Ophthalmology, Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi, 10, 56126, Pisa, Italy.
Int Ophthalmol. 2024 Feb 17;44(1):93. doi: 10.1007/s10792-024-02958-5.
The most common retinal complications after glaucoma surgery are choroidal detachment, hypotony maculopathy, malignant glaucoma, vitreous hemorrhage, endophthalmitis and retinal detachment. However, if glaucoma surgery is a risk factor for the ERM development needs to be clarified. This study aims to assess the incidence of epiretinal membrane (ERM) in 2 years of follow-up in patients with primary open-angle glaucoma (POAG) treated with Ex-Press shunt implant.
A prospective, consecutive, single-center, case-control study. We enrolled patients affected by POAG and scheduled for Ex-Press device implant with or without concomitant cataract surgery. The control group was the contralateral eyes which continues anti-glaucomatous eyedrops. Complete ophthalmologic evaluation and spectral-domain optical coherence tomography were performed before surgery, at 6 months and 24 months of follow-up.
Eighty-two eyes of 41 consecutive patients, 18 males and 23 females with a mean age of 70, 29 ± 8,45, were analyzed at 24 months. 39.1% of eyes developed ERM: 29.3% were cellophane macular reflex (CMR) and 9.8% were pre-macular fibrosis (PMF). In the control group, 19.5% of eyes developed ERM: 17.1% were CMR and 2.4% were PMF. No statistically significant difference was reported (p = 0.121) between treated and control group. ERM development did not affect significantly the central foveal thickness (260.13 ± 35.01 μm at baseline, 265.03 ± 34.90 μm at 6 months and 275.18 ± 33.31 μm at 24 months) and macular volume (7.75 ± 0.43 mm at baseline, 7.77 ± 0.48 mm at 6 months and 7.77 ± 0.46 mm at 24 months), remained comparable to reported average measures in healthy individuals during the follow-up. Concomitant cataract surgery did not increase the ERM incidence.
Ex-Press implant may increase the ERM incidence regardless concomitant cataract surgery, accelerating or inducing a posterior vitreous detachment, such as other ocular surgical procedure. Nevertheless, the vast majority of ERM are CMR, not affecting the macular profile.
青光眼手术后最常见的视网膜并发症是脉络膜脱离、低眼压性黄斑病变、恶性青光眼、玻璃体积血、眼内炎和视网膜脱离。然而，青光眼手术是否是 ERM 发展的危险因素仍需阐明。本研究旨在评估原发性开角型青光眼（POAG）患者在接受 Ex-Press 引流植入术后 2 年的内界膜（ERM）发生率。
这是一项前瞻性、连续的、单中心病例对照研究。我们纳入了接受 Ex-Press 装置植入术且伴或不伴并发性白内障手术的 POAG 患者。对照组为对侧眼，继续使用抗青光眼滴眼液。术前、术后 6 个月和 24 个月进行全面眼科评估和频域光学相干断层扫描。
41 例连续患者的 82 只眼（18 名男性，23 名女性，平均年龄 70 岁，29±8.45 岁）在 24 个月时进行了分析。39.1%的眼发生了 ERM：29.3%为窗膜黄斑反射（CMR），9.8%为黄斑前纤维（PMF）。对照组中，19.5%的眼发生了 ERM：17.1%为 CMR，2.4%为 PMF。两组间无统计学差异（p=0.121）。ERM 的发展并未显著影响中央黄斑厚度（基线时 260.13±35.01μm，术后 6 个月时 265.03±34.90μm，术后 24 个月时 275.18±33.31μm）和黄斑体积（基线时 7.75±0.43mm，术后 6 个月时 7.77±0.48mm，术后 24 个月时 7.77±0.46mm），在随访期间仍与健康个体的平均水平相当。伴发性白内障手术并未增加 ERM 的发生率。
Ex-Press 植入物可能会增加 ERM 的发生率，无论是否伴发白内障手术，加速或诱导后玻璃体脱离，就像其他眼部手术一样。然而，绝大多数 ERM 为 CMR，不会影响黄斑形态。
