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Ophthalmology. Retina Dec 2021To provide a comparative assessment of clinical outcomes between patients undergoing intraoperative OCT (iOCT) and conventional surgery for pars plana vitrectomy (PPV)... (Comparative Study)
Comparative Study
PURPOSE
To provide a comparative assessment of clinical outcomes between patients undergoing intraoperative OCT (iOCT) and conventional surgery for pars plana vitrectomy (PPV) with epiretinal membrane (ERM) peel.
DESIGN
Case-control retrospective, comparative assessment.
PARTICIPANTS
Patients undergoing PPV with membrane peel for ERM with eyes pooled from the prospective Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery (DISCOVER) iOCT study and eyes undergoing conventional ERM surgery without iOCT.
METHODS
Visual acuity and OCT assessment before ERM surgery and at 1-, 3-, 6-, and 12-month follow-up after standard small-gauge PPV with iOCT feedback (iOCT DISCOVER group) or PPV with compulsory internal limiting membrane (ILM) peeling (conventional group). Visual acuity, central subfield thickness (CST), reoperation rate, and ERM recurrence were determined by record review and post hoc assessment of clinical OCTs after ERM peel.
MAIN OUTCOME MEASURES
Visual acuity and ERM recurrence.
RESULTS
A total of 262 eyes were included. Visual acuity (VA) improved 11.9 letters in the iOCT group (P < 0.0001) and 12.1 letters in the conventional group (P < 0.0001) at 12 months after ERM surgery. Visual acuity improvement did not differ between the iOCT and conventional groups at 1, 3, 6, or 12 months after surgery (P > 0.05 for each time point). Preoperative mean CST decreased in the iOCT group (P < 0.0001) and conventional group (P < 0.0001) with no difference between groups in CST reduction at 12 months (P = 0.36). No reoperations or visually significant recurrent ERMs occurred in either cohort.
CONCLUSIONS
Intraoperative OCT-guided ERM removal without mandated ILM peeling provided similar VA and anatomic results to conventional ILM peeling for ERM. Future randomized prospective studies are needed to assess fully the possible role of iOCT in ERM surgery and to evaluate the potential impact of nonfoveal ERM persistence or recurrence in comparison with conventional surgery.
Topics: Basement Membrane; Case-Control Studies; Epiretinal Membrane; Humans; Prospective Studies; Retrospective Studies; Surgery, Computer-Assisted; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 33647472
DOI: 10.1016/j.oret.2021.02.013 -
International Journal of Molecular... Jun 2023Epiretinal membranes (ERMs) are sheets of tissue that pathologically develop in the vitreoretinal interface leading to progressive vision loss. They are formed by... (Review)
Review
Epiretinal membranes (ERMs) are sheets of tissue that pathologically develop in the vitreoretinal interface leading to progressive vision loss. They are formed by different cell types and by an exuberant deposition of extracellular matrix proteins. Recently, we reviewed ERMs' extracellular matrix components to better understand molecular dysfunctions that trigger and fuel the onset and development of this disease. The bioinformatics approach we applied delineated a comprehensive overview on this fibrocellular tissue and on critical proteins that could really impact ERM physiopathology. Our interactomic analysis proposed the hyaluronic-acid-receptor cluster of differentiation 44 (CD44) as a central regulator of ERM aberrant dynamics and progression. Interestingly, the interaction between CD44 and podoplanin (PDPN) was shown to promote directional migration in epithelial cells. PDPN is a glycoprotein overexpressed in various cancers and a growing body of evidence indicates its relevant function in several fibrotic and inflammatory pathologies. The binding of PDPN to partner proteins and/or its ligand results in the modulation of signaling pathways regulating proliferation, contractility, migration, epithelial-mesenchymal transition, and extracellular matrix remodeling, all processes that are vital in ERM formation. In this context, the understanding of the PDPN role can help to modulate signaling during fibrosis, hence opening a new line of therapy.
