The effect of indocyanine-green on functional outcome of macular pucker surgery

PURPOSE: To compare functional results after surgery for macular pucker either with or without indocyanine-green staining of the internal limiting membrane (ILM) and to evaluate the ultrastructure of the tissue removed. DESIGN: Retrospective analysis of two successive, consecutive, interventional case series. METHODS: Functional outcome (visual acuity, Goldmann perimetry) of 48 eyes of 48 consecutive patients with (group 1, n = 20) or without (group 2, n = 28) intraoperative use of indocyanine-green (ICG) was retrospectively analyzed. For statistical analysis, best-corrected visual acuity measured at the last presentation was considered. Only patients with an idiopathic macular pucker were included. Surgery consisted of three-port pars plana vitrectomy, and removal of epiretinal tissue and the ILM in a second step. Commercially available ICG with a concentration of.05% and an osmolarity of 275 mOsm was used to stain the ILM. The surgical technique used for both groups was identical, except the use of ICG. Epiretinal tissue of all eyes was harvested and prepared for ultrastructural analysis using light and electron microscopy. RESULTS: Follow-up time was 8.5 months in group 1 and 5.4 months in group 2. Whereas patients operated on without ICG experienced a significant improvement of median best-corrected visual acuity from 20/63 (range, 20/400 to 20/32) preoperatively to 20/40 (range, 20/200 to 20/25) postoperatively (P < .001), median best-corrected visual acuity remained 20/63 before (range, 20/200 to 20/63) and after (range, 20/400 to 20/20) (P > .9) ICG-assisted peeling. There was a statistically significant difference (P = .013) in best-corrected postoperative visual acuity of patients with and without the use of ICG. An improvement of vision was noted in 86% of patients without and 55% of patients with ICG-assisted surgery. Thirty-five percent of patients after ICG application presented with a deterioration of visual acuity. Furthermore, we observed large visual field defects in 7 of 20 patients after ILM staining. No visual field defects were noted after conventional peeling. Histologic analysis revealed clear differences between the two groups concerning the amount of cellular elements adjacent to the retinal surface of the ILM: There was more cellular debris visible in specimens after ICG application during surgery. Additionally, in contrast to surgery without ILM staining, epiretinal cells had ruptured and lost their cellular integrity after ICG-assisted vitrectomy. CONCLUSIONS: Indocyanine green-assisted surgery for macular pucker might have an adverse effect on functional outcome. Although there were obvious differences in the ultrastructure of tissue removed during surgery, our observations cannot be explained by histologic analysis alone. Other, so far unknown mechanisms of action must be considered.     

Surgical management of macular pucker after retinal reattachment surgery

We used vitrectomy techniques to remove epiretinal membranes that caused reduced visual acuity in 13 consecutive eyes with macular pucker after otherwise successful retinal reattachment surgery. A technically successful result with visual improvement was achieved in each case. An iatrogenic retinal tear (successfully repaired) occurred in one eye, and recurrent retinal detachment requiring an additional operation occurred postoperatively in two eyes. Despite such risks, and that the best postoperative visual acuity achieved was 6/9 (20/30), the use of vitrectomy methods in removal of epiretinal membranes in selected cases of macular pucker can provide significant improvement in vision.     

Retinal pigment epithelial atrophy following indocyanine green dye-assisted surgery for serous macular detachment

To report subretinal migration of indocyanine green dye (ICG) and subsequent retinal pigment epithelial (RPE) atrophy during macular surgery for serous macular detachment. A 65-year-old woman presented with residual epiretinal membrane and serous detachment of the macula following vitreoretinal surgery for epiretinal membrane. She underwent resurgery with ICG-assisted internal limiting membrane peeling and intraocular tamponade. Intraoperatively a large area of subretinal ICG was seen with subsequent RPE mottling and atrophy of the macula in the area involved during follow-up. This case demonstrates that subretinal migration of ICG is possible and can be toxic to RPE.     

