Epiretinal membrane fragments: the origin of recurrent membranes after epiretinal membrane peeling
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Published on: September 6, 2018
Taiichi Hikichi1, Natsuki Kubo1, Moe Tabata1
1Hikichi Eye Clinic, Sapporo, Japan.
Objective:
To investigate the participation of residual fragments of epiretinal membranes (ERMs) in recurrent ERMs after pars plana vitrectomy (PPV) for ERMs.
Design:
Retrospective comparison study.
Participants:
Consecutive 195 eyes of 195 patients with ERMs who underwent PPV.
Methods:
Internal limiting membrane (ILM) was removed without use of Brilliant Blue G (BBG) dye in any eyes until May 2017 (group 1) and thereafter using BBG dye in all eyes (group 2). Optical coherence tomography (OCT) images were obtained 3 days and 3 years after PPV.
Results:
Group 1 was made up of 87 eyes, and group 2 was made up of 108 eyes. OCT images obtained 3 days after PPV showed ERM fragments with retinal surface wrinkling in 53 eyes (27.2%) and retinal surface wrinkling alone in 9 eyes (4.6%). OCT images obtained 3 years postoperatively showed ERMs in 63 eyes (32.3%), all of which except 1 eye had ERM fragments and (or) retinal surface wrinkling on OCT image 3 days after PPV. Residual ERM 3 days postoperatively grew in 20 (64.5%) of the 31 eyes with residual ERM 3 days postoperatively in group 1 and 5 (22.7%) of the 22 eyes with residual ERM 3 days postoperatively in group 2, which rates were significantly different (p = 0.003).
Conclusions:
ERM fragments may be the source of recurrent ERMs after PPV, and ILM peeling assisted with BBG dye may prevent growth of residual ERM. Eliminating ERM and ILM fragments intraoperatively may effectively reduce another surgery for ERM peeling.
Insights
Residual epiretinal membrane (ERM) fragments contribute to ERM recurrence after pars plana vitrectomy (PPV). Using Brilliant Blue G dye during internal limiting membrane (ILM) peeling may reduce recurrence rates.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Microscopy
Background:
- Epiretinal membranes (ERMs) can cause visual impairment.
- Recurrence of ERMs after pars plana vitrectomy (PPV) necessitates further surgical intervention.
- Identifying the source of ERM recurrence is crucial for improving surgical outcomes.
Purpose of the Study:
- To determine if residual epiretinal membrane (ERM) fragments contribute to recurrent ERMs following PPV.
- To evaluate the impact of internal limiting membrane (ILM) peeling with and without Brilliant Blue G (BBG) dye on ERM recurrence.
Main Methods:
- A retrospective comparison of 195 patients undergoing PPV for ERMs.
- Group 1: ILM removal without BBG dye. Group 2: ILM removal with BBG dye.
- Optical coherence tomography (OCT) imaging was performed 3 days and 3 years post-surgery.
Main Results:
- ERM fragments and retinal wrinkling were observed in 27.2% of eyes 3 days post-PPV.
- Recurrent ERMs were present in 32.3% of eyes at 3 years.
- Eyes treated with BBG dye showed significantly lower rates of residual ERM growth compared to those without (22.7% vs. 64.5%).
Conclusions:
- Residual ERM fragments are a likely source of ERM recurrence after PPV.
- ILM peeling facilitated by BBG dye may inhibit the growth of residual ERMs.
- Thorough intraoperative removal of ERM and ILM fragments could reduce the need for repeat surgeries.
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