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Secondary Epiretinal Membrane After Trabeculectomy
Abstract
Purpose:
To determine the frequency of epiretinal membranes (ERM) in eyes with primary open-angle glaucoma subjected to trabeculectomy.
Methods:
We conducted a retrospective study on patients subjected to trabeculectomy with at least a 6-month follow-up. Ophthalmologic examination and spectral-domain optical coherence tomography (SD-OCT) were analyzed. Eyes with previous surgical or laser treatments or other pathologies (other than glaucoma and ERM) were excluded.
Results:
A total of 50 eyes (40 patients) were included in this study. The mean follow-up time after surgery was 27.8 months. After surgery, 9 eyes (18%) had preretinal macular fibrosis and 19 eyes (38%) had cellophane macular reflex. Of the 16 eyes with a preoperative macular SD-OCT, 3 (18.8%) developed ERM and 4 (25%) progressed from cellophane macular reflex to preretinal macular fibrosis, after surgery. The ERM frequency did not differ significantly between eyes subjected to trabeculectomy with or without the use of antimetabolites (P=0.08), or between eyes subjected to simple or combined surgery (phacotrabeculectomy) (P=0.09).
Conclusion:
Trabeculectomy may predispose one to the appearance and progression of ERM. Further studies are needed to clarify this intriguing relation.
... Epiretinal membrane (ERM) seems due to proliferation of glial cells, astrocytes, fibrocytes and myofibroblasts after migration through defects in the internal limiting membrane [1]. Even if ERM is idiopathic in most cases, several ocular conditions have been reported as risk factor: diabetic retinopathy, ocular trauma, inflammatory disease and ocular surgery [2]. ...
... Descriptive statistics was used to summarize mean values and standard deviations of all numerical data. Sample size was calculated using the effect size from the results of a previous similar study [1] and indicated that 54 subjects were required to detect a 25.7% difference in the incidence of ERM, with a power of 80% and a significance level of 0.05. Post hoc analysis indicated that this study had a power of 90% with an actual α of 0.02 to detect a 24% difference in the incidence of ERM between treated eyes and controls. ...
... Vieria et al. reported an ERM incidence after trabeculectomy of 56%, of whom 9/50 eyes (18%) with PMF and 19/50 eyes (38%) with CMR. The mean follow-up time after surgery was 27.8 months [1]. ...
Background
The most common retinal complications after glaucoma surgery are choroidal detachment, hypotony maculopathy, malignant glaucoma, vitreous hemorrhage, endophthalmitis and retinal detachment. However, if glaucoma surgery is a risk factor for the ERM development needs to be clarified. This study aims to assess the incidence of epiretinal membrane (ERM) in 2 years of follow-up in patients with primary open-angle glaucoma (POAG) treated with Ex-Press shunt implant.
Methods
A prospective, consecutive, single-center, case–control study. We enrolled patients affected by POAG and scheduled for Ex-Press device implant with or without concomitant cataract surgery. The control group was the contralateral eyes which continues anti-glaucomatous eyedrops. Complete ophthalmologic evaluation and spectral-domain optical coherence tomography were performed before surgery, at 6 months and 24 months of follow-up.
Results
Eighty-two eyes of 41 consecutive patients, 18 males and 23 females with a mean age of 70, 29 ± 8,45, were analyzed at 24 months. 39.1% of eyes developed ERM: 29.3% were cellophane macular reflex (CMR) and 9.8% were pre-macular fibrosis (PMF). In the control group, 19.5% of eyes developed ERM: 17.1% were CMR and 2.4% were PMF. No statistically significant difference was reported (p = 0.121) between treated and control group. ERM development did not affect significantly the central foveal thickness (260.13 ± 35.01 μm at baseline, 265.03 ± 34.90 μm at 6 months and 275.18 ± 33.31 μm at 24 months) and macular volume (7.75 ± 0.43 mm³ at baseline, 7.77 ± 0.48 mm³ at 6 months and 7.77 ± 0.46 mm³ at 24 months), remained comparable to reported average measures in healthy individuals during the follow-up. Concomitant cataract surgery did not increase the ERM incidence.
Conclusion
Ex-Press implant may increase the ERM incidence regardless concomitant cataract surgery, accelerating or inducing a posterior vitreous detachment, such as other ocular surgical procedure. Nevertheless, the vast majority of ERM are CMR, not affecting the macular profile.
... It has been hypothesized that glaucoma filtration surgery may predispose one to the development and progression of ERM [16]. To date, trabeculectomy is considered the gold standard for the surgical treatment of glaucoma. ...
... Descriptive statistic was used to summarize mean values and standard deviations of all numerical data. Sample size was calculated using the effect size from the results of a previous similar study [16] and indicated that 54 subjects were required to detect a 25.7% difference in the incidence of ERM, with a power of 80% and a significance level of 0.05. Post-hoc analysis indicated that this study had a power of 90% with an actual α of 0.02 to detect a 24% difference in the incidence of ERM between treated eyes and controls. ...