Vitreous surgery with trypan blue staining of membranes in PVR retinal detachment surgery

BACKGROUND: In our clinic we used trypan blue staining routinely for removal of internal limiting membranes (ILM) and epiretinal membranes (ERM) during vitreoretinal surgery for PVR retinal detachment. PATIENTS AND METHODS: We treated 27 eyes of 27 patients with severe PVR retinal detachment with vitreoretinal surgery. After complete vitrectomy and removal of epiretinal membranes we injected 0.15 % trypan blue solution and proceeded with further removal of the visualized remaining epiretinal membranes and ILM. We performed relaxing retinotomies in 14 eyes. Follow-up lasted six months. RESULTS: After the first surgery the retina was reattached in 24 of 27 eyes and after the second surgery in all eyes. The final visual acuity was: hand movements in 3 eyes, 1/50 or better in 24 eyes (eight of them had a visual acuity of 0.1 - 0.5). No case of macular pucker was observed during the follow-up. CONCLUSIONS: Trypan blue staining during vitreoretinal surgery in PVR retinal detachment therapy allows complete removal of ILM, ERM, and peripheral vitreous. It upgrades the quality of the surgery.     

Incidence and characteristics of macular pucker formation after primary retinal detachment repair by pars plana vitrectomy alone

PURPOSE: To evaluate postoperative macular pucker formation in patients who underwent pars plana vitrectomy (PPV) for repair of primary rhegmatogenous retinal detachment (RD). METHODS: A retrospective, observational case series of 141 consecutive patients who underwent primary RD repair by PPV alone was performed. Patient charts were selected based on coding searches of a database from May 1, 2002, to December 31, 2003, in a large retina referral practice. Patients with a history of retinal surgery, silicone oil tamponade, or another visually significant ocular condition were excluded. RESULTS: Of 141 patients, 18 (12.8%) were noted to have a postoperative epiretinal membrane at clinical examination. Of 18 patients, 6 (33.3%) underwent a second vitrectomy procedure with membrane peeling for macular pucker removal. The mean time from RD surgery to membrane peeling surgery was 5.4 months. The average improvement in vision after repeated surgery was 5.6 Snellen chart lines. CONCLUSIONS: In our series, 12.8% of patients who underwent repair of a primary RD by PPV alone developed a postoperative macular pucker. Overall, the 4.3% of patients who underwent repeated surgery for removal of macular epiretinal membranes benefited with visual acuity improvement.     

Anatomy and function of the macula after surgery for retinal detachment complicated by proliferative vitreoretinopathy

PURPOSE: To investigate the macular changes following silicone oil removal after surgery for complicated retinal detachment (RD) with proliferative vitreoretinopathy (PVR). DESIGN: Retrospective interventional case series. METHODS: setting: Vienna, Austria. study population: Thirty-nine patients with attached retina after silicone oil removal following previous vitrectomy and silicone oil tamponade for complicated RD and PVR grade C3 and worse. observation procedures: Examination of macular anatomy with biomicroscopy, optical coherence tomography (OCT), and fluorescein angiography (FA). Macular function was tested by assessing logMAR distance visual acuity (VA) using Early Treatment Diabetic Retinopathy Study (ETDRS) charts and reading acuity and reading speed using a standardized test (Radner charts). main outcome measures: Macular anatomy, VA, reading acuity, and reading speed. RESULTS: The macula was clinically normal in five patients (12.8%). Retinal pigment epithelium (RPE) irregularities were found in nine patients (23.1%). Eight patients (20.5%) had macular pucker, seven (18.0%) had cystoid macular edema (CME), and 10 (25.6%) had subretinal fibrosis. The mean VA of all patients was logMAR 0.67 +/- 0.68 (range, -0.1 to 3.0). Six eyes did not achieve reading acuity. The distance VA of the remaining 33 eyes was logMAR 0.44 +/- 0.29 and their mean reading acuity was logRAD 0.62 +/- 0.35, with a reading speed ranging from 55 to 240 words per minute. CONCLUSIONS: We found macular changes in 87% of the patients, one-third thereof being eligible for further treatment (macular pucker or CME). Thus, the majority of these patients do not seem to be eligible for a further improvement of anatomic or functional outcome.     

