Role of the vitreous in idiopathic preretinal macular fibrosis

Of 250 eyes with idiopathic preretinal macular fibrosis, 56 had no posterior vitreous detachment (Group 1), ten had partial posterior vitreous detachments without vitreous traction to the macula (Group 2), 29 had partial posterior vitreous detachments with vitreous traction to the macula (Group 3), and 155 had complete posterior vitreous detachments (Group 4). There were significantly more eyes with visual acuities of 20/60 or worse, cystoid macular changes, or macular fluorescein leakage in Group 3 than in Group 1 or Group 4. Thus, the presence of vitreous traction to the macula was associated with worse anatomic and functional findings.     

Two cases of idiopathic preretinal macular fibrosis in children

We report herein the findings in two patients less than 15 years old with the diagnosis of idiopathic preretinal macular fibrosis, a disorder found primarily in the older population. Only a few reports have discussed idiopathic preretinal macular fibrosis in children and its pathogenesis is still unknown. One is a 10-year-old boy and the other is a 14-year-old girl who visited our hospital with a chief complaint of blurred vision in their right eyes. Epiretinal membranes were recognized on the macular region of their right eyes. Since there was no causative factors, a diagnosis of idiopathic preretinal macular fibrosis was made. They were conservatively followed up. The vision of the boy once worsened but improved spontaneously and remained stable for three years. Because the vision of the girl worsened rapidly, vitreous surgery was performed to remove the epiretinal membrane, resulting in poor vision. It was suggested that this disorder in children should be followed up conservatively and the indication of vitreous surgery should be carefully determined.     

Spontaneous detachment of the preretinal membrane in preretinal macular fibrosis

Preretinal macular fibrosis is one of the most frequently encountered conditions of the macula; it is based on the formation of a transparent or white-gray preretinal membrane. Usually these changes do not progress and persist without change for many years. In rare cases it may come to a spontaneous detachment of the preretinal membrane connected usually with an improvement of the visual acuity. Presented are 2 patients with preretinal macular fibrosis in whom--after a various duration of the disease--it came to a spontaneous detachment of the preretinal membrane.     

Nd-YAG laser treatment in preretinal macular fibrosis

Three eyes with preretinal macular fibrosis (PMF) were treated with the Q-switched Nd-YAG laser. The PMF was idiopathic in two eyes and associated with a vitreous hemorrhage, due to ocular trauma, in the third eye. The three eyes had in common a partial posterior vitreous detachment with vitreous traction on the macula. The Nd-YAG laser beam was focused on the detached posterior hyaloid in front of the macular region. Some holes were made in this membrane or in the adjacent collapsed vitreous cortex. Treatment increased the visual acuity in the three eyes; the vitreous remained partially detached in the two eyes with idiopathic PMF and detached completely in the eye with the secondary PMF. The disentanglement of the fovelar area was revealed by the unfolded appearance of the retinal vessels on fluoangiography.Presented at the XVth Meeting of the Club Jules Gonin, Copenhagen, 10–15 August 1986This work was supported by the Belgian National Foundation for Scientific Research     

特发性黄斑视网膜前膜的眼底分析

探讨特发性黄斑视网膜前膜的眼底改变特性及其视力预后。方法采用眼底彩照和荧光血管造影对６５例患者进行检查,其中１５例,作了眼底形态和视力的随访观察。结果依据患者的眼底及ＦＦＡ改变特征将其分为Ⅰ、Ⅱ、Ⅲ期;６８．３％的患眼视力≥０．５。所有随访患超的视均保持稳定。结论因病程不同,眼底可有多种改变,但大部分患眼的视力预后良好。     

The incidence of idiopathic preretinal macular gliosis

A series of 1,000 consecutive routine eye examinations performed on patients over the age of 50 was evaluated with particular reference to the presence of idiopathic preretinal macular gliosis (IPMG). In this group, there were 64 patients with IPMG (6.4%), 13 (20%) of whom had bilateral IPMG. The large majority of cases (63%), however, had only minor visual disability as a result of this disorder.     