... The ERM incidence after glaucoma surgery has been investigated by Vieria et al. in 2016 [16]. In their retrospective study, they analysed the development and progression of ERM after trabeculectomy for primary open-angle glaucoma. ...
Purpose
To estimate the frequency of epiretinal membrane (ERM) in eyes with primary open-angle glaucoma (POAG) treated with Ex-Press shunt implant. Secondarily, we aimed to assess the role of concomitant cataract surgery and the impact of the ERM on central foveal thickness and macular volume.
Methods
In this prospective, consecutive, case-control study, we enrolled 54 patients affected by PAOG and scheduled for Ex-Press device implant with or without contemporary phacoemulsification. Contralateral eyes affected by POAG and receiving anti-glaucomatous eyedrops constituted the control group. Complete ophthalmologic evaluation and spectral-domain optical coherence tomography (OCT) were performed before and 1, 3 and 6 months after surgery.
Results
Twenty-six eyes received the Ex-Press implant alone, and 28 eyes underwent the combined procedure. Six months postoperatively, we observed 18 (33%) cases of ERM: 15 (28%) of cellophane macular reflex (CMR) and 3 (6%) of pre-macular fibrosis (PMF). In the control group, 9 (17%) eyes developed an ERM: 8 (15%) were CMR, and 1 (2%) was PMF. The frequency of ERM statistically differs between treated and contralateral eyes (P = 0.032, χ² test). The ERM frequency did not statically differ between eyes subjected to simple or combined surgery (P = 0.846, χ² test). Mean central foveal thickness and mean macular volume did not significantly differ between groups.
Conclusion
The Ex-Press glaucoma shunt may increase the risk of ERM onset regardless of the concomitant cataract surgery; however, most cases were cellophane macular reflex with limited functional and anatomical impact.
... However, the prevalence of ERM has been found to increase after trabeculectomy. 17 After filtering surgery, elongation of the ERM may occur, and further VA deterioration may result. This finding is contrasting with stable ERM in eyes without surgical intervention. ...
Precis:
Postsurgical hypotension at 1 week and the presence of an epiretinal membrane (ERM) were significant risk factors for the deterioration of postsurgical visual acuity (VA) at 3 and 12 months, respectively.
Purpose:
The purpose of this study was to assess the effects of an ERM and postsurgical hypotension <6 mm Hg at 1 week on postsurgical VA loss.
Patients and methods:
A total of 69 patients (69 eyes) who underwent trabeculectomy with adjunctive mitomycin C between 2017 and 2019 (mean follow-up period: 22.8 mo) were enrolled, and 14 parameters that could be associated with the deterioration of VA at 3 and 12 months were studied.
Results:
There was a significant association between VA loss at 3 months and postsurgical intraocular pressure at 1 week (P=0.006 by multiple regression) and hypotony maculopathy (P=0.024 by Fisher exact test). However, this association was lost at 12 months. Instead of postsurgical hypotension, the presence of an ERM was significantly associated with VA loss at 12 months (P=0.035 by Fisher exact test, and P=0.023 by logistic regression).
Conclusions:
Postsurgical hypotension at 1 week was significantly associated with mid-term, but not long-term, postsurgical VA loss. The presence of an ERM, which was not a risk factor for mid-term acuity loss, was a significant risk factor for VA loss at 12 months.
Objectives
This study aimed to determine the frequency of epiretinal membrane (ERM) in the long term after neodymium-doped yttrium aluminum garnet laser iridotomy (LI) using spectral domain optical coherence tomography (SD-OCT).
Materials and Methods
This retrospective study included 94 eyes that underwent LI for primary angle-closure glaucoma, were followed for at least 4 years, and had no ERM before the procedure. The control group consisted of 66 eyes that were followed for suspected glaucoma did not have a previous ERM. We compared the ERM frequencies of the groups at the last visit. Additionally, ERM frequencies were compared between those who had cataract surgery in the post-LI period and those who did not.
Results
After a follow-up period of at least 4 years, ERM developed in 36 of 94 eyes (38.2%) in the LI group. Of these, 32 were stage 1 ERM (34.0%) and 4 were stage 2 ERM (4.2%). In the control group, ERM developed in 13 of 66 eyes (19.6%), 12 of which were stage 1 ERM (18.1%) and 1 was stage 2 ERM (1.5%) (p=0.012). ERM developed in 14 of 32 eyes (43.7%) who underwent phacoemulsification surgery after LI and in 22 of 62 eyes (35.4%) that underwent only LI without subsequent cataract surgery (p=0.435). ERM developed significantly more frequently in the 62 phakic eyes that underwent only LI than in the eyes in the control group (p=0.045).
Conclusion
LI appears to be a predisposing factor for the development of ERM, regardless of subsequent cataract surgery.