Acute macular pucker

PURPOSE: To describe the presenting features, histopathology, and surgical outcome in a group of patients with rapidly progressive macular pucker. DESIGN: Retrospective interventional noncomparative case series. PARTICIPANTS: Five patients. METHODS: Review of case notes and the existing literature. RESULTS: All five patients had rapidly progressive visual loss and metamorphopsia over 2 weeks to 3 months, secondary to macular pucker after retinal tears or detachment. Vitrectomy and epiretinal membrane removal was performed within 1 month of diagnosis. In the absence of complications, there was rapid recovery of the visual acuity with resolution of metamorphopsia within 6 weeks to 3 months. Surgical complications limited the visual outcome in two cases. Histopathologic examination of epiretinal membrane removed from two of the cases suggests that these tend to form tubuloacinar structures and contain more retinal pigment epithelium-derived cells than tissue excised from cases with idiopathic macular pucker. CONCLUSIONS: Patients with acute macular pucker have precipitous visual loss caused by epiretinal membrane formation after retinal tear or detachment. Early surgery in these patients results in rapid recovery of visual acuity and resolution of metamorphopsia. The clinical features and comparative immunohistochemistry suggest that acute macular pucker is a distinct clinicopathologic entity.     

Vitrectomy for traction macular edema

Purpose: Traction macular edema may develop through contraction of macular epiretinal membranes (ERM), or due to persistant vitreomacular traction during the evolution of vitreomacular traction syndrome (VMS). The purpose of this retrospective study was to determine the effect of vitreous surgery and the release of the vitreomacular traction or the removal of epiretinal membranes, on the evolution of traction induced macular edema. Material and methods: Fourteen eyes from 14 patients presenting with idiopathic or secondary epiretinal membranes, and 11 eyes from 10 patients presenting with vitreomacular traction syndrome, underwent vitrectomy for reduced vision and cystoid macular edema, identified by slit-lamp examination and fluorescein angiography. No coexistent ocular conditions that might have caused macular traction were present. History, preoperative eye examination, operative findings, postoperative course and final examination as well as pre- and postoperative fluorescein angiography were reviewed. Results: In the ERM group, cystoid macular edema disappeared in all cases during the postoperative period and the mean visual acuity (VA) at the end of the follow-up (0.48 ± 0.23) significantly increased compared to the preoperative one (0.29 ± 0.2) (p=0.004). In the group of patients suffering from VMS, the posterior vitreous traction on the macula was released and macular edema disappeared in all cases but one. The mean v.a. at the end of the follow-up (0.42 ± 0.24) significantly increased compared to the preoperative one (0.18 ± 0.1) (p=0.01). Complications included intraoperative small petechias and postoperative progressive nuclear sclerosis, retinal detachment and retinal pigment epitheliopathy. Conclusions: Cystoid macular edema may develop secondary to vitreomacular traction syndrome or epiretinal membrane contraction. Vitrectomy is effective in releasing macular traction which, in turn, may induce a decrease of the macular edema with improvement of visual acuity. This revised version was published online in July 2006 with corrections to the Cover Date.     

Persistent indocyanine green (ICG) fluorescence 6 weeks after intraocular ICG administration for macular hole surgery

BACKGROUND: Macular hole surgery including vitrectomy and peeling of epiretinal membranes and the internal limiting membrane (ILM) has become a standard procedure in retinal surgery. Poor visualization of epiretinal membranes and the ILM is an obstacle to successful surgery. Recently, indocyanine green (ICG) has been reported to be a helpful intraocular substance in identifying these membranes. METHODS: In a case of stage IV macular hole, epiretinal membranes and ILM were intraoperatively stained with three drops of 1:9 diluted ICG. After 1 min incubation the vitreous cavity was rinsed with Ringer's lactate solution, and the membranes were peeled. Autologous thrombocytes were applied to the macular hole, and the eye was endotamponaded with 20% SF6 gas. Six weeks postoperatively, visual acuity was measured and fundus photographs and autofluorescence images, as well as a multifocal ERG, were obtained. RESULTS: Intraoperatively, the ILM could be nicely visualized by ICG, which allowed immediate peeling. Six weeks after surgery, the visual acuity had improved from 0.1 to 0.7 and the macular hole was closed. Autofluorescence imaging at 795 nm revealed a strong signal. Multifocal ERG recording showed regular amplitudes. CONCLUSION: ICG as an intraocular tool for staining of the ILM is helpful in macular hole surgery. We did not observe any negative effect on retinal function; however, we were surprised to identify traces of ICG in retinal fluorescein angiography images 6 weeks postoperatively.     

