J Korean Ophthalmol Soc.  2013 Jul;54(7):1038-1045. 10.3341/jkos.2013.54.7.1038.

The Effect of Internal Limiting Membrane Peeling in Epiretinal Membrane Including Pseudolamellar Macular Hole

• Oh SY
• Lee SJ
• Park JM

• KMID: 2217413
• DOI: http://doi.org/10.3341/jkos.2013.54.7.1038

Abstract

PURPOSE
To report the effect and visual improvement of internal limiting membrane (ILM) peeling, and epiretinal membrane (ERM) peeling in symptomatic ERM with pseudolamellar macular hole.
METHODS
This study included 27 eyes in 26 consecutive patients with ERM including pseudolamellar macular hole that underwent vitrectomy, ERM peeling, intravitreal gas tamponade, and maintained a face-down position for 7 days. ILM peeling was performed only in 13 eyes of 13 patients. The patients were divided into 2 groups: eyes with or without ILM peeling (14 eyes and 13 eyes, respectively) and the follow-up period was 12 months or more in all cases. The postoperative anatomic results based on optical coherence tomography (OCT) and improvement of best corrected visual acuity (BCVA) were retrospectively compared between the 2 groups.
RESULTS
Anatomic closure after surgery was achieved in 11 eyes (78.6%) in the ILM without peeling group and in 12 eyes (92.3%) in the ILM with peeling group (p = 0.596). The BCVA improved from 0.41 +/- 0.31 (log MAR) to 0.33 +/- 0.21 in the ILM without peeling group (p = 0.479) and from 0.46 +/- 0.41 (log MAR) to 0.28 +/- 0.25 in the ILM with peeling group (p = 0.001).
CONCLUSIONS
ILM peeling with the addition of ERM peeling is an effective technique for BCVA improvement in the ERM with pseudolamellar macular hole. Vitrectomy, ERM peeling, gas tamponade, and ILM peeling are important for anatomic and functional success in the ERM with pseudolamellar macular hole.

Keyword

Epiretinal membrane; Internal limiting membrane peeling; Pseudolamellar macular hole

MeSH Terms

Epiretinal Membrane
Eye
Follow-Up Studies
Humans
Membranes
Retinal Perforations
Retrospective Studies
Tomography, Optical Coherence
Visual Acuity
Vitrectomy

Figure

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  Figure 1. (A) Preoperative OCT image with visual acuity log MAR 0.52. This image shows the ERM and fulfills the criteria for OCT diagnosis of lamellar macular hole (1) irregular foveal contour; (2) dehiscence in the inner fovea; (3) separation of the inner from the outer fovea retinal layers, leading to an intraretinal split; (4) absence of a full-thickness foveal defect. (B) OCT at 12 months after operation with visual acuity log MAR 0.22. This image shows the postoperative normalization of the fovea contour.

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  Figure 2. (A) Preoperative OCT image with visual acuity log MAR 0.40. This image shows the ERM and fulfills the OCT diagnosis of macular pseudohole (1) centripetal contraction of an ERM; (2) steepened foveal pit; (3) well-demarcated round or oval shape. (B) OCT at 12 months after operation with visual acuity log MAR 0.22. This image shows the postoperative normalization of the fovea contour.

Reference

References

1. Gass JD. Lamellar macular hole: a complication of cystoid macular edema after cataract extraction: a clinicopathologic case report. Trans Am Ophthalmol Soc. 1975; 73:231–50.

2. Allen AW Jr, Gass JD. Contraction of a perifoveal epiretinal mem-brane simulating a macular hole. Am J Ophthalmol. 1976; 82:684–91.

3. Gass JDM. Vitreofoveal separation and lamellar hole formation Steroscopic atlas of macular disease: diagnosis and treatment. 4th ed. St Louis: CV Mosby;p. p 926–7.

4. Takahashi H, Kishi S. Tomographic features of a lamellar macular hole formation and a lamellar hole that progressed to a full-thick-ness macular hole. Am J Ophthalmol. 2000; 130:677–9.

5. Haouchine B, Massin P, Tadayoni R, et al. Diagnosis of macular pseudoholes and lamellar macular holes by optical coherence tomography. Am J Ophthalmol. 2004; 138:732–9.

6. Witkin AJ, Ko TH, Fujimoto JG, et al. Redefining lamellar holes and the vitreomacular interface: an ultrahigh-resolution optical co-herence tomography study. Ophthalmology. 2006; 113:388–97.

