Search

Purpose: To access the efficacy of surgical treatment for premacular membranes in four children., Design: Interventional case series., Methods: Premacular membranes in four children were observed. Initial visual acuity ranged from 0.08 to 0.4. The premacular membranes were approximately 1/3 PD to 4 PD in size, and the center of them was located at the fovea in all the patients. Vitreous surgeries were performed in all four patients. The membranes were removed successfully without complications. Occlusion therapy was performed one month after the operation. Follow-up was from 6 to 16 months (means 8.3 months)., Results: Vision eventually improved in all patients. Final vision acuity ranged from 0.2 to 1.0., Conclusions: Vitreous surgeries may be safe and effective in children with premacular membrances.

Purpose: Peeling of the internal limiting membrane (ILM) has improved the outcomes in vitreoretinal surgery of macular diseases. Indocyanine green (ICG) is used to stain and improve the visualization of the ILM. This paper aims to describe a modified approach to stain and peel the ILM avoiding potential adverse side effects., Methods: After a core vitrectomy, 0.05 ml of ICG in a concentration of 5 mg/ml is quickly injected under water around the macular region. The tip of the syringe is positioned about 5 mm from the macular tissue, in a way that about a 3-mm diameter area around the fovea is stained by the ICG. Additional ICG is immediately removed by aspiration. Peeling of the ILM is accomplished with a forceps., Results: Neither residual ICG in the vitreous cavity nor any clinical signs of phototoxicity like retinal edema were detected in any patients operated by this technique., Conclusions: This modified technique to stain the ILM limits the amount and concentration of ICG. The locally limited contact of ICG with the retinal surface seems to be a safe procedure to stain the ILM., (Copyright 2004 S. Karger AG, Basel)

Purpose: To describe the resolution of cystoid macular edema associated with vitreomacular separation in a diabetic patient., Methods: Case report. A 58-year-old man who had cataract surgery 3 years earlier developed diabetic macular edema after panretinal laser photocoagulation. For a detailed fundus examination, we performed neodymium: YAG (Nd:YAG) laser capsulotomy in the left eye as the initial management., Results: Two days after the laser capsulotomy, fundus biomicroscopy and B-mode ultrasonography disclosed a vitreomacular separation in the left eye that was not detectable preoperatively. Optical coherence tomography through the macula disclosed a dramatic decrease in the size of intraretinal cystoid spaces with an improvement of visual acuity. Scanning retinal thickness analysis also confirmed the decrease of retinal thickness at the macula with the resolution of cystoid macular edema., Conclusion: Resolution of diabetic macular edema with subsequent visual recovery is potentially associated with the vitreomacular separation in a patient after Nd:YAG laser capsulotomy.

Objective: To determine whether macular edema affects the surgical outcome in eyes with idiopathic epiretinal membrane., Design: Case series., Setting: University-based referral practice in Vancouver., Patients: Sixty-one patients (63 eyes) (37 women and 24 men ranging in age from 47 to 96 [mean 70] years) who underwent pars plana vitrectomy with membrane peeling for idiopathic epiretinal membrane., Outcome Measures: Degree of macular edema on preoperative fluorescein angiograms (none, mild or severe), as rated independently by two masked observers, and preoperative and postoperative Snellen visual acuity., Results: Of the 63 eyes 32 had no macular edema, 21 had mild edema, and 10 had severe edema. Fifty-two eyes (83%) had an improvement in visual acuity. The mean number of lines of improvement in visual acuity for the three groups was 2.2, 3.7 and 2.6 respectively. Multiple regression analysis showed that the factor with the greatest adverse effect on visual outcome was intraoperative macular hole formation. The presence of macular edema preoperatively did not significantly affect visual outcome., Conclusions: Our results suggest that even eyes with significant macular edema secondary to idiopathic epiretinal membranes may benefit from vitrectomy with membrane peeling.