Retinal toxicity of indocyanine green

Purpose: To describe a case of scattered toxicity of indocyanine green on the outer retina and retinal pigment epithelium (RPE) after indocyanine green (ICG) assisted membrane peeling for macular pucker. Methods: A 61-year-old woman was examined by slit-lamp biomicroscopy, fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT), 1 month and 1 year after ICG assisted membrane peeling for macular pucker. Results: In the absence of significant fundoscopic changes, we have noted on FA and ICGA an occurrence of scattered unusual outer retinal and pigment epithelial changes at the 1- and the 12-month follow-up, probably due to the enhanced phototoxicity associated with the use of ICG at a high concentration (0.5%). Conclusions: Retinal toxicity of ICG in macular surgery depends on many factors. In our patient, the retinal changes seem to have been caused by a combination of all the toxic factors. This is the first reported case describing both the angiographic and OCT patterns of diffuse scattered toxicity of ICG on outer retinal layers and pigment epithelium after ICG assisted membrane peeling for macular pucker.     

Pars plana vitrectomy with removal of the internal limiting membrane in the treatment of persistent diabetic macular edema

PURPOSE: To evaluate the benefit of pars plana vitrectomy (PPV) and removal of the internal limiting membrane (ILM) in eyes with diffuse diabetic macular edema refractory to laser photocoagulation. DESIGN: Prospective, consecutive, interventional case series. METHODS: Diabetic patients with biomicroscopic, angiographic, and tomographic evidence of diabetic macular edema persisting for at least 3 months after numerous sessions of macular photocoagulation were evaluated for inclusion. Patients with biomicroscopic evidence of epiretinal membrane or taut posterior hyaloid, previous vitreoretinal surgery, or active proliferative diabetic retinopathy were excluded. The main outcome measures were macular thickness, as measured by optical coherence tomography (OCT) and visual acuity (VA). RESULTS: PPV with ILM removal was performed in 11 eyes of 10 patients (four men, six women; mean age = 58.2 years). Six-month follow-up data were available for 10 eyes (91%). At 6 months postoperatively, central macular thickness had improved by at least 20% in eight of 11 eyes (mean preoperative thickness of 421 mum compared with mean postoperative thickness of 188 mum; P = .007). Mean VA improved from 20/352 to 20/94 at 6 months (P = .002). By the most recent visit (range = 6-20 months postoperatively), VA had improved by at least 2 Snellen lines in 6 of 10 eyes treated with surgery alone. CONCLUSIONS: The early results of this ongoing study suggest that PPV with ILM removal may provide anatomic and visual benefit in some eyes with chronic diabetic macular edema unresponsive or unamenable to additional laser photocoagulation.     

Adult retinal pigment epithelial transplantation in exudative age-related macular degeneration

