Damasceno Nadyr A, Damasceno Eduardo F, Yannuzzi Nicolas A, Crane Ashley M, Relhan Nidhi, Smiddy William E, Flynn Harry W
Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
Department of Ophthalmology, Hospital Naval Marcilio Dias, Rio de Janeiro, RJ, Brazil.
Clin Ophthalmol. 2020 Aug 17;14:2353-2359. doi: 10.2147/OPTH.S254544. eCollection 2020.
To report both the unoperated clinical course and the surgical outcomes of eyes with a central foveal bouquet (CB) secondary to idiopathic epiretinal membranes (iERMs).
Retrospective, consecutive, and observational case series.
All patients examined between January 1, 2014, and December 31, 2019, for evaluation of epiretinal membrane with a CB lesion identified on spectral domain optical coherence tomography (SD-OCT) were included. Exclusion criteria included vitreoretinal comorbidities associated with secondary ERMs and an absence of CB lesions on SD-OCT. Patients were divided into two groups: those who were followed with observation (Group I) and those who received surgery (Group II). Each group had 3 different types of mechanical abnormalities of the CB previously described as cotton ball sign, subfoveal detachment, or acquired vitelliform lesion, without a subanalysis discrimination.
Best-corrected visual acuity (BCVA) at baseline and last follow-up, subjective metamorphopsia, central retinal thickness (CMT), mechanical stress lesions of the CB, and resolution or evolution of the CB lesions during the follow-up interval.
Two hundred seventy-six eyes with iERM were reviewed, and 46 eyes met the inclusion criteria. Among these, 21 of 46 (46%) were observed, and 25 of 46 (54%) underwent surgery. Metamorphopsia was identified in 61.9% of patients in Group I and 81.2% of patients in Group II, at baseline. The mean BCVA was 0.19 ± 0.17 (20/30) in Group I and 0.31 ± 0.33 (20/40) in Group II at presentation. At the final exam, patients in Group I achieved a mean BCVA of 0.24 ± 0.18 (20/30), while patients in Group II obtained a mean BCVA of 0.15 ± 0.21 (20/30). Spontaneous resolution of the CB sign occurred in 5 of 21 eyes (23.8%) that were observed, whereas, after surgery, the CB sign resolved in 16 of 25 eyes (61.5%). Mean CMT was 422 ± 84.2μm in Group I and 531 ± 143.9μm in Group II, at baseline, while at the latest follow-up, the mean CMT was 400 ± 40.8μm in the cases followed with observation and 454 ± 148.7μm in the surgical cases.
The clinical course and surgical outcomes of CB findings in iERM are favorable in terms of visual acuity. However, those receiving surgery had an increase in visual acuity and resolution of the CB abnormality.
报告继发于特发性视网膜前膜（iERM）的中心凹束状（CB）眼的非手术临床病程及手术结果。
回顾性、连续性观察病例系列。
纳入2014年1月1日至2019年12月31日期间接受检查以评估视网膜前膜且在光谱域光学相干断层扫描（SD-OCT）上发现有CB病变的所有患者。排除标准包括与继发性视网膜前膜相关的玻璃体视网膜合并症以及SD-OCT上无CB病变。患者分为两组：观察组（I组）和手术组（II组）。每组有3种先前描述的CB机械性异常类型，即棉球征、黄斑下脱离或后天性卵黄样病变，未进行亚分析区分。
基线及末次随访时的最佳矫正视力（BCVA）、主观视物变形、中心视网膜厚度（CMT）、CB的机械性应力病变以及随访期间CB病变的消退或进展情况。
对276只iERM眼进行了评估，46只眼符合纳入标准。其中，46只眼中的21只（46%）进行观察，46只眼中的25只（54%）接受了手术。基线时，I组61.9%的患者和II组81.2%的患者存在视物变形。I组初诊时平均BCVA为0.19±0.17（20/30），II组为0.31±0.33（20/40）。在最后一次检查时，I组患者平均BCVA为0.24±0.18（20/30），而II组患者平均BCVA为0.15±0.21（20/30）。观察组21只眼中有5只（23.8%）的CB征自发消退，而手术后，25只眼中有16只（61.5%）的CB征消退。基线时，I组平均CMT为422±84.2μm，II组为531±143.9μm，而在最近一次随访时，观察组患者平均CMT为400±40.8μm，手术组患者为454±148.7μm。
iERM中CB表现的临床病程及手术结果在视力方面是良好的。然而，接受手术的患者视力有所提高且CB异常得到消退。