Aims/background: This study was performed to identify factors predictive for recurrence of idiopathic and secondary epiretinal membranes after vitrectomy. Long term visual outcome was determined and compared with eyes without recurrence of epiretinal tissue., Methods: Out of 350 consecutive cases vitrectomised for removal of epiretinal macular membranes, 42 patients (42 eyes) with recurrence of epiretinal membranes were re-examined and their records reviewed. Recurrence of epiretinal membranes was determined by new appearance of epiretinal tissue or abnormal sheen of the central retina. The preoperative findings, best postoperative and final visual acuity of these patients were compared with a comparable cohort of eyes without recurrence after removal of macular pucker (131 eyes). The eligibility criterion was a follow up of at least 6 months., Results: The best postoperative (0.46 (SD 0.24)) and the final visual acuity (0.39 (0.26)) of eyes with recurrent membranes (42 eyes) was statistically better than preoperative vision (0.27 (0.22)) (p = 0.0003 and 0.0089). Because of reduced or distorted vision eight of the 42 eyes underwent a revitrectomy during the follow up (mean 23 months). Best postoperative visual acuity (0.50 (0.21)) and final visual acuity (0.47 (0.25)) of eyes which received a second vitrectomy (n = 8) were not statistically different from the 32 eyes with recurrence of epiretinal tissue but without revitrectomy (p = 0.253 and 0.343). In addition, eyes with recurrence showed no different visual outcome compared with eyes without recurrence of epiretinal membranes after vitrectomy (p = 0.84). Recurrence of epiretinal membranes was correlated with neither the type of membrane (thick or thin) nor incomplete membrane removal during pars plana vitrectomy., Conclusion: This study demonstrates the overall favourable visual prognosis of patients with vitrectomy for macular pucker, even with recurrence of the premacular membrane.

The cases of two children who had idiopathic epiretinal membranes are reported. Causes for juvenile epiretinal membranes, including trauma, pars planitis, toxocariasis, Coats' disease, or combined hamartomas, were not present. Both patients previously had documented normal vision in the affected eye. Observation revealed deterioration of vision, and a pars plana vitrectomy and a membranectomy were performed. The 5-year -old girl's vision improved from counting fingers at 5 feet to 20/80. The 12-year-old boy's vision improved from 20/200 to 20/80. Selected cases of juvenile epiretinal membranes may benefit from surgical excision.

Background: The predictability of the measurement of the macular function by white light interferometry was evaluated in a group of patients whose epiretinal membranes had been surgically removed., Method: Fifteen patients presenting either primitive or secondary epiretinal membranes were included. We used the apparatus described by W. Lotmar. The main evaluation criteria was the best corrected visual acuity (VA) chosen between the third month and the sixth month examinations., Results: Preoperatively the mean visual acuity was 0.227 +/- 0.105. The mean final visual acuity was 0.507 +/- 0.198. The final visual acuity was predicted within an 0.1 interval in ten cases (67%). In two cases the predicted visual acuity was identical to the pre-operative VA and the final results confirmed the test. No improvement occurred., Conclusion: The Lotmar visometer is statistically predictive of the visual outcome after epi-retinal membranes surgery.

The authors presented preliminary results of pars plana vitrectomy applied in 8 eyes with macular pucker. The aim of the surgery was to remove epiretinal membranes and it was achieved in 7 eyes; in one some fragments of the membrane remained. Visual acuity before surgery ranged from 1/50 to 3/50, after the treatment it was improved in 7 cases, in one being the same as before.

The files of 40 patients operated on for epimacular membranes were reviewed in order to correlate the functional and anatomical results with the presence or absence of internal limiting membrane on histological specimens. Only the eyes with idiopathic membranes were considered for the study. Visual acuity and fluorescein angiography were obtained preoperatively and at the 6 months postoperative visit. The surface of the posterior pole was measured on fluorescein angiogram pre and postoperatively by computerized image analysis. Light microscopy looked for the presence of significant segments of internal limiting membrane. In 28 cases (group 1) long segments of internal limiting membrane were adherent to the epimacular membrane and in 12 cases (group 2) no internal limiting membrane fragments or only small fragments were present. Mean postoperative visual acuity was the same in the two groups; 64% of eyes from group I and 50% from group 2 had visual acuity superior or equal to 0.5 (NS). Image analysis showed that the posterior pole surface area increased by 25% in group 1 but only by 15% in group 2 (p < 0.025). Internal limiting membrane ablation does not preclude good visual recovery and is correlated with improved unfolding of the posterior pole.