Topics: Humans; Epiretinal Membrane; Extracellular Matrix Proteins; Fibrosis; Hyaluronan Receptors; Transcription Factors; Vitreoretinopathy, Proliferative
PubMed: 37298679
DOI: 10.3390/ijms24119728 -
PloS One 2022The abnormal posterior vitreous detachment (PVD) is speculated as an important mechanism of the development of the epiretinal membrane (ERM). However, there is only...
The abnormal posterior vitreous detachment (PVD) is speculated as an important mechanism of the development of the epiretinal membrane (ERM). However, there is only limited information about the molecular mechanism. Sphingosine-1-phosphate (S1P) is a mediator of the mechanosensitive response in several cell types that may have a role in the pathogenesis of ERM during abnormal PVD. Therefore, we evaluated the expression of S1P in the human ERM and the role of S1P in cultured human Muller glial cells. Among 24 ERM specimens, seven specimens (29.2%) exhibited S1P expression. Patients with secondary ERM or ellipsoid zone defects, which suggest abnormal PVD presented a significantly higher S1P+ cell density (secondary ERM: 128.20 ± 135.61 and 9.68 ± 36.01 cells, p = 0.002; EZ defects: 87.56 ± 117.79 vs 2.80 ± 8.85, p = 0.036). The addition of S1P increased the migrative ability and expression of N-cadherin and α-SMA in human Muller glial cells, suggesting S1P is a potential causative molecule for the development of ERM during abnormal PVD.
Topics: Epiretinal Membrane; Humans; Lysophospholipids; Sphingosine; Vitreous Detachment
PubMed: 36044534
DOI: 10.1371/journal.pone.0273674 -
BMC Ophthalmology May 2023To demonstrate the associations between the morphology of macular retinal vasculature and disease severity of idiopathic epiretinal membrane (ERM).
BACKGROUND
To demonstrate the associations between the morphology of macular retinal vasculature and disease severity of idiopathic epiretinal membrane (ERM).
METHODS
Macular structures were assessed using optical coherence tomography (OCT), and were classified as "with pseudohole" or "without pseudohole". The 3 × 3 mm macular OCT angiography images were analyzed using the Fiji software to obtain the vessel density, skeleton density, average vessel diameter, vessel tortuosity, fractal dimension, and foveal avascular zone (FAZ)-related parameters. The correlations between these parameters and ERM grading as well as visual acuity were analyzed.
RESULTS
For ERM with or without a pseudohole, increased average vessel diameter, decreased skeleton density, and decreased vessel tortuosity were all associated with inner retinal folding and thickened inner nuclear layer, indicating more severe ERM. In 191 eyes without a pseudohole, the average vessel diameter increased, fractal dimension decreased and vessel tortuosity decreased with increasing ERM severity. The FAZ was not associated with ERM severity. Decreased skeleton density (r = -0.37), vessel tortuosity (r = -0.35), and increased average vessel diameter (r = 0.42) were correlated with worse visual acuity (All P < 0.001). In 58 eyes with pseudoholes, a larger FAZ was associated with a smaller average vessel diameter (r = -0.43, P = 0.015), higher skeleton density (r = 0.49, P < 0.001), and vessel tortuosity (r = 0.32, P = 0.015). However, none of the retinal vasculature parameters correlated with visual acuity and central foveal thickness.
CONCLUSION
Increased average vessel diameter, decreased skeleton density, decreased fractal dimension and decreased vessel tortuosity were good indicators of ERM severity and associated visual impairment.
Topics: Humans; Epiretinal Membrane; Fovea Centralis; Retinal Vessels; Macula Lutea; Retina; Tomography, Optical Coherence; Retrospective Studies; Fluorescein Angiography
PubMed: 37147577
DOI: 10.1186/s12886-023-02945-x -
Ophthalmology. Retina Aug 2019Epiretinal proliferation is a distinct clinical entity from epiretinal membrane that classically is associated with lamellar macular holes, but its prevalence and...
