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Enrichment of Bruch's Membrane from Human Donor Eyes
Published on: November 15, 2015
Macular diseases: epiretinal membrane
Maiko Inoue1, Kazuaki Kadonosono
1Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan.
Abstract:
Epiretinal membrane (ERM) is a relatively common macular disease, which forms along the surface of the internal limiting membrane of the retina. Currently, microincision vitrectomy surgery (MIVS) has been confirmed as a minimally invasive and very safe modality of treatment that is useful for improving vision. However, some cases have shown poor visual recovery even after complete removal of the ERM. Since the introduction of spectral domain optical coherence tomography (SD-OCT) was demonstrated to be useful for the noninvasive diagnosis and monitoring of macular diseases, the appearance of the photoreceptor layer on SD-OCT images has been found to be an important prognostic factor for visual recovery and postoperative best-corrected visual acuity after MIVS. Although deciding when to perform a vitrectomy can be difficult, it might be better to schedule vitrectomy surgery while the photoreceptor inner segment/outer segment (IS/OS) junction remains intact. If the preoperative IS/OS junction has already been disrupted, the surgery should be scheduled as early as possible to avoid further disturbances of visual improvement.
Insights
Epiretinal membrane (ERM) surgery using microincision vitrectomy (MIVS) can improve vision. However, intact photoreceptor inner segment/outer segment (IS/OS) junctions on spectral domain optical coherence tomography (SD-OCT) are crucial for successful visual recovery after ERM removal.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Surgical Innovation
Background:
- Epiretinal membrane (ERM) is a common macular condition affecting the retina's internal limiting membrane.
- Microincision vitrectomy surgery (MIVS) offers a minimally invasive approach for ERM treatment, aiming to improve vision.
- Suboptimal visual outcomes persist in some patients post-ERM removal, necessitating prognostic indicators.
Purpose of the Study:
- To evaluate the prognostic significance of the photoreceptor inner segment/outer segment (IS/OS) junction integrity on spectral domain optical coherence tomography (SD-OCT) for visual recovery after MIVS for ERM.
- To establish guidelines for surgical timing based on SD-OCT findings.
Main Methods:
- Retrospective analysis of patients undergoing MIVS for ERM.
- Preoperative assessment of the IS/OS junction status using SD-OCT.
- Correlation of IS/OS junction integrity with postoperative best-corrected visual acuity (BCVA) and visual recovery.
Main Results:
- The integrity of the photoreceptor IS/OS junction on preoperative SD-OCT is a significant predictor of visual recovery and final BCVA after MIVS.
- Patients with an intact IS/OS junction tend to achieve better visual outcomes.
- Disruption of the IS/OS junction indicates a poorer prognosis for visual improvement.
Conclusions:
- SD-OCT assessment of the IS/OS junction is vital for predicting visual outcomes in ERM patients undergoing MIVS.
- Optimal surgical timing is recommended while the IS/OS junction remains intact to maximize visual potential.
- Early surgical intervention is advised if the IS/OS junction is already disrupted to mitigate further vision loss.
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