Vitrectomy for idiopathic and secondary preretinal macular membrane

PURPOSE: To evaluate the results of pars plana vitrectomy and membrane stripping for idiopathic and secondary preretinal macular membrane (PMM). MATERIAL AND METHODS: Twenty one consecutive subjects (21 eyes) ranging in age from 40 to 78 (mean 66.9) with PMM underwent vitrectomy and membrane peeling. 17 cases had membranes that were considered idiopathic, and 4 cases were associated with other disorders: 3 occurred after successful retinal reattachment surgery, 1--after laserotherapy in the course of diabetic retinopathy. Visual acuity (VA), Amsler grid, and postoperative complications were assessed. The follow-up was 1 to 22 months, mean 5.7. RESULTS: Visual acuity improved postoperatively in 15 eyes (71.4%), at least two lines on the Snellen chart in 8 eyes (38.1%), entirely in patients with idiopathic PMM. It remained unchanged in 3 eyes (14.3%) and deteriorated in 3 eyes (14.3%). Eyes with transparent membrane showed greater visual improvement than opaque ones. The preoperative Amsler test was positive in 15 patients (71.4%), postoperatively--in 4 cases (19%). 2 idiopathic cases with VA of 0.7 showed postoperatively VA of 1.0. Complications included retinal detachment in 2 eyes (1 in idiopathic and 1 in secondary PMM), and development of nuclear sclerotic cataract in 2 eyes. At 6 months of follow-up, a residual membrane formation in 1 cases appeared. Macular pseudohole was observed in 1 eye with no impact on visual results. CONCLUSIONS: 1. Vitrectomy with membrane peeling for preretinal macular membrane provides improvement in visual acuity and reduces metamorphopsia 2. Thin, cellophane-like appearance of the membrane gives a better prognosis of visual function improvement.     

Idiopathic preretinal fibrosis with concurrent cystoid macular edema

Idiopathic preretinal fibrosis is a common disorder which typically affects elderly individuals. The epiretinal membranes are of glial origin in the retina where they migrate through breaks in the internal limiting membrane to form fibroglial sheets on the surface of the retina. Although visual symptomatology is rare, the epiretinal membranes may, in some instances, grow rapidly and contract causing tractional changes to occur involving the underlying retina and retinal vessels. This paper presents a case of preretinal fibrosis with accompanying cystoid macular edema and consequent dramatically reduced vision. The diagnosis, pathophysiology and management of preretinal fibrosis are discussed.     

Role of the vitreous in idiopathic preretinal macular fibrosis indicated by visual acuity in follow-up cases

The vitreous and visual acuity in 103 eyes with idiopathic preretinal macular fibrosis were examined. The vitreous was studied biomicroscopically and the follow-up course was 6 months or more. Twenty-two eyes had no posterior vitreous detachment (group 1), 4 eyes had partial posterior vitreous detachment without traction to the macula (group 2), 17 eyes had partial posterior vitreous detachment with traction to the macula (group 3), and 60 eyes had complete posterior vitreous detachment (group 4). There were significantly more eyes with a visual acuity of 0.4 or worse, decreased acuity, or macular fluorescein leakage in group 3 than in groups 1 or 4. Decreased visual acuity was found in 41% of eyes with macular fluorescein leakage, but in only 11% of eyes without macular fluorescein leakage. It is presumed that the vitreous traction to the macula and macular fluorescein leakage are closely related to the outcome of visual acuity in cases with idiopathic preretinal macular fibrosis.     

特发性黄斑视网膜前膜

为观察６０例６７眼特发性黄斑视网膜前膜的临床特点和视力预后，并探讨其程度分期。用荧光造影，９０Ｄ前置镜或三面镜裂隙灯作检查。结果①视网膜前膜多发生在老年人，本组占９６．７％，单眼发病占８８．３％，双眼发病占１１．７％，左右眼发病无差异。②玻璃体后脱离占６１．２％。③按程度分期：一期３８只眼占５６．７％，二期２１只眼占３１．３％，三期５只眼占７．５％。４．３６例（６４．３％）视力在０．５以上。结论：视网膜前膜为一老年性病变，病情发展缓慢，视力预后好。有明显膜形成者作玻璃体切割和膜剥离术可改善视力。     

Therapy of preretinal macular hemorrhages

Within the first 3 to 4 days after occurrence of a premacular subhyaloid hemorrhage the posterior vitreous boundary layer may be lacerated by argon laser coagulation in such a way, that the blood floats into the vitreous body, where it is absorbed within a few weeks. Older premacular hemorrhages under an intact vitreous boundary layer, typically green-white in color have to be treated by more invasive vitreo-surgical procedures.     

Idiopathic preretinal macular fibrosis. Study of correlation between morphologic changes and visual acuity

Idiopathic preretinal macular fibrosis is an affection characterized by the development of preretinal membranes, macular distortion and, sometimes, macular edema. These changes as well as the consequent reduction of the visual acuity may vary very widely from one case to another. In this study, the degree of correlation among the various retinal morphological changes and among them and the visual acuity was investigated. This study shows that the importance of retinal distortion is strictly dependent on the appearance of the preretinal membranes that the appearance of the preretinal membrane and the importance of the retinal distortion are equally valid predictors of visual acuity, that the macular edema (defined as fluorescein leakage) depends mainly on the degree of contraction of the preretinal membrane and that such leakage does not represent the best parameter in order to predict the visual acuity.     