PURPOSE
Epiretinal proliferation is a distinct clinical entity from epiretinal membrane that classically is associated with lamellar macular holes, but its prevalence and association with full-thickness macular holes (FTMH) have not been well described. We characterized macular hole-associated epiretinal proliferation (MHEP) and its effects on long-term surgical outcomes.
DESIGN
Multicenter, interventional, retrospective case-control study.
PARTICIPANTS
Consecutive eyes that underwent surgery for FTMH with a minimum of 12 months follow-up.
METHODS
All eyes underwent pars plana vitrectomy, removal of any epiretinal membranes, and gas tamponade, with or without internal limiting membrane (ILM) peeling. Spectral-domain OCT imaging was obtained before and after surgery.
MAIN OUTCOME MEASURES
Improvement in visual acuity and single-surgery hole closure rates in eyes with, versus without, MHEP at 12 months.
RESULTS
Seven hundred twenty-five charts were analyzed, and 113 patients met inclusion criteria. Of 113 eyes with FTMH, 30 (26.5%) showed MHEP. Patients with FTMH and MHEP were older (P < 0.002) and more often men (P = 0.001), and showed more advanced macular hole stages than those without MHEP (P = 0.010). A full posterior vitreous detachment was more common in eyes with MHEP (P < 0.004). Twelve months after surgery, FTMH with MHEP patients showed significantly less improvement in visual acuity (P = 0.019) with higher rates of ellipsoid and external limiting membrane defects (P < 0.05) and with a higher rate of failure to close with 1 surgery compared to FTMH without MHEP (26.7% vs. 4.8%; P = 0.002]). Peeling the ILM was associated with improved rates of hole closure in FTMH with MHEP (P < 0.001). Multivariate testing confirmed that the presence of MHEP was an independent risk factor for less visual improvement (P = 0.031) and for single-surgery nonclosure (P = 0.009) and that ILM peeling improved single-surgery closure rates (P = 0.026).
CONCLUSIONS
We found that FTMH with MHEP showed poorer anatomic and visual outcomes after vitrectomy compared with FTMH without MHEP. Internal limiting membrane peeling was associated with improved closure rates and should be considered when MHEP is detected before surgery.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Case-Control Studies; Endotamponade; Epiretinal Membrane; Female; Follow-Up Studies; Humans; Male; Middle Aged; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 31104985
DOI: 10.1016/j.oret.2019.03.022 -
Computerized Medical Imaging and... Jun 2022The Epiretinal Membrane (ERM) is an ocular disease that can cause visual distortions and irreversible vision loss. Patient sight preservation relies on an early...
BACKGROUND AND OBJECTIVES
The Epiretinal Membrane (ERM) is an ocular disease that can cause visual distortions and irreversible vision loss. Patient sight preservation relies on an early diagnosis and on determining the location of the ERM in order to be treated and potentially removed. In this context, the visual inspection of the images in order to screen for ERM signs is a costly and subjective process.
METHODS
In this work, we propose and study three end-to-end fully-automatic approaches for the simultaneous segmentation and screening of ERM signs in Optical Coherence Tomography images. These convolutional approaches exploit a multi-task learning context to leverage inter-task complementarity in order to guide the training process. The proposed architectures are combined with three different state of the art encoder architectures of reference in order to provide an exhaustive study of the suitability of each of the approaches for these tasks. Furthermore, these architectures work in an end-to-end manner, entailing a significant simplification of the development process since they are able to be trained directly from annotated images without the need for a series of purpose-specific steps.
RESULTS
In terms of segmentation, the proposed models obtained a precision of 0.760 ± 0.050, a sensitivity of 0.768 ± 0.210 and a specificity of 0.945 ± 0.011. For the screening task, these models achieved a precision of 0.963 ± 0.068, a sensitivity of 0.816 ± 0.162 and a specificity of 0.983 ± 0.068. The obtained results show that these multi-task approaches are able to perform competitively with or even outperform single-task methods tailored for either the segmentation or the screening of the ERM.
