Caporossi Tomaso, Picardi Stefano Maria, Gambini Gloria, Baldascino Antonio, Carlà Matteo Mario, Molle Andrea, Scampoli Alessandra, Governatori Lorenzo, Rizzo Stanislao
Vitreoretinal Surgery Unit, Fatebenefratelli Isola Tiberina Gemelli Isola Hospital, 00186 Rome, Italy.
Ophthalmology Unit, Catholic University Sacro Cuore, 20123 Rome, Italy.
Life (Basel). 2023 Jan 17;13(2):253. doi: 10.3390/life13020253.
The aim of this study is to provide intraoperative data demonstrating a significant difference in the membrane peeling dynamics performed under a perfluorocarbon (PFCL) bubble, compared to normal balanced saline solution (BSS).
This is a prospective, interventional, single-center study on a series of 36 consecutive eyes of 36 patients affected by primary epiretinal membrane (ERM). Eighteen eyes underwent standard ERM peeling, while 18 eyes received a PFCL-assisted procedure. Intraoperative optical coherence tomography (iOCT) B-Scans were collected to evaluate the displacement angle (DA) between the underlying retinal plane and the flap of epiretinal tissue, along with the number of times the surgeon had to grab the flap during the intervention. Follow-up visits were carried out at postoperative week 1 and months 1, 3 and 6.
The mean DA was 164.8° ± 4.0 in the PFCL-assisted group and 119.7° ± 8.7 in the standard group, with a statistically significant difference between groups ( < 0.001). Moreover, we found a significant difference in the amount of ERM grabs between the two groups (7.2 ± 2.5 in the PFCL-assisted group vs. 10.3 ± 3.1 in the standard group, = 0.005). The mean BCVA and metamorphopsia significantly improved in both groups ( < 0.05), with no significant intergroup difference at all follow-up visits. Similarly, CST significantly decreased in both groups, and final CST was similar between the two groups ( = 0.719). Overall, three eyes in the standard group developed postoperative dissociated optic nerve fiber layer (DONFL, 16.6%), compared to none of the PFCL-assisted group.
We reported a statistically significant difference in the intraoperative peeling dynamics of the PFCL-assisted group, accounting for a decreased tendency in the tearing of the ERM flap and possibly reduced damage to the fiber layer, with equal effectiveness in improving visual function and foveal thickness.
本研究旨在提供术中数据，以证明与普通平衡盐溶液（BSS）相比，在全氟碳（PFCL）气泡下进行的膜剥离动力学存在显著差异。
这是一项前瞻性、干预性、单中心研究，对36例原发性视网膜前膜（ERM）患者的36只连续眼睛进行了研究。18只眼睛接受了标准的ERM剥离，而18只眼睛接受了PFCL辅助手术。术中收集光学相干断层扫描（iOCT）B扫描，以评估视网膜下层平面与视网膜前组织瓣之间的位移角度（DA），以及手术过程中外科医生抓取组织瓣的次数。术后第1周以及术后1、3和6个月进行随访。
PFCL辅助组的平均DA为164.8°±4.0，标准组为119.7°±8.7，两组之间存在统计学显著差异（<0.001）。此外，我们发现两组之间ERM抓取量存在显著差异（PFCL辅助组为7.2±2.5，标准组为10.3±3.1，=0.005）。两组的平均最佳矫正视力（BCVA）和视物变形均有显著改善（<0.05），在所有随访中组间均无显著差异。同样，两组的中心凹下视网膜厚度（CST）均显著降低，两组最终的CST相似（=0.719）。总体而言，标准组有3只眼睛出现了术后分离性视神经纤维层（DONFL，16.6%），而PFCL辅助组没有。
我们报告了PFCL辅助组术中剥离动力学存在统计学显著差异，这导致ERM瓣撕裂的趋势降低，可能减少了对纤维层的损伤，在改善视觉功能和黄斑厚度方面具有同等效果。