Seventy consecutive cases of idiopathic epimacular membrane removal were reviewed in order to evaluate the prognosis factors of this surgery. The characteristics analyzed where the duration of the symptoms, pre and postoperative visual acuity and the macular changes on fluorescein angiography. The mean follow-up after surgery was 9 months. Mean preoperative visual acuity was 0.17 and the mean best postoperative visual acuity 0.43. Visual acuity improved by 2 lines or more in 81% of the cases and the mean improvement was 3.5 lines. The complications of epimacular membrane surgery included nuclear cataract (10 eyes underwent cataract surgery), peripheral retinal breaks (3%), and retinal detachment (3%) successfully operated. Three of the main preoperative data were related to better postoperative visual outcome: preoperative visual acuity: eyes with visual acuity of 0.16 or more tended to have better postoperative vision than eyes with poorer preoperative vision (mean postoperative visual acuity 0.5 and 0.34 respectively; p < or = 0.05); duration of visual impairment before surgery: eyes with a visual impairment of less than 2 years had better postoperative vision than the others (mean postoperative visual acuity, 0.5 and 0.3 respectively; p < or = 0.05); the absence of preoperative angiographic macular edema: eyes without preoperative macular edema had better postoperative vision than the others (mean postoperative visual acuity: 0.5 and 0.4 respectively; p < or = 0.05). The normal postoperative pattern of macular vessels and foveolar shape was also a statistically significant factor of good vision recovery.

A young woman was followed for over 20 years with a macular combined hamartoma of the retina and retinal pigment epithelium. When vision deteriorated due to contracture of an overlying epiretinal membrane, a pars plana vitrectomy with removal of the membrane was performed. Decreased vascular tortuosity and retinal vascular leakage resulted in postoperative improvement of visual acuity. Selected patients with combined retinal and retinal pigment epithelial hamartomas may benefit from removal of epiretinal membranes.

Based on the improved understanding of massive periretinal proliferation (MPP) as a proliferative membrane-forming disease, a new therapeutic approach is presented with the technique of pars plana vitreous surgery. Not only vitreous membranes but also preretinal membranes are removed. Forty-seven consecutive patients who suffered from severe massive periretinal proliferation were operated on with this technique and followed for six months or more. Seventeen patients (36%) had an attached retina. Twelve patients had a major visual improvement. The major postoperative complication was phthisis bulbi, found in ten eyes (21%).

Cellular membranes growing on the inner retinal surface occur in various ocular disorders, and modern methods of vitreous surgery permit removal of these membranes in selected cases. The surgical treatment of epiretinal membranes complicating proliferative retinopathies and rhegmatogenous retinal detachment is briefly described, and the results of such surgery in a series of thirteen consecutive eyes with macular pucker after otherwise successful surgery for rhegmatogenous retinal detachment are presented in detail. A technically successful result with visual improvement was achieved in each of the thirteen eyes. An iatrogenic retinal tear (successfully repaired) occurred in one eye, and recurrent retinal detachment requiring an additional operation occurred postoperatively in two eyes. Progression of lens opacities occurred postoperatively in four of six phakic eyes, and one eye later required cataract extraction. Despite such risks, and the fact that the best postoperative visual acuity achieved was 20/30, use of vitrectomy methods to remove epiretinal membranes can provide significant visual improvement in selected cases.

We performed clinicopathologic correlation on ten surgically removed pigmented epiretinal membranes causing macular pucker. All cases occurred in eyes with existing retinal holes or tears, including eight cases of macular pucker after previous retinal detachment. These cases probably represented a limited form of proliferative vitreoretinopathy. All membranes contained pigment epithelial cells with polarity, basement membrane, and melanosomes. Cytoplasmic melanin granules accounted for the clinical feature of pigmentation in these eyes.