CONCLUSIONS
These results highlight the advantages of using complementary knowledge related to the segmentation and screening tasks in the diagnosis of this relevant pathology, constituting the first proposal to address the diagnosis of the ERM from a multi-task perspective.
Topics: Early Diagnosis; Epiretinal Membrane; Humans; Tomography, Optical Coherence
PubMed: 35489237
DOI: 10.1016/j.compmedimag.2022.102068 -
BMC Ophthalmology Nov 2022To assess visual outcomes of epiretinal membrane (ERM) removal in multifocal intraocular lens (MIOL)-implanted eyes, according to ERM stage.
BACKGROUND
To assess visual outcomes of epiretinal membrane (ERM) removal in multifocal intraocular lens (MIOL)-implanted eyes, according to ERM stage.
METHODS
Retrospective chart reviews were undertaken in patients with diffractive-type MIOL implants, each undergoing pars plana vitrectomy and ERM removal between February 2018 and November 2020 at Gyeongju St. Mary's Eye Clinic and KEYE Eye Center. Assessments focused on monocular uncorrected and corrected values of distant visual acuity (UDVA and CDVA) and uncorrected near visual acuity (UNVA) at postoperative 12 months according to the stage of ERM.
RESULTS
The present study included a total of 49 MIOL-implanted eyes from 49 enrollees, 25 undergoing pars plana vitrectomy for ERM removal (11 eyes with Stage 2 and 14 eyes with Stage 3), and 24 acting as age-matched controls. There was a significant difference in UDVA and UNVA between control and Stage 3 ERM (UDVA; 0.01 ± 0.04 for control, and 0.07 ± 0.08 for stage 3 ERM, p = 0.035, UNVA; 0.03 ± 0.05 for control, and 0.13 ± 0.16 for Stage 3 ERM, p = 0.029). There were no significant differences in CDVA between groups (p = 0.121, ANOVA test).
CONCLUSIONS
Eyes with Stage 3 ERM did not achieve visual acuity comparable to control eyes, suggesting the necessity of an early intervention for ERM in eyes with diffractive type MIOL. A meticulous preoperative retinal evaluation for ERM development is mandatory when planning diffractive-type MIOL implantation.
Topics: Humans; Multifocal Intraocular Lenses; Lens Implantation, Intraocular; Epiretinal Membrane; Retrospective Studies; Lenses, Intraocular; Prosthesis Design; Phacoemulsification
PubMed: 36344966
DOI: 10.1186/s12886-022-02649-8 -
PloS One 2017Studies on vitrectomy with and without internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (ERM) have yielded uncertain results regarding... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Studies on vitrectomy with and without internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (ERM) have yielded uncertain results regarding clinical outcomes and recurrence rates.
OBJECTIVE
To compare the clinical outcomes of vitrectomy with and without ILM peeling for idiopathic ERM.
METHODS
Databases, including PubMed, Embase, Cochrane, Web of Science, Google Scholar, CNKI databases, FDA.gov, and ClinicalTrials.gov, published until July 2016, were searched to identify studies comparing the clinical outcomes following vitrectomy with ERM and ILM peeling and with only ERM peeling, for treating idiopathic ERM. Studies with sufficient data were selected. Pooled results were expressed as mean differences (MDs) and risk ratios (RRs) with corresponding 95% confidence intervals (CI) for vitrectomy with and without ILM peeling with regard to postoperative best corrected visual acuity (BCVA), central retinal thickness (CRT), and ERM recurrence rate.
