Complete epiretinal membrane separation in highly myopic eyes with retinal detachment resulting from a macular hole
Y Oshima1, Y Ikuno, M Motokura
1Department of Ophthalmology, Osaka Rosai Hospital, Sakai-City, Japan. y-oshima@orh.go.jp
Purpose:
Epiretinal membranes (ERMs) in highly myopic eyes may result in macular holes and subsequent retinal detachment. However, removing friable, thin ERMs from detached retinas is often difficult. We report the efficacy of a diamond-dusted silicone cannula in the removal of ERMs from detached retinas.
Methods:
Seventeen consecutive highly myopic eyes (16 patients) with retinal detachment underwent pars plana vitrectomy with gas tamponade. Peeling of the ERM adjacent to the macular hole was performed using either conventional tools (n = 11) or a diamond-dusted silicone cannula (n = 6). The rate of complete membrane peeling and the effect of membrane removal on the anatomic success rate were compared between groups.
Results:
Retinal reattachment occurred in 13 (92.9%) of the 14 eyes in which the ERM was removed completely; redetachment occurred in the other three eyes, with further surgical interventions in two eyes. The reattachment rate was significantly higher (P = .005) when ERM removal was complete than when there was residual ERM. In the initial surgery, the ERM was successfully removed in all 6 eyes (100%) in the diamond-dusted silicone cannula group and in 5 of 11 eyes (45.5%) in the conventional group (P = .041); the reattachment rate was 100% in the diamond-dusted silicone cannula group and 45.5% in the conventional group (P = .005). When a second surgery was performed, the use of the diamond-dusted silicone cannula was also better than conventional tools for removing the residual ERMs, resulting in retinal reattachment.
Conclusion:
In highly myopic eyes with a macular hole and subsequent retinal detachment, complete ERM removal is closely related to successful retinal reattachment. The diamond-dusted silicone cannula appears to be more effective than conventional tools for removing ERM and may increase the anatomic success rate. Because of the limitations of a small series, a prospective, randomized trial is required to confirm the current beneficial results of using a diamond-dusted silicone cannula.
Insights
A novel diamond-dusted silicone cannula effectively removes epiretinal membranes (ERMs) in highly myopic eyes with retinal detachment, improving surgical success and retinal reattachment rates compared to conventional tools.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Microsurgery
Background:
- Epiretinal membranes (ERMs) in highly myopic eyes can lead to macular holes and retinal detachment.
- Removing thin, friable ERMs from detached retinas presents significant surgical challenges.
Purpose of the Study:
- To evaluate the efficacy of a diamond-dusted silicone cannula for removing ERMs in highly myopic eyes with retinal detachment.
- To compare the outcomes of using the diamond-dusted silicone cannula versus conventional tools for ERM removal.
Main Methods:
- A comparative study involving 17 highly myopic eyes (16 patients) undergoing pars plana vitrectomy for retinal detachment.
- ERM peeling was performed using either conventional instruments (n=11) or a diamond-dusted silicone cannula (n=6).
- Outcomes assessed included complete membrane peeling rate and the impact on anatomic success (retinal reattachment).
Main Results:
- Complete ERM removal was achieved in 100% of cases using the diamond-dusted silicone cannula, compared to 45.5% with conventional tools (P=.041).
- Retinal reattachment rates were 100% in the diamond-dusted cannula group versus 45.5% in the conventional group (P=.005).
- The diamond-dusted cannula also demonstrated superior efficacy in secondary surgeries for residual ERMs.
Conclusions:
- Complete epiretinal membrane removal is crucial for successful retinal reattachment in highly myopic eyes with macular holes and detachment.
- The diamond-dusted silicone cannula appears more effective than conventional tools for ERM removal, potentially increasing anatomic success rates.
- Further prospective, randomized trials are warranted to validate these findings due to the small sample size.