PURPOSE: To improve visual function by retinal pigment epithelial (RPE) cell transplantation and systemic immunosuppression at the time of surgical removal of subfoveal choroidal neovascularization in exudative age-related macular degeneration (AMD). DESIGN: An interventional case series of RPE transplantation in exudative AMD. METHODS: Twelve patients (one eye only) underwent subfoveal membranectomy with transplantation of a sheet of adult human allogeneic RPE cells at a single institution and were followed for one year. Eligibility criteria included age >60, best-corrected acuity < or =20/63 and subfoveal neovascularization < or =9 disk areas on preoperative fluorescein angiography. All patients were started on triple immunosuppression postoperatively. The primary outcome measure was best-corrected vision, with contrast sensitivity and reading speed as secondary outcome measures. RESULTS: The best-corrected visual acuity (P = .085), contrast sensitivity (P = .204), and the reading speed (P = .077) did not change significantly at one year compared with preoperative values. Transplants showed no signs of rejection in patients who were able to continue the immunosuppressants for six months. Postoperative surgical complications included cataract progression requiring surgery (three of eight phakic eyes), retinal detachment (three eyes), intraoperative retinal breaks (two eyes), and macular pucker (two eyes). None of the patients developed cystoid macular edema on postoperative fluorescein angiography or postoperative inflammation. CONCLUSIONS: A sheet of adult human allogeneic RPE can be transplanted into the subretinal space in AMD patients at the time of subfoveal membranectomy. Systemic immune suppression appeared to prevent rejection of the transplanted tissue, but did not lead to an improvement in visual function.     

继发性与特发性黄斑前膜的手术疗效分析

目的 探讨玻璃体视网膜手术后继发性黄斑前膜的影响因素，比较继发性黄斑前膜与特发性黄斑前膜的手术效果。 方法 分析26例黄斑前膜患者的26只眼（其中玻璃体视网膜手术后继发性黄斑前膜18只眼，特发性黄斑前膜8只眼）行玻璃体切割、黄斑前膜剥离等治疗前后的视力、眼底彩色照相以及部分患者的光相干断层扫描（optical coherence tomography，OCT）检查和随访3~12个月的临床资料。 结果 8例继发性黄斑前膜患者中，与手术有关者9例，占50.0%。巩 膜外冷凝、眼内激光光凝封闭巨大视网膜裂孔手术后继发黄斑前膜差异有显著性的意义（χ2=12.24，P＜0.05）。与玻璃体积血有关的继发性黄斑前膜11例，占61.1%。手术后3个月内视物变形消失者8例，占30.8%；视物变形改善者18例，占69.2% ；两组患者手术后视力均有明显提高。其中，继发性黄斑前膜患者手术后视力平均提高1.33行，最好矫正视力为0.6；特发性黄斑前膜患者手术后视力平均提高3行，最好矫正视力达0.8。 结论 巩膜外冷凝封闭巨大视网膜裂孔、手术前后伴玻璃体积血是玻璃体视网膜手术后继发黄斑前膜的高危因素。特发性黄斑前膜的手术疗效明显好于继发性黄斑前膜。 （中华眼底病杂志，2003，19：90-92）     

Macular hole surgery complicated by accidental massive subretinal indocyanine green,and retinal tear

Background To report a case of macular hole (MH) surgery complicated by accidental massive subretinal indocyanine green (ICG), and a retinal tear through the papillomacular bundle. Methods A 64-year-old woman complained of one-year history of poor vision in her left eye (LE) and of one month in her right (RE). Dilated fundus examination, fluorescein angiography, and optical coherence tomography (OCT) demonstrated a bilateral full-thickness MH with cystic changes and no posterior vitreous detachment RE and a full-thickness hole with significant surrounding retinal edema and cystic changes LE. Results A vitrectomy and posterior vitreous mechanical detachment were performed to close the MH RE. Approximately 0.3 ml of 0.5% ICG was applied to stain the internal limiting membrane (ILM). The assistant surgical nurse at the beginning of the instillation pushed the ICG syringe’s embolus with too much force into the vitreous cavity with a 20-gauge cannula. Subretinal ICG was accidentally introduced through the macular hole, and an iatrogenic macular retinal tear though the papillomacular bundle was created. Infusion was resumed immediately, and ICG was removed from the vitreous cavity, and the ILM was removed in a circular fashion in the usual manner. The eye was left with 14% perfluoropropane gas. Fundus examination and OCT performed after the intraocular gas was reabsorbed one month after the surgery revealed that the macular hole was completely closed with choroidal hypereflectivity due to RPE and choriocapillaris atrophy. Best-corrected visual acuity was 20/150 with a closed macular hole and ICG still present in the subretinal space seven months after surgery. Conclusion Our anatomic and functional results were poor with retinal and retinal pigment epithelium (RPE) atrophy, and a visual acuity of 20/150. Subretinal ICG and contact of ICG with the RPE should be avoided, and precautions should be taken when using intravitreous ICG to stain the ILM. Further studies are necessary to determine ICG safety in vitreoretinal surgery. Presented at the 7th Annual American Society of Retina Specialists (ASRS) Film Festival (Rhett Buckler Award Winner Film) at the American Society of Retina Specialists Annual Meeting in Montreal, Canada, July 2005. The authors have no proprietary or financial interest in any products or techniques described in this article. Supported in part by the Fundacion Arevalo-Coutinho para la Investigación en Oftalmología (FACO), Caracas, Venezuela.     

