Abstract
Purpose: The aim of the present study was to analyze the effect of phacoemulsification on outcomes among patients undergoing vitrectomy with membrane peeling for idiopathic epiretinal membranes, with respect to new postoperative intraretinal cystoid changes and early transient macular edema. Procedures: This retrospective analysis included patients from 6 prospective studies, examining outcomes of 23G pars plana vitrectomy with membrane peeling due to idiopathic epiretinal membranes. Phacovitrectomy with membrane peeling was performed only in the case of coexisting vision affecting cataract. Optical coherence tomography was performed prior to surgery, in the first week, and 3 months after surgery. Results: In total, 183 patients were included. The occurrence of new postoperative intraretinal cystoid changes and early transient macular edema showed a trend toward being higher among patients undergoing phacovitrectomy with membrane peeling, compared to vitrectomy with membrane peeling alone, but it did not reach statistical significance (p = 0.5 and p = 0.186). The final best corrected distance visual acuity (BCVA) 3 months after surgery was significantly lower among patients with new postoperative intraretinal cystoid changes compared to patients without (with a median difference of 1 line between groups; p = 0.016). Conclusions: New postoperative intraretinal cystoid changes and early transient macular edema are more frequent among patients undergoing phacovitrectomy with membrane peeling compared to patients with vitrectomy with membrane peeling alone.
References
1.
Mitchell
P
, Smith
W
, Chey
T
, Wang
JJ
, Chang
A
. Prevalence and associations of epiretinal membranes. The Blue Mountains Eye Study, Australia
. Ophthalmology
. 1997
Jun
;104
(6
):1033
–40
.
[PubMed]
0161-64202.
Aung
KZ
, Makeyeva
G
, Adams
MK
, Chong
EW
, Busija
L
, Giles
GG
, et al. The prevalence and risk factors of epiretinal membranes: the Melbourne Collaborative Cohort Study
. Retina
. 2013
May
;33
(5
):1026
–34
.
[PubMed]
0275-004X3.
Ng
CH
, Cheung
N
, Wang
JJ
, Islam
AF
, Kawasaki
R
, Meuer
SM
, et al. Prevalence and risk factors for epiretinal membranes in a multi-ethnic United States population
. Ophthalmology
. 2011
Apr
;118
(4
):694
–9
.
[PubMed]
0161-64204.
Kohno
RI
, Hata
Y
, Kawahara
S
, Kita
T
, Arita
R
, Mochizuki
Y
, et al. Possible contribution of hyalocytes to idiopathic epiretinal membrane formation and its contraction
. Br J Ophthalmol
. 2009
Aug
;93
(8
):1020
–6
.
[PubMed]
0007-11615.
Zhao
F
, Gandorfer
A
, Haritoglou
C
, Scheler
R
, Schaumberger
MM
, Kampik
A
, et al. Epiretinal cell proliferation in macular pucker and vitreomacular traction syndrome: analysis of flat-mounted internal limiting membrane specimens
. Retina
. 2013
Jan
;33
(1
):77
–88
.
[PubMed]
0275-004X6.
Sebag
J
. Anatomy and pathology of the vitreo-retinal interface
. Eye (Lond)
. 1992
;6
(Pt 6
):541
–52
.
[PubMed]
0950-222X7.
Guidry
C
. The role of Müller cells in fibrocontractive retinal disorders
. Prog Retin Eye Res
. 2005
Jan
;24
(1
):75
–86
.
[PubMed]
1350-94628.
Vinores
SA
, Campochiaro
PA
, McGehee
R
, Orman
W
, Hackett
SF
, Hjelmeland
LM
. Ultrastructural and immunocytochemical changes in retinal pigment epithelium, retinal glia, and fibroblasts in vitreous culture
. Invest Ophthalmol Vis Sci
. 1990
Dec
;31
(12
):2529
–45
.
[PubMed]
0146-04049.
Mitamura
Y
, Hirano
K
, Baba
T
, Yamamoto
S
. Correlation of visual recovery with presence of photoreceptor inner/outer segment junction in optical coherence images after epiretinal membrane surgery
. Br J Ophthalmol
. 2009
Feb
;93
(2
):171
–5
.
[PubMed]
0007-116110.
Suh
MH
, Seo
JM
, Park
KH
, Yu
HG
. Associations between macular findings by optical coherence tomography and visual outcomes after epiretinal membrane removal
. Am J Ophthalmol
. 2009
Mar
;147
(3
):473
–480.e3
.
