Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Laboratory of Retinal Cell Biology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Br J Ophthalmol. 2021 Dec;105(12):1683-1687. doi: 10.1136/bjophthalmol-2020-317478. Epub 2020 Oct 5.
BACKGROUND/AIMS: Pars plana vitrectomy (PPV) is widely performed in patients with idiopathic epiretinal membrane (iERM) to improve vision. Postoperative visual field defects (VFDs) have been previously reported. However, whether they occur when using the most recent PPV system, and the frequency of VFDs as measured by standard automated perimetry, remain poorly documented and were examined in this study.
Data of 30 eyes (30 patients; mean age, 66.1 years; 15 men) who underwent PPV for iERM during February 2016-June 2019 and had preoperative and postoperative visual field measurements using standard automated perimetry (Humphrey visual field analyser 30-2 program) were retrospectively analysed. Eyes with diseases other than iERM, including moderate-to-severe cataract or preoperative VFDs were excluded.
VFD, defined by the Anderson and Patella's criteria, was found in 73.3% of the eyes 1 month after PPV. After age adjustment, internal limiting membrane (ILM) peeling was identified as a risk factor for postoperative VFD (p=0.035; 95% CI 1.173 to 92.8). Postoperative VFD was frequently observed nasally (86.4%, p=0.002), and on optical coherence tomography measurements, ganglion cell layer (GCL) thinning was found temporal to the fovea (p=0.008). Thinning of the superior and inferior retinal nerve fibre layers and of the GCL temporal to the fovea were significant in eyes after ILM peeling (all p<0.05).
ILM peeling may cause inner retinal degeneration and lead to the development of VFDs after PPV, which should be further examined.
背景/目的： 板层玻璃体切除术（PPV）广泛应用于特发性视网膜内膜（iERM）患者，以改善视力。先前已有报道称术后视野缺损（VFD）。然而，使用最新的 PPV 系统时是否会发生这种情况，以及标准自动视野计测量的 VFD 频率，记录较差，本研究对此进行了检查。
回顾性分析了 2016 年 2 月至 2019 年 6 月期间因 iERM 接受 PPV 的 30 只眼（30 例患者；平均年龄 66.1 岁；男性 15 例）的数据，这些患者术前和术后均使用标准自动视野计（Humphrey 视野分析仪 30-2 程序）进行了视野测量。排除了患有除 iERM 以外的其他疾病的眼睛，包括中度至重度白内障或术前 VFD。
根据 Anderson 和 Patella 的标准，73.3%的眼在 PPV 后 1 个月发现 VFD。在年龄调整后，内界膜（ILM）剥离被确定为术后 VFD 的危险因素（p=0.035；95%CI 1.173 至 92.8）。术后 VFD 常观察到鼻侧（86.4%，p=0.002），在光学相干断层扫描测量中，发现视盘颞侧的神经节细胞层（GCL）变薄（p=0.008）。ILM 剥离后，眼内神经纤维层和 GCL 的上、下视网膜神经纤维层以及 GCL 视盘颞侧变薄均有统计学意义（所有 p<0.05）。
ILM 剥离可能导致内视网膜变性，并导致 PPV 后 VFD 的发生，这需要进一步检查。