The authors reviewed 33 consecutive cases of idiopathic epiretinal membranes removed by vitreous surgical techniques. Visual acuity improved in 79% of surgically treated eyes. In uncomplicated cases, a 47% gain in visual acuity was achieved. Of those eyes that had improved visual acuity post-operatively, 82.5% of the final visual acuity returned by four to eight weeks post-operatively. Eyes with opaque membranes had visual acuity results no worse than those with translucent membranes. Eyes with no pre-operative cystoid edema had better visual acuity results than eyes with cystoid macular edema (CME), although no statistically significant difference was shown. Surgical removal of membranes decreased fluorescein dye leakage in 30% of eyes; while no change in post-operative leakage was noted in 60%, one eye had increased CME post-operatively. Complications included development of nuclear sclerotic cataract, retinal breaks, retinal detachment, and one case of pigment epithelial/retinal burn from the endoilluminator, residual and recurrent membrane formation, and anterior ischemic optic neuropathy.

Between December 1981 and June 1984 scleral resection was performed in 35 patients suffering from end-stage proliferative diabetic retinopathy with traction retinal detachment involving the macula. In all cases, vitrectomy, membranectomy, segmentation, and delamination proved to be insufficient to mobilize the "shrunken" retina. In 22 cases (63%), retinal detachment was at least partially flattened in the area of the posterior pole of the eye. Visual acuity thus achieved ranged between 6/24 and 1/60, corresponding to an improvement of visual acuity compared with the preoperative situation in about one-third of the cases successfully treated (8 eyes).

Vitreous surgery was used to remove epiretinal macular membranes in 328 cases, 184 (56%) of which had membranes that were considered idiopathic and 144 (44%) which were due to other causes. The 12- to 92-month follow-up showed that visual acuity improved two lines or more in 243 (74%) of the eyes, 79 (24%) were unchanged and 6 (2%) became worse. Recurrence of membranes was seen in 24 (7.3%) eyes and 27 (8%) eyes developed complications. In the idiopathic cases visual results were significantly better and complications fewer. Rapidly progressive nuclear sclerosis was noted in 23 (12.5%) eyes. The degree of cystoid edema had no relationship to the final visual result. Pseudoholes which were present in 14 (8%) of the idiopathic cases either became smaller or disappeared following successful surgery with an average increase in acuity of five lines.

Two patients (a 44-year-old woman and a 26-year-old man) with progressive visual loss associated with macular combined retinal-retinal pigment epithelial hamartomas underwent pars plana vitrectomies with peeling of macular epiretinal membranes. Histopathologic findings for one of the membranes were similar to those in idiopathic or other secondary epiretinal membranes. Although the epiretinal membranes were satisfactorily removed, visual acuity improved in neither eye. Fluorescein angiography showed persistence of vascular tortuosity and leakage and cystoid macular edema after surgery in both cases. One eye developed a late postoperative operculated retinal tear which was successfully treated with cryopexy. The role of vitrectomy and membrane removal in cases of macular combined retinal-retinal pigment epithelial hamartomas appears to be limited.

The use of silicone oil in the management of intractable retinal detachment associated with proliferative vitreoretinopathy is increasing. Based on clinical experience in over 240 cases, the authors describe their current surgical techniques involving silicone oil, as well as the avoidance and management of associated intraoperative complications.

Idiopathic epiretinal membranes were observed in six patients, all under 35 years of age. The clinical features were similar to those of idiopathic epiretinal membranes seen in older age groups. The center of the membrane was located over a large retinal vessel in five of the patients. Follow-up periods, mostly without surgery, ranged from four months to nine years. Fluctuating levels of vision were observed, but the vision eventually improved in three patients, and remained stable in two others. In one patient the vision worsened, and vitreous surgery was used to remove the epiretinal membrane, resulting in improved vision.