视网膜脱离手术后黄斑皱褶及其手术治疗

目的：探讨视网膜脱离复位手术后黄斑皱褶的发生原因、手术治疗和预防措施。方法：分析总结了３１例网脱复位术后发生黄斑皱褶的特点,并进行玻璃手术治疗。应用视网膜钩、铲、眼内镊子、笛形针等器械将黄斑前膜剥离,使皱褶松开。结果：黄斑皱褶产生的主要因素包括：大的马蹄形裂孔、冷凝过度、术中眼内出血、术后裂孔后缘皱襞和不恰当的眼底激光治疗等。通过玻璃体手术,３１例黄斑皱褶被被完全松解并恢复正常黄斑形态,未见严重并     

The impact of macular surgery in different grades of epiretinal membrane

AIM: To assess the impact of macular surgery on the functional and anatomic outcomes of the patients in different grades of epiretinal membrane (ERM). METHODS: Seventy-one eyes of 71 patients who underwent 23-gauge transconjunctival sutureless pars plana vitrectomy for primary isolated ERM were evaluated in this study. RESULTS: There were 38 females (53.5%) and 33 males (46.5%). The average age of the patients was 68.1y (range 42-89y). Mean follow up period was 14mo (range 6-26mo). The cases were divided into two subgroups of cellophane maculopathy (CM) and macular pucker (MP). An improvement was observed in the postoperative best-corrected visual acuity (BCVA), as well as a decrement in central foveal thickness (CFT) in both groups (both of these being statistically significant; P=0.001). In comparison between two groups, it was found that there was a significant improvement on BCVA and CFT in CM group than MP group (P=0.01). Furthermore, the postoperative fundus findings regarding RPE alterations and macular edema were significantly higher in MP group when compared to the CM group (P=0.01). CONCLUSION: ERM and internal limiting membrane peeling surgery can lead to a significant reduction of CFT and visual improvements in idiopathic ERM. A long-term ERM persistence will cause unrecoverable retinal damage and visual loss.     

Long-term observation of fundus infrared fluorescence after indocyanine green-assisted vitrectomy

PURPOSE: To observe the persistence of infrared fluorescence after indocyanine green (ICG)-assisted vitrectomy. METHODS: Eighteen consecutive patients underwent ICG-assisted vitrectomy for eyes with macular holes, epiretinal membranes, diabetic macular edema, and macular edema due to retinal vein occlusion. The internal limiting membrane was peeled after staining with 0.42% ICG solution. Postoperative observation of fundus infrared fluorescence was carried out using Heidelberg Retina Angiography (Heidelberg, Germany). RESULTS: Within a few months after surgery, intense fluorescence was observed around the macular hole and on the optic disk, photocoagulation scars, and the optic nerve fiber and was especially strong in the area along the vascular arcade. At the final visit (16-36 months after surgery), 12 (67%) of 18 eyes had infrared fluorescence that included fluorescence corresponding to the macular hole, retinal edema, and photocoagulation scars. The fluorescence over chorioretinal atrophy in a highly myopic eye disappeared compared with the area having an intact retinal pigment epithelium. CONCLUSIONS: Infrared fluorescence from ICG persists for 16 months to 36 months after ICG-assisted vitrectomy. ICG introduced directly into the vitreous cavity may remain in the eye over years. Careful long-term observation for the adverse effects of ICG is needed.     