[PubMed]
0002-939411.
Oster
SF
, Mojana
F
, Brar
M
, Yuson
RM
, Cheng
L
, Freeman
WR
. Disruption of the photoreceptor inner segment/outer segment layer on spectral domain-optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes
. Retina
. 2010
May
;30
(5
):713
–8
.
[PubMed]
0275-004X12.
Inoue
M
, Morita
S
, Watanabe
Y
, Kaneko
T
, Yamane
S
, Kobayashi
S
, et al. Preoperative inner segment/outer segment junction in spectral-domain optical coherence tomography as a prognostic factor in epiretinal membrane surgery
. Retina
. 2011
Jul-Aug
;31
(7
):1366
–72
.
[PubMed]
0275-004X13.
Shimozono
M
, Oishi
A
, Hata
M
, Matsuki
T
, Ito
S
, Ishida
K
, et al. The significance of cone outer segment tips as a prognostic factor in epiretinal membrane surgery
. Am J Ophthalmol
. 2012
Apr
;153
(4
):698
–704
.
[PubMed]
0002-939414.
Watanabe
K
, Tsunoda
K
, Mizuno
Y
, Akiyama
K
, Noda
T
. Outer retinal morphology and visual function in patients with idiopathic epiretinal membrane
. JAMA Ophthalmol
. 2013
Feb
;131
(2
):172
–7
.
[PubMed]
2168-616515.
Cobos
E
, Arias
L
, Ruiz-Moreno
J
, Rubio
M
, Garcia-Bru
P
, Caminal
J
, et al. Preoperative study of the inner segment/outer segment junction of photoreceptors by spectral-domain optical coherence tomography as a prognostic factor in patients with epiretinal membranes
. Clin Ophthalmol
. 2013
;7
:1467
–70
.
[PubMed]
1177-546716.
Govetto
A
, Virgili
G
, Rodriguez
FJ
, Figueroa
MS
, Sarraf
D
, Hubschman
JP
. Functional and anatomical significance of the ectopic inner foveal layers in eyes with idiopathic epiretinal membranes: surgical results at 12 months
. Retina
. 2019
Feb
;39
(2
):347
–57
.
[PubMed]
0275-004X17.
Liu
H
, Zuo
S
, Ding
C
, Dai
X
, Zhu
X
. Comparison of the Effectiveness of Pars Plana Vitrectomy with and without Internal Limiting Membrane Peeling for Idiopathic Retinal Membrane Removal: A Meta-Analysis
. J Ophthalmol
. 2015
;2015
:974568
.
[PubMed]
2090-004X18.
Chang
WC
, Lin
C
, Lee
CH
, Sung
TL
, Tung
TH
, Liu
JH
. Vitrectomy with or without internal limiting membrane peeling for idiopathic epiretinal membrane: A meta-analysis
. PLoS One
. 2017
Jun
;12
(6
):e0179105
.
[PubMed]
1932-620319.
Schechet
SA
, DeVience
E
, Thompson
JT
. The effect of internal limiting membrane peeling on the idiopathic epiretinal membrane surgery, with a review of the literature
. Retina
. 2017
May
;37
(5
):873
–80
.
[PubMed]
0275-004X20.
Azuma
K
, Ueta
T
, Eguchi
S
, Aihara
M
. EFFECTS OF INTERNAL LIMITING MEMBRANE PEELING COMBINED WITH REMOVAL OF IDIOPATHIC EPIRETINAL MEMBRANE: A Systematic Review of Literature and Meta-Analysis
. Retina
. 2017
Oct
;37
(10
):1813
–9
.
[PubMed]
0275-004X21.
Díaz-Valverde
A
, Wu
L
. To peel or not to peel the internal limiting membrane in idiopathic epiretinal membranes
. Retina
. 2018
Sep
;38
Suppl 1
:S5
–11
.
[PubMed]
0275-004X22.
Bonnet
S
, Locht
B
. [Cataract and epi-retinal macular membrane extraction: a 1 or 2 time operation]
. Bull Soc Belge Ophtalmol
. 1999
;272
:73
–5
.
[PubMed]
0081-074623.
Frisina
R
, Pinackatt
SJ
, Sartore
M
, Monfardini
A
, Baldi
A
, Cesana
BM
, et al. Cystoid macular edema after pars plana vitrectomy for idiopathic epiretinal membrane
. Graefes Arch Clin Exp Ophthalmol
. 2015
Jan
;253
(1
):47
–56
.
