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      Tratamiento quirúrgico de las membranas epirretinales Translated title: Surgical treatment of the epiretinal membranes

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          Abstract

          Se evaluaron los resultados funcionales y anatómicos de los pacientes operados de membrana epirretinal macular para determinar las complicaciones, así como correlacionar los factores clínicos y demográficos que influyen en el resultado visual. Se procedió al estudio retrospectivo de 33 pacientes operados mediante vitrectomía vía pars plana en un período de 2 años. Los resultados demuestran que existió una mejoría visual de más de 2 líneas en el 69 % de los casos, el éxito anatómico fue de un 93 % y ocurrieron complicaciones en el 15,5 %. Además de la mejoría visual significativa y sintomatológica posoperatoria, existió una baja frecuencia de complicaciones. La etiología de la membrana, el tiempo de evolución y las complicaciones, influyeron en la agudeza visual final y la técnica de extracción de las membranas fue la adecuada.

          Translated abstract

          The functional and anatomical results of the patients operated on of the epiretinal macular membrane to determine the complications and to correlate the clinical and demographic factors influencing the visual result were evaluated. A retrospective study was conducted in 33 patients that underwent vitrectomy via pars plana in a period of 2 years. The results showed that there was a visual improvement of more than 2 lines in 69 % of the cases. The anatomical success was of 93 % and there were complications in 15.5 %. In addition to the significant symptomatological postoperative visual improvement, a low frequency of complications was observed. The etiology of the membrane, the time of evolution and the complications influenced the final visual acuity. The membrane removal procedure proved to be the most adequate.

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          Most cited references27

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          Prevalence and associations of epiretinal membranes. The Blue Mountains Eye Study, Australia.

          The purpose of the study is to determine the prevalence and associations of epiretinal membranes in a defined older Australian population and to assess their influence on visual acuity. Three thousand six hundred fifty-four persons 49 years of age or older, representing 88% of permanent residents from an area west of Sydney, underwent a detailed eye examination, including stereo retinal photography. Epiretinal membranes were diagnosed clinically and from photographic grading. Signs of epiretinal membranes were found in 243 participants (7%; 95% confidence interval [CI], 6.1, 7.6), bilateral in 31%. The prevalence was 1.9% in persons younger than 60 years of age, 7.2% in persons 60 to 69 years of age, 11.6% in persons 70 to 79 years of age, and 9.3% in persons 80 years of age and older, with slightly higher rates in women. Two stages were identified: an early form without retinal folds, termed "cellophane macular reflex" present in 4.8%, and a later stage with retinal folds, termed "preretinal macular fibrosis" (PMF), found in 2.2% of the population. Preretinal macular fibrosis, but not cellophane macular reflex, had a small, significant effect on visual acuity. Preretinal macular fibrosis was significantly associated with diabetes, after age-gender adjustment, in subjects without signs of diabetic retinopathy (odds ratio, 3.2; 95% CI, 1.4, 7.2). Preretinal macular fibrosis also was associated with increased fasting plasma glucose (odds ratio, 1.2; 95% CI, 1.1, 1.3). Epiretinal membranes were found in 16.8% of persons who had undergone cataract surgery in one or both eyes (including PMF in 3.7%), in 16.1% of retinal vein occlusion cases (PMF in 12.5%), both significantly higher rates than in subjects without these conditions (P < 0.0001), and in 11% of persons with diabetic retinopathy (PMF in 3.6%), not significantly higher (P = 0.17). This study has documented the frequency and mild effect on vision of epiretinal membranes in an older population. Diabetes was associated significantly with idiopathic cases, whereas well-known associations with past cataract surgery and retinal disease were confirmed.
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            Characterization of epiretinal membranes using optical coherence tomography.

            To evaluate optical coherence tomography (OCT), a novel noncontact and noninvasive imaging technique, for the diagnosis and quantitative characterization of epiretinal membranes. Optical coherence tomography is similar to an ultrasound B-scan, except that light rather than sound is used, which enables higher resolution. Over a 2-year period, OCT was used to examine 186 eyes of 160 patients who had a diagnosis of an epiretinal membrane. Optical coherence tomograms were correlated with visual acuity, slit-lamp biomicroscopy, fluorescein angiography, and funds photography. Based on OCT, the epiretinal membrane was clearly separated from the retina with focal points of attachment in 49 eyes and globally adherent (no observed separation) in 125 eyes. Globally adherent membranes were associated with the following features: macular pseudohole (32 eyes), a difference in optical reflectivity between the membrane and retina (65 eyes), and/or a visible membrane tuft or edge (92 eyes). The membrane was undetectable on OCT in 12 eyes. The membrane thickness (mean +/- standard deviation) was 61 +/- 28 microns in the 169 eyes in which the thickness could be measured with OCT. Mean central macular thickness measured with OCT correlated with visual acuity (R2 = 0.73). Optical coherence tomography was able to provide a structural assessment of the macula that was useful in the preoperative and postoperative evaluation of epiretinal membrane surgery. Quantitative measurements and the assessment of membrane adherence with OCT may be useful in characterizing the surgical prognosis of eyes with an epiretinal membrane.
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              Nuclear sclerotic cataract after vitrectomy for idiopathic epiretinal membranes causing macular pucker.

              We evaluated the occurrence or progression of nuclear sclerosis of the crystalline lens in 100 eyes after vitrectomy for removal of idiopathic epiretinal membranes causing macular pucker. The follow-up period ranged from six to 99 months (average, 29 months). Visually significant nuclear sclerosis was present preoperatively in three of the operated on eyes and four of the fellow eyes. The rate of occurrence or progression of visually significant nuclear sclerosis was far greater in the operated on eyes (P less than .0001). Of 100 patients, 80 operated on eyes and 24 fellow eyes had visually significant nuclear sclerosis or had undergone previous cataract extraction at the conclusion of the study. Different concentrations of glucose in the intraocular irrigating solution did not affect occurrence of later nuclear sclerosis. Patients older than 50 years of age had a far greater incidence of later nuclear sclerosis than patients younger than 50 years of age (P = .0003). Nuclear sclerosis may be caused by altered lens metabolism after removal of part of the vitreous gel, since nuclear sclerosis also occurs in other conditions associated with vitreous liquefaction.
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                Author and article information

                Journal
                oft
                Revista Cubana de Oftalmología
                Rev Cubana Oftalmol
                Editorial Ciencias Médicas (Ciudad de la Habana, , Cuba )
                0864-2176
                1561-3070
                June 2003
                : 16
                : 1
                Affiliations
                [01] Ciudad de La Habana orgnameHospital Oftalmológico Docente Ramón Pando Ferrer Cuba
                Article
                S0864-21762003000100009 S0864-2176(03)01600109
                b3d8df52-8d65-4e6f-beaa-38c74bebbcc0

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 13 February 2002
                : 29 July 2003
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 0
                Product

                SciELO Cuba

                Categories
                ARTÍCULO NOVEDOSO

                VITRECTOMIA,MEMBRANA EPIRRETINAL,EPIRETINAL MEMBRANE,VITRECTOMY

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