7. Chen JC, Lee LR. Clinical spectrum of lamellar macular defects in-cluding pseudoholes and pseudocysts defined by optical coherence tomography. Br J Ophthalmol. 2008; 92:1342–6.

8. Androudi S, Stangos A, Brazitikos PD. Lamellar macular holes: to-mographic features and surgical outcome. Am J Ophthalmol. 2009; 148:420–6.

9. Kinoshita T, Kovacs KD, Wagley S, Arroyo JG. Morphologic dif-ferences in epiretinal membranes on ocular coherence tomography as a predictive factor for surgical outcome. Retina. 2011; 31:1692–8.

10. Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol. 1991; 109:654–9.

11. Haouchine B, Massin P, Gaudric A. Foveal pseudocyst as the first step in macular hole formation: a prospective study by optical co-herence tomography. Ophthalmology. 2001; 108:15–22.

12. Michalewski J, Michalewska Z, Dzię gielewski K, et al. Evolution from macular pseudohole to lamellar macular hole - spectral do-main OCT study. Graefes Arch Clin Exp Ophthalmol. 2011; 249:175–8.

13. Fine BS. Limiting membranes of the sensory retina and pigment epithelium. An electron microscopic study. Arch Ophthalmol. 1961; 66:847–60.

14. de Bustros S, Thompson JT, Michels RG, et al. Vitrectomy for idio-pathic epiretinal membranes causing macular pucker. Br J Ophthalmol. 1988; 72:692–5.

15. de Bustros S, Rice TA, Michels RG, et al. Vitrectomy for macular pucker. Use after treatment of retinal tears or retinal detachment. Arch Ophthalmol. 1988; 106:758–60.

16. Mittleman D, Green WR, Michels RG, de la Cruz Z. Clinicopathologic correlation of an eye after surgical removal of an epiretinal membrane. Retina. 1989; 9:143–7.

17. Witkin AJ, Castro LC, Reichel E, et al. Anatomic and visual out-comes of vitrectomy for lamellar macular holes. Ophthalmic Surg Lasers Imaging. 2010; 41:418–24.

18. Michalewska Z, Michalewski J, Odrobina D, et al. Surgical treat-ment of lamellar macular holes. Graefes Arch Clin Exp Ophthalmol. 2010; 248:1395–400.

19. Garretson BR, Pollack JS, Ruby AJ, et al. Vitrectomy for a sympto-matic lamellar macular hole. Ophthalmology. 2008; 115:884–6.

20. Haritoglou C, Gass CA, Schaumberger M, et al. Macular changes after peeling of the internal limiting membrane in macular hole surgery. Am J Ophthalmol. 2001; 132:363–8.

21. Uemoto R, Yamamoto S, Takeuchi S. Epimacular proliferative re-sponse following internal limiting membrane peeling for idio-pathic macular holes. Graefes Arch Clin Exp Ophthalmol. 2004; 242:177–80.

22. Simddy WE, Feuer W, Cordahi G. Internal limiting membrane peel-ing in macular hole Surgery. Ophthalmology. 2001; 108:1471–8.

23. Engelbrecht NE, Freeman J, Sternberg Jr P, et al. Retinal pigment epithelial changes after macular hole surgery with indocyanine green-assisted internal limiting membrane peeling. Am J Ophthalmol. 2002; 133:89–94.

24. Gale JS, Proulx AA, Gonder JR, et al. Comparison of the in vitro toxicity of green to that of trypan blue in human retinal pigment ep-ithelium cell cultures. Am J Ophthalmol. 2004; 138:64–9.

25. Umeura A, Kanda S, Sakamoto Y, Kita H. Visual field defects after uneventful vitrectomy for epiretinal membrane with indocyanine green-assisted internal limiting membrane peeling. Am J Ophthalmol. 2003; 136:252–7.

26. Kwok AK, Lai TY, Yuen KS, et al. Macular hole surgery with or without indocyanine green stained internal limiting peeling. Clin Exp Ophthalmol. 2003; 31:470–5.

27. Park UC, Park KH, Yu YS, Chung H. Comparision of indocyanine green and triamcinolone acetonide for internal limiting membrane peeling in macular hole. J Korean Ophthalmol Soc. 2005; 46:1995–2003.

28. Lee SJ, Jang SY, Moon D, et al. Long-term surgical outcomes after vitrectomy for symptomatic lamellar macular holes. Retina. 2012; 32:1743–8.

29. Cho WB, Shin HJ, Moon JW, Kim HC. Four cases of pars plana vi-trectomy for treatment of symptomatic lamellar macular holes. J Korean Ophthalmol Soc. 2009; 50:1427–31.