[PubMed]
0721-832X24.
Leisser
C
, Hirnschall
N
, Hackl
C
, Döller
B
, Varsits
R
, Ullrich
M
, et al. Risk factors for postoperative intraretinal cystoid changes after peeling of idiopathic epiretinal membranes among patients randomized for balanced salt solution and air-tamponade
. Acta Ophthalmol
. 2018
Jun
;96
(4
):e439
–44
.
[PubMed]
1755-375X25.
Savastano
A
, Savastano
MC
, Barca
F
, Petrarchini
F
, Mariotti
C
, Rizzo
S
. Combining cataract surgery with 25-gauge high-speed pars plana vitrectomy: results from a retrospective study
. Ophthalmology
. 2014
Jan
;121
(1
):299
–304
.
[PubMed]
0161-642026.
Dugas
B
, Ouled-Moussa
R
, Lafontaine
PO
, Guillaubey
A
, Berrod
JP
, Hubert
I
, et al. Idiopathic epiretinal macular membrane and cataract extraction: combined versus consecutive surgery
. Am J Ophthalmol
. 2010
Feb
;149
(2
):302
–6
.
[PubMed]
0002-939427.
Hamoudi
H
, Correll Christensen
U
, La Cour
M
. Epiretinal membrane surgery: an analysis of 2-step sequential- or combined phacovitrectomy surgery on refraction and macular anatomy in a prospective trial
. Acta Ophthalmol
. 2018
May
;96
(3
):243
–50
.
[PubMed]
1755-375X28.
Mylonas
G
, Sacu
S
, Deák
G
, Dunavoelgyi
R
, Buehl
W
, Georgopoulos
M
, et al.; Macula Study Group Vienna
. Macular edema following cataract surgery in eyes with previous 23-gauge vitrectomy and peeling of the internal limiting membrane
. Am J Ophthalmol
. 2013
Feb
;155
(2
):253
–259.e2
.
[PubMed]
0002-939429.
Leisser
C
, Hackl
C
, Hirnschall
N
, Luft
N
, Döller
B
, Draschl
P
, et al. Visualizing Macular Structures During Membrane Peeling Surgery With an Intraoperative Spectral-Domain Optical Coherence Tomography Device
. Ophthalmic Surg Lasers Imaging Retina
. 2016
Apr
;47
(4
):328
–32
.
[PubMed]
2325-816030.
Leisser
C
, Hirnschall
N
, Findl
O
. Subfoveal fluid and intraretinal edema 2 days after uneventful phacoemulsification
. Spektrum Augenheilkd
. 2017
;31
(5
):212
–3
. 0930-428231.
Leisser
C
, Hackl
C
, Hirnschall
N
, Findl
O
. Effect of subfoveal and extrafoveal hyporeflective zones due to iatrogenic traction during membrane peeling for epiretinal membranes on postoperative outcomes
. Ophthalmologica
. 2019
;5
:
[PubMed]
0030-375532.
Leisser
C
, Hirnschall
N
, Findl
O
. Effect of Air Tamponade on Tilt of the Intraocular Lens after Phacovitrectomy
. Ophthalmologica
. 2019
;242
(2
):118
–22
.
[PubMed]
0030-375533.
Leisser
C
, Hirnschall
N
, Palkovits
S
, Doeller
B
, Kefer
K
, Findl
O
. Intraoperative Optical Coherence Tomography-Guided Membrane Peeling for Surgery of Macular Pucker: advantages and Limitations
. Ophthalmologica
. 2019
;241
(4
):234
–40
.
[PubMed]
0030-375534.
Leisser
C
, Stimpfl
T
, Ruiss
M
, Pilwachs
C
, Hienert
J
, Fisus
A
, et al. Caffeine uptake into the vitreous after peroral coffee consumption
. Ophthalmic Res
. 2020
Mar
;•••
:
[PubMed]
0030-374735.
Miyake
K
, Mibu
H
, Horiguchi
M
, Shirasawa
E
. Inflammatory mediators in postoperative aphakic and pseudophakic baboon eyes
. Arch Ophthalmol
. 1990
Dec
;108
(12
):1764
–7
.
[PubMed]
0003-995036.
Bucci
FA
Jr, Waterbury
LD
. Prostaglandin E2 inhibition of ketorolac 0.45%, bromfenac 0.09%, and nepafenac 0.1% in patients undergoing phacoemulsification
. Adv Ther
. 2011
Dec
;28
(12
):1089
–95
.