RESULTS
Eleven retrospective studies and one randomized controlled trial involving 756 eyes were identified. This demonstrated that the postoperative BCVA within 12 months was significantly better in the non-ILM peeling group (MD = 0.04, 95% CI: 0.00 to 0.08; P = 0.0460), but that the patients in the ILM peeling group had significantly better postoperative BCVA after 18 months (MD = -0.13, 95% CI: -0.23 to -0.04; P = 0.0049) than did those in the non-ILM peeling group. The non-ILM peeling group exhibited a higher reduction in postoperative CRT (MD = 51.55, 95% CI:-84.23 to -18.88; P = 0.0020) and a higher recurrence rate of ERM (RR = 0.34, 95% CI:0.16 to 0.72; P = 0.0048) than did the ILM peeling group. However, the improvement rates of BCVA (RR = 1.03, 95% CI:0.72 to 1.47; P = 0.8802) and postoperative CRTs (MD = 18.15, 95% CI:-2.29 to 38.60; P = 0.0818) were similar between the two groups.
CONCLUSIONS
Vitrectomy with ILM peeling results in better visual improvement in long-term follow-ups and lower ERM recurrence rates, and vitrectomy with only ERM peeling is more efficacious in reduction of CRT than is vitrectomy with ILM peeling.
Topics: Epiretinal Membrane; Female; Humans; Male; Vitrectomy
PubMed: 28622372
DOI: 10.1371/journal.pone.0179105 -
Romanian Journal of Ophthalmology 2022To describe the development of retinal pigment epithelium (RPE) atrophy after uncomplicated pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and/or internal...
To describe the development of retinal pigment epithelium (RPE) atrophy after uncomplicated pars plana vitrectomy (PPV) with epiretinal membrane (ERM) and/or internal limiting membrane (ILM) peeling in 2 patients. : Case 1: A 79-years-old female with diagnosis of a full-thickness macular hole in her right eye (OD) with best corrected visual acuity (BCVA) of: 20/100 and left eye (OS): 20/70. After surgery she developed large RPE hyperplasia and presented hand movement that did not improve with pinhole. Case 2: A 69-years-old female patient who had ERM in her OS with BCVA of 20/30 in both eyes (OU). PPV was assisted with brilliant blue (BB) to better visualize the ILM. During follow-up visits we evidenced RPE atrophy in the zone where peeling was done. In the last control after 2-years, her visual acuity was 20/40 that did not improve with pinhole. There are three possible mechanisms to explain this complication: toxic damage, mechanical trauma during the membrane removal with forceps, or a combination of both. In our cases, a combination of them is probably the cause of the presence of RPE atrophy. Vitrectomy with membrane removal is successful in most cases with low rate of complications. Because RPE atrophy is infrequent, our suggestion is to continue performing this technique and if possible, it should be done without dye staining to minimize risks. ERM = epiretinal membrane, ILM = internal limiting membrane, MH = macular hole, RPE = Retinal pigment epithelium, OD = right eye, BCVA = Best corrected visual acuity, OS = left eye, OU = both eyes, IOL = intraocular lens, OCT = Optical coherence tomography, BB = Brilliant blue, TB = Trypan blue, ICG = indocyanine green.
Topics: Aged; Atrophy; Basement Membrane; Epiretinal Membrane; Female; Humans; Retinal Perforations; Retinal Pigment Epithelium; Retrospective Studies; Tomography, Optical Coherence; Vitrectomy
PubMed: 35531456
DOI: 10.22336/rjo.2022.16 -
Hong Kong Medical Journal = Xianggang... Dec 2005Epiretinal membrane is a common surgical disease of the elderly. The aetiology, clinical presentation, and diagnosis are briefly described. Management, principally... (Review)
Review
Epiretinal membrane is a common surgical disease of the elderly. The aetiology, clinical presentation, and diagnosis are briefly described. Management, principally vitrectomy and membrane removal, is then elaborated. Recent advances such as internal limiting membrane peeling are further discussed. The safety and efficacy of intra-ocular dyes, including indocyanine green and trypan blue, as well as the new technique of 'double staining', are evaluated.
Topics: Aging; Coloring Agents; Epiretinal Membrane; Hong Kong; Humans; Indocyanine Green; Postoperative Complications; Trypan Blue; Visual Acuity; Vitrectomy
PubMed: 16340027
DOI: No ID Found