内界膜剥除联合玻璃体内注射曲安奈德治疗继发性黄斑前膜的疗效观察

目的 观察内界膜剥除联合玻璃体内注射曲安奈德治疗继发性黄斑前膜的疗效.方法 回顾性分析我院2011年6月至2015年6月因继发性黄斑前膜需行玻璃体视网膜手术者42例42眼,所有患者均行标准的23 G经睫状体平坦部的三通道玻璃体切割+黄斑前膜剥除+视网膜内界膜剥除+玻璃体内注射曲安奈德术,术后随访3.0～18.0(8.3±2.4)个月,对手术前后最佳矫正视力、黄斑形态及手术并发症等进行观察.结果 随访期末,最佳矫正视力提高者30眼,不变者8眼,下降者4眼;术后最佳矫正视力与术前相比,差异有统计学意义(t=3.145,P=0.000).黄斑中心神经上皮层厚度术前为(315.62±132.12)μm,术后为(233.42±146.32) μm,手术前后相比差异有统计学意义(t=4.322,P=0.000).术后视网膜少许出血6眼,玻璃体积血1眼,一过性高眼压6眼;3眼周边牵引性小裂孔,激光治疗后,行玻璃体内C3F8填充,视网膜在位.结论 玻璃体内注射曲安奈德可以加速黄斑水肿消退,降低黄斑前膜复发,促进视功能恢复.视网膜内界膜剥除在继发性黄斑前膜手术中可以松解黄斑区视网膜皱褶,解除对黄斑中心凹的牵引,改善黄斑区局部的代谢,有利于黄斑功能的恢复.     

【In Press】The impact of macular surgery in different grades of epiretinal membrane

AIM: To assess the impact of macular surgery on the functional and anatomic outcomes of the patients in different grades of epiretinal membrane (ERM). METHODS: Seventy-one eyes of 71 patients who underwent 23-gauge transconjunctival sutureless pars plana vitrectomy for primary isolated ERM were evaluated in this study. RESULTS: There were 38 female (53.5%) and 33 male (46.5%) patients. The average age of the patients was 68.1y (range 42-89y). Mean follow up period was 14mo (range 6-26mo). The cases were divided into two subgroups of cellophane maculopathy (CM) and macular pucker (MP). An improvement was observed in the postoperative best-corrected visual acuity (BCVA), as well as a decrement in central foveal thickness (CFT) in both groups (both of these being statistically significant; P=0.001). In comparison between two groups, it was found that there was a significant improvement on BCVA and CFT in CM group than MP group (P=0.01). Furthermore, the postoperative fundus findings regarding RPE alterations and macular edema were significantly higher in MP group when compared to the CM group (P=0.01). CONCLUSION: ERM and internal limiting membrane peeling surgery can lead to a significant reduction of CFT and visual improvements in idiopathic ERM. A long-term ERM persistence will cause unrecoverable retinal damage and visual loss.     

Trypan blue-assisted vitrectomy

PURPOSE: To evaluate the efficacy of trypan blue dye for the staining and removal of the internal limiting membrane, epiretinal membranes, and the posterior hyaloid during pars plana vitrectomy. METHODS: The authors retrospectively reviewed a consecutive series of 26 eyes of 26 patients in whom trypan blue 0.15% dye was used to stain intraocular tissues during vitrectomy surgery. RESULTS: The cases reviewed included the following diagnoses: epiretinal membrane (13), macular hole (9), proliferative vitreoretinopathy (2), chronic pseudophakic cystoid macular edema (1), and chronic diabetic macular edema (1). The application of trypan blue resulted in a useful and consistent bluish staining, facilitating the identification, delineation, and removal of the epiretinal membrane, internal limiting membrane, or posterior hyaloid in all patients. Six months after the surgery, visual acuity was better or the same in 21 of the 26 patients. There were no clinical signs of retinal toxicity in any patients. CONCLUSION: Trypan blue staining of the internal limiting membrane, epiretinal membranes, and the posterior hyaloid is a useful adjunct in vitreoretinal surgery and improves the efficiency and safety of membrane identification and removal.