Management in preretinal macular hemorrhage. Case report

The report presents a method of management in case of clotted premacular haemorrhage in a 46 year-old woman. The used method of treatment proceeded in 2 stages: 1) pars plana, intravitreal injection of 50 mg tissue plasminogen activator (tPA-Actilise), 2) after 24 hours intravitreal 0.5 cc SF6 with air mixture (1:5). Fibrinolytic tPA action and mechanic action of expanding gas caused after argon laser puncture intravitreal haemorrhage dislocation and following its resorption. The almost full visual acuity persisted for over 2 years.     

特发性黄斑前膜术后解剖与功能恢复的预期影响因素

特发性黄斑前膜的标准手术方案是玻璃体切割联合前膜剥除术。然而同样成功的手术后患者视力、视物变形等功能和黄斑区解剖结构的预后却不尽相同。通过查阅大量相关文献,发现许多影响术后解剖和功能恢复的预期影响因素。术前因素中除术前最佳矫正视力和病程等我们熟知的影响因素外,频域光学相干断层成像技术的应用提供了更多黄斑前膜组织结构的改变,如术前黄斑中心区厚度、内核层厚度和光感受器细胞层连续性的改变等,这些信息可以作为我们推测预后的指标;手术方式、联合用药等术中因素和术后眼局部和全身用药情况均影响患者术后解剖和功能预后。     

Prognostic factors and results after surgical treatment of idiopathic macular holes, stage 2 and 3

PURPOSE: To determine prognostic factors, functional outcome and subjective rating after surgery for macular holes stage 2 and 3. METHODS: We studied 53 eyes of 49 patients undergoing vitreous surgery for macular holes stage 2 (46%) and 3 (54%). Mean follow-op was 114 weeks (32-204, std.dev. +/- 48), mean age 68.9 years (44-89, std.dev. +/- 6.8). 72% were female, 11% were pseudophakic, 19% phakic, 70% had a combined procedure (pars plana vitrectomy, phacoemulsification and IOL). Surgery consisted in a pars plana vitrectomy, peeling of epiretinal membranes and ILM, internal tamponade with SF6 (98%) resp. Si-oil in one case. Patients had to keep face-down position 6 x 20 minutes per day. RESULTS: The hole was completely closed in 90.6%. Anatomical failures included, 86% had an increase of VA, 41% = 5 lines (Final VA median 20/30, max. 20/20). No further increase of the retinal function occurred after 6 months. The visual result did not correlate with the duration of symptoms. 84% were satisfied with the outcome, subjective rating was not correlated with final VA or change of VA. 19% showed postoperative typical peripheral visual field defects. Visual field loss was not correlated with perioperative IOP elevation. CONCLUSION: Macular hole surgery has a high functional success rate. Postoperative visual field defects are an important problem.     

激光治疗糖尿病黄斑水肿的预后影响因素

目的:分析影响激光光凝治疗糖尿病黄斑水肿(DME)疗效的影响因素。方法:回顾分析本院80例80眼经532激光局部/格栅治疗的2型糖尿病并发糖尿病黄斑水肿患者的临床资料。结果:Logistic回归分析,有3个危险因素对糖尿病黄斑水肿激光治疗预后的影响有统计学意义(P<0.05),分别为糖化血红蛋白(HbA1c)、高血脂及DME分型。结论:糖尿病黄斑水肿激光治疗预后与糖化血红蛋白(HbA1c)水平、高血脂及DME分型有关。     

老年特发性黄斑裂孔玻璃体切割手术预后的多因素分析

目的 评价多种因素与老年特发性黄斑裂孔玻璃体切割术后视力的关联情况.方法 对109例行玻璃体切割术的老年特发性黄斑裂孔患者进行回顾性分析.分析术前矫正远视力、病程、黄斑裂孔的分期及孔径大小,术中是否剥除内界膜、是否使用血小板,术后裂孔是否闭合与术后视力预后的关系.结果 术前远视力(P=0.016)、孔径(P=0.028)、是否使用血小板(P＜0.05)这3个因素在不同的视力预后分组之间差异有统计学意义.术中使用血小板的患者术后视力相对较好(相关系数为3.106,P=0.014).结论 使用浓缩血小板封孔,可以增加老年特发性黄斑裂孔患者术后视力提高或者稳定的概率.