Department of Ophthalmology, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.
Laboratory of Visual Physiology, National Institute of Sensory Organs, National Hospital Organization, Tokyo Medical Center, Tokyo, Japan.
Retin Cases Brief Rep. 2021 Mar 1;15(2):114-119. doi: 10.1097/ICB.0000000000000758.
To compare the visual outcomes and prevalence of epiretinal membrane (ERM) growth postoperatively between eyes treated with and without internal limiting membrane peeling during vitrectomy for macula-sparing rhegmatogenous retinal detachment.
Fifty-five consecutive cases who underwent vitrectomy for macula-sparing rhegmatogenous retinal detachment were reviewed retrospectively. The inclusion criteria were a minimal 6-month follow-up postoperatively and spectral domain optical coherence tomographic images available at follow-up. Cases with any pre-existing macular condition possibly affecting the visual prognosis were excluded. All cases were divided into two groups: 22 cases without internal limiting membrane peeling (Group 1) and 33 cases with internal limiting membrane peeling (Group 2). The two groups were compared using the Mann-Whitney U test and Fisher exact test in terms of the best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution) before vitrectomy, postoperative BCVA, and the presence of postoperative ERM growth. Postoperative BCVA and ERM growth were determined at 6 months, 12 months, and the last visit. The visual outcomes were also analyzed between cases with and without postoperative symptomatic ERM growth, which caused visual impairment and required surgical removal.
The mean postoperative BCVAs were 0.00, -0.08, and -0.08 logarithm of the minimum angle of resolution in Group 1, and -0.08, -0.08, and -0.08 logarithm of the minimum angle of resolution in Group 2 at 6 months, 12 months, and the last visit, respectively, and did not differ significantly between the 2 groups at each time point except for at 12 months (P = 0.027). An ERM developed in 14 cases in Group 1, 7 of which were symptomatic. No cases in Group 2 had ERM growth. The prevalence of ERM growth was significantly (P < 0.001) higher in Group 1 than Group 2. The BCVA was significantly worse at 6 months (P = 0.011), 12 months (P = 0.003), and the last visit (P = 0.019) in 7 cases with symptomatic ERMs (median, 0.30, 0.15, and 0.10 logarithm of the minimum angle of resolution, respectively) than in 48 cases without symptomatic ERMs (median, -0.08, -0.08, and -0.08 logarithm of the minimum angle of resolution, respectively).
Internal limiting membrane peeling did not result in decreased visual acuity postoperatively in cases with a macula-sparing rhegmatogenous retinal detachment, and the procedure significantly prevented postsurgical ERM growth. Symptomatic ERMs led to decreased visual acuity even after surgical removal. These results support the validity and efficacy of internal limiting membrane peeling for preventing ERM growth after rhegmatogenous retinal detachment repair.
比较在保留黄斑的孔源性视网膜脱离玻璃体切除术中行与不行内界膜剥除术治疗后，患眼的术后视力结果和眼内膜（ERM）生长的发生率。
回顾性分析 55 例连续接受保留黄斑的孔源性视网膜脱离玻璃体切除术的患者。纳入标准为术后至少 6 个月的随访和可获得随访时的光谱域光学相干断层扫描图像。排除可能影响视觉预后的任何预先存在的黄斑病变的病例。所有病例分为两组：22 例未行内界膜剥除术（组 1）和 33 例行内界膜剥除术（组 2）。使用 Mann-Whitney U 检验和 Fisher 确切概率检验比较两组之间的最佳矫正视力（BCVA）（最小分辨角对数）、术后 BCVA 和术后 ERM 生长情况。术后 6 个月、12 个月和最后一次就诊时确定术后 BCVA 和 ERM 生长情况。还分析了术后有和无症状 ERM 生长的病例之间的视力结果，这些病例导致视力损害并需要手术切除。
在组 1 中，术后 6 个月、12 个月和最后一次就诊时的平均术后 BCVA 分别为 0.00、-0.08 和-0.08 对数最小分辨角，在组 2 中，分别为-0.08、-0.08 和-0.08 对数最小分辨角，除了在 12 个月时，两组之间在每个时间点的差异均无统计学意义（P=0.027）。在组 1 中有 14 例发生 ERM，其中 7 例为有症状的。在组 2 中没有发生 ERM 生长。ERM 生长的发生率在组 1 中显著高于组 2（P＜0.001）。在有症状的 ERM 的 7 例病例中，6 个月（P=0.011）、12 个月（P=0.003）和最后一次就诊时（P=0.019）的 BCVA 明显更差（中位数分别为 0.30、0.15 和 0.10 对数最小分辨角），而在 48 例无症状的 ERM 病例中，BCVA 差异无统计学意义（中位数分别为-0.08、-0.08 和-0.08 对数最小分辨角）。
在保留黄斑的孔源性视网膜脱离患者中，内界膜剥除术并不会导致术后视力下降，而且该手术可显著预防术后 ERM 生长。有症状的 ERM 即使在手术后也会导致视力下降。这些结果支持内界膜剥除术在预防孔源性视网膜脱离修复术后 ERM 生长方面的有效性和功效。