[PubMed]
0741-238X37.
Hwang
HS
, Ahn
YJ
, Lee
HJ
, Kim
MS
, Kim
EC
. Comparison of macular thickness and inflammatory cytokine levels after microincision versus small incision coaxial cataract surgery
. Acta Ophthalmol
. 2016
May
;94
(3
):e189
–94
.
[PubMed]
1755-375X38.
Liu
YC
, Setiawan
M
, Ang
M
, Yam
GH
, Mehta
JS
. Changes in aqueous oxidative stress, prostaglandins, and cytokines: comparisons of low-energy femtosecond laser-assisted cataract surgery versus conventional phacoemulsification
. J Cataract Refract Surg
. 2019
Feb
;45
(2
):196
–203
.
[PubMed]
0886-335039.
Siegfried
CJ
, Shui
YB
, Tian
B
, Nork
TM
, Heatley
GA
, Kaufman
PL
. Effects of vitrectomy and lensectomy on older rhesus macaques: oxygen distribution, antioxidant status, and aqueous humor dynamics
. Invest Ophthalmol Vis Sci
. 2017
Aug
;58
(10
):4003
–14
.
[PubMed]
0146-040440.
Sant
DW
, Camarena
V
, Mustafi
S
, Li
Y
, Wilkes
Z
, Van Booven
D
, et al. Ascorbate suppresses VEGF expression in retinal pigment epithelial cells
. Invest Ophthalmol Vis Sci
. 2018
Jul
;59
(8
):3608
–18
.
[PubMed]
0146-040441.
Wong
DC
, Waxman
MD
, Herrinton
LJ
, Shorstein
NH
. Transient macular edema after intracameral injection of a moderately elevated dose of cefuroxime during phacoemulsification surgery
. JAMA Ophthalmol
. 2015
Oct
;133
(10
):1194
–7
.
[PubMed]
2168-616542.
Buyukyildiz
HZ
, Gulkilik
G
, Kumcuoglu
YZ
. Early serous macular detachment after phacoemulsification surgery
. J Cataract Refract Surg
. 2010
Nov
;36
(11
):1999
–2002
.
[PubMed]
0886-335043.
Fuller
D
, Machemer
R
, Knighton
RW
. Retinal damage produced by intraocular fiber optic light
. Am J Ophthalmol
. 1978
Apr
;85
(4
):519
–37
.
[PubMed]
0002-939444.
Azzolini
C
, Brancato
R
, Venturi
G
, Bandello
F
, Pece
A
, Santoro
P
. Updating on intraoperative light-induced retinal injury
. Int Ophthalmol
. 1994-1995-1995
;18
(5
):269
–76
.
[PubMed]
0165-570145.
van den Biesen
PR
, Berenschot
T
, Verdaasdonk
RM
, van Weelden
H
, van Norren
D
. Endoillumination during vitrectomy and phototoxicity thresholds
. Br J Ophthalmol
. 2000
Dec
;84
(12
):1372
–5
.
[PubMed]
0007-116146.
Miller
SA
, Landry
RJ
, Byrnes
GA
. Endoilluminators: evaluation of potential retinal hazards
. Appl Opt
. 2004
Mar
;43
(8
):1648
–53
.
[PubMed]
1559-128X47.
Ham
WT
Jr, Mueller
HA
, Ruffolo
JJ
Jr, Guerry
D
3rd, Guerry
RK
. Action spectrum for retinal injury from near-ultraviolet radiation in the aphakic monkey
. Am J Ophthalmol
. 1982
Mar
;93
(3
):299
–306
.
[PubMed]
0002-939448.
Coppola
M
, Cicinelli
MV
, Rabiolo
A
, Querques
G
, Bandello
F
. Importance of Light Filters in Modern Vitreoretinal Surgery: An Update of the Literature
. Ophthalmic Res
. 2017
;58
(4
):189
–93
.
[PubMed]
0030-374749.
Leisser
C
, Bartl
G
. [Comparison of preoperative retinometer values with postoperative visual acuity after surgery of epiretinal membranes]
. Klin Monatsbl Augenheilkd
. 2004
Jun
;221
(6
):485
–8
.
[PubMed]
0023-216550.
Leisser
C
, Bartl
G
. Visual acuity 4 years after excision of epiretinal membranes
. Spektrum Augenheilkd
. 2005
;19
(6
):341
–3
. 0930-4282© 2020 S. Karger AG, Basel
2020
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
