Περίληψη:
Purpose To correlate the frequency and extent of simultaneous
inadvertent internal limiting membrane (ILM) peeling during idiopathic
epiretinal membrane (ERM) removal with characteristics of ERM adherence
demonstrated on pre-operative spectral domain optical coherence
tomography (SD-OCT).
Patients and methods This is a prospective, observational, case series
of patients undergoing pars plana vitrectomy for idiopathic ERM. Inner
retina-ERM adhesion was categorized as focal, broad or complete in five
anatomic locations at macular area based on preoperative SD-OCT
findings. The extent of spontaneous ILM peeling was quantified on a
scale 0-100% in each of the aforementioned anatomic locations by the
operating surgeons who were masked to the OCT characteristics. All
operations were recorded with a high definition recording system and the
area of simultaneous ILM peel was quantified by a second masked
observer. The final extent of spontaneous ILM peel was calculated as the
average of the two scores.
Results Thirty consecutive subjects who underwent surgery for idiopathic
ERM were included in the study. Evidence of simultaneous ILM peeling was
identified in 80.3% of individuals. With regards to the type of
ERM-macula adhesion, inadvertent ILM peel was observed in 70% of the
patients who pre-operatively showed complete adhesion, in 43% with
broad adhesion and in only 21% with focal adhesion (P<0.001). The
extent of the spontaneous ILM peel during removal of ERM was also
significantly dependent on the type of ERM-inner retina adhesion. Total
simultaneous ILM peel was observed in 59% of locations with complete
ERM-macula adhesion but only in 22% and 7% of locations with broad and
focal adhesion respectively (P<0.001).
Conclusions Simultaneous ILM peel is a frequent occurrence during ERM
surgery, especially when there is complete or broad ERM adherence to the
macula. The type of ERM-inner retina adhesion represents a valid
predictor of the extent of simultaneous ILM peel during removal of ERM.
Thorough evaluation of preoperative OCT may be a useful tool in
determining a safer, more simplistic strategy in ERM surgery.
Συγγραφείς:
Tranos, P.
Wickham, L.
Dervenis, N.
Vakalis, A. and
Asteriades, S.
Stavrakas, P.
