Department of Ophthalmology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
Retina. 2021 Aug 1;41(8):1618-1626. doi: 10.1097/IAE.0000000000003094.
To assess the validity of retinal surface wrinkling (RSW) as an indicator to select patients relevant for internal limiting membrane peeling during vitrectomy for rhegmatogenous retinal detachment, to prevent postoperative visual decline due to epiretinal membrane growth.
This was a prospective, interventional case series of 78 consecutive eyes that underwent initial vitrectomy to repair rhegmatogenous retinal detachments and were followed for 6 months. The presence/absence of RSW was evaluated presurgically on en face optical coherence tomographic images. The internal limiting membrane was peeled if RSW was identified. The main outcome measure was the prevalence of postsurgical epiretinal membrane growth that caused a visual decline of 0.2 or more in logarithm of the minimum angle of resolution unit.
The internal limiting membrane was peeled for RSW appearance in 22 eyes (28.2%). Mild epiretinal membranes developed in 8 of the 56 internal limiting membrane-unpeeled eyes (10.3% of total, 6 eyes at stage 1 in the classification of Govetto); however, visual decline occurred in none of them with the mean visual acuity of these 8 eyes maintained at -0.08 ± 0.11 in logarithm of the minimum angle of resolution (≈20/16).
Visual decline due to epiretinal membrane growth after rhegmatogenous retinal detachment repair was entirely prevented by peeling the internal limiting membrane in about 30% of cases selected for the presence of RSW.
评估视网膜表面皱襞（RSW）作为选择在孔源性视网膜脱离玻璃体切除术中进行内界膜剥离以预防术后因视网膜前膜生长导致视力下降的指标的有效性。
这是一项连续 78 例孔源性视网膜脱离患者的前瞻性、干预性病例系列研究，随访时间为 6 个月。在手术前通过共焦光学相干断层扫描图像评估 RSW 的存在/缺失。如果存在 RSW，则进行内界膜剥离。主要观察指标是手术后导致最小角分辨率对数视力下降 0.2 或更多的视网膜前膜生长的发生率。
在 22 只眼（28.2%）中，因 RSW 外观而进行了内界膜剥离。在 56 只未进行内界膜剥离的眼中，有 8 只出现轻度视网膜前膜（总发生率为 10.3%，Govetto 分类中为 6 只处于 1 期）；然而，这些眼中没有一只出现视力下降，8 只眼的平均视力保持在对数最小角分辨率的-0.08 ± 0.11（≈20/16）。
在约 30%因存在 RSW 而选择进行内界膜剥离的病例中，完全预防了孔源性视网膜脱离修复后因视网膜前膜生长导致的视力下降。
