of the 198 (19.2%) patients developed elevated IOP compared with 9 of the 198 (4.5%) unoperated fellow eyes (P less than 0.0001, Fisher exact test; odds ratio, 4.988). Possible risk factors include a family history of open-angle glaucoma (P = 0.0004 Fisher exact test; odds ratio, 7.206) and cataract surgery (P = 0.0270 Fisher exact test; odds ratio, 2.506). CONCLUSION:: Uncomplicated PPV seems to increase the IOP, particularly in those who are pseudophakic and have a family history of open-angle glaucoma. This increase in IOP may lead to glaucomatous damage if not managed appropriately. Patients with a previous PPV need to be followed by an ophthalmologist to monitor the IOP in the vitrectomized eye. Copyright © by Ophthalmic Communications Society, Inc.

PURPOSE The aim of the present study is to evaluate the roles of TGFs β1 and β2, glial cell line-derived neurotrophic factor (GDNF), and nerve growth factor (NGF) in the pathogenesis of idiopathic epiretinal membrane (ERM). METHODS Eight patients, six males and two females, with an average age of 60.25 ± 17.16 years (range, 33-75 years) who were affected by idiopathic ERM were enrolled in the study. All patients underwent standard pars plana vitrectomy surgery with membrane removal and specific ELISA was performed to evaluate TGFβ1, TGFβ2, GDNF, and NGF in the vitreous samples. This was repeated after acidification of the samples with hydrochloric acid. RESULTS Before acidification, ELISA analysis revealed a significant increase of TGFβ2 in the samples with idiopathic ERM (327.98 ± 99.58 pg/mL; range, 206.864-466.235 pg/mL) compared to the control group (187.17 ± 58.20 pg/mL; range, 132.758-271.707 pg/mL; t = 3.4; P < 0.05). A statistically significant difference was also obtained after acidification of the samples (618.15 ± 201.43 pg/mL; range, 409.795-866.215 pg/mL compared to 265.04 ± 98.15 pg/mL; range, 152.478-352.101 pg/mL; t = 4.5; P < 0.05). Notably, before acidification the differences in NGF between the two groups were not statistically significant (t = 0.79; P = 0.46), while after acidification a significant increase of the NGF levels in ERM samples was found in comparison with the control group (723.41 ± 235.4 vs. 242.84 ± 104.61; t = 3; P < 0.05). CONCLUSIONS The present study reveals that TGFβ2 and NGF are associated with idiopathic ERMs, suggesting a novel compensatory mechanism so far never proposed.