Secondary epiretinal membranes (ERMs) can develop from various causes, including those associated with glaucoma treatments such as trabeculectomy (TLE) and EX-PRESS (EXP) insertion surgery. This study aimed to investigate the occurrence of new ERMs and changes in preexisting ERMs following TLE or EXP insertion. Between April 2018 and March 2019, 102 and 74 eyes that underwent primary and standalone TLE and EXP insertion, respectively, were evaluated. Of these, 48 eyes were included in the TLE group and 32 eyes were included in the EXP group. Optical coherence tomography (OCT) was used to assess preoperative and postoperative ERMs. In the TLE group, postoperative ERMs were observed in one (case 1) (3%) out of 34 eyes without preexisting ERMs and in one (case 2) (7%) out of 14 eyes with preexisting ERMs, showing an increase in ERM stage. In the EXP group, postoperative ERMs were observed in one (case 3) (5%) out of 22 eyes without preexisting ERMs and in one (case 4) (10%) out of 10 eyes with preexisting ERMs, showing a decrease in the ERM stage. Case 1 was a 58-year-old man with primary open-angle glaucoma (POAG) in the left eye who underwent TLE. Although no preoperative ERMs were observed, postoperative ERM was noted at the three-month follow-up. Case 2 was a 49-year-old man with POAG in the right eye who underwent TLE. Although ERM was observed preoperatively, ERM progressed at six months postoperatively. Case 3 was a 59-year-old woman with POAG in the right eye who underwent EXP insertion. No preoperative ERMs were observed, but an ERM was noted at the 15-month follow-up. Case 4 was a 72-year-old woman with steroid-induced glaucoma in the right eye who underwent EXP insertion surgery. A preoperative ERM was present, and the foveal pit was absent; however, the foveal pit was observed at the 12-month follow-up. Despite the low incidence of ERMs, filtration surgery may be associated with ERM development and the progression or regression of preexisting ERMs.
Purpose:
To examine hypotony-associated foveal lesions (FovLs) utilizing optical coherence tomography and to assess risk factors of visual deterioration after glaucoma filtering surgery.
Methods:
Parameters that may be associated with post-surgical deterioration of visual acuity were retrospectively studied in 44 eyes of 44 patients who experienced post-surgical intraocular hypotension ≤6 mmHg between 2015 and 2019.
Results:
Six eyes (14%) had FovLs, such as detachment of photoreceptors (five eyes, 11%) and acquired vitelliform lesions (one eye, 2%) at 3 months after trabeculectomy. Logistic regression analysis revealed that hypotony maculopathy (P=0.0141 at 3 months) and FovLs (P=0.0486 and 0.0296 at 3 and 12 months, respectively) were significant risk factors for VA loss after trabeculectomy. The FovLs were located just behind the Müller cell cone (MCC). Visual acuity at 3 and 12 months after surgery in patients with FovLs was significantly lower than in those without FovLs (P=0.0013 and P=0.006, respectively). Epiretinal membrane was more common in eyes with FovLs (5 of 6 eyes, 83%) than in eyes without FovLs (7 of 38 eyes, 18%; P=0.0037).
Conclusion:
MCC-associated FovLs lead to long-lasting visual acuity loss after filtering surgery.
Optical coherence tomography (OCT) is a commonly used imaging modality in the evaluation of glaucomatous damage. The commercially available spectral domain (SD)-OCT offers benefits in glaucoma assessment over the earlier generation of time domain-OCT due to increased axial resolution, faster scanning speeds and has been reported to have improved reproducibility but similar diagnostic accuracy. The capabilities of SD-OCT are rapidly advancing with 3D imaging, reproducible registration, and advanced segmentation algorithms of macular and optic nerve head regions. A review of the evidence to date suggests that retinal nerve fibre layer remains the dominant parameter for glaucoma diagnosis and detection of progression while initial studies of macular and optic nerve head parameters have shown promising results. SD-OCT still currently lacks the diagnostic performance for glaucoma screening.
A technique called optical coherence tomography (OCT) has been developed
for noninvasive cross-sectional imaging in biological systems. OCT uses
low-coherence interferometry to produce a two-dimensional image of
optical scattering from internal tissue microstructures in a way that is
analogous to ultrasonic pulse-echo imaging. OCT has longitudinal and
lateral spatial resolutions of a few micrometers and can detect
reflected signals as small as ~10-10 of the incident optical
power. Tomographic imaging is demonstrated in vitro in the peripapillary
area of the retina and in the coronary artery, two clinically relevant
examples that are representative of transparent and turbid media,
respectively.
To assess the risk of long-term vision loss after trabeculectomy and to determine the course of long-term vision loss vs transient loss and recovery.
The medical records of 301 eyes in 262 patients undergoing trabeculectomy between January 1999 and September 2003 were retrospectively reviewed. Postoperative vision loss was categorized as mild or moderate (decrease in Snellen visual acuity of 3-5 lines) vs severe (decrease of >5 lines). Postoperative vision loss was considered permanent if visual acuity did not have a return of 3 lines within a 6-month follow-up period.
Permanent vision loss occurred in 24 of 301 eyes (8.0%): 13 (4.3%) had mild or moderate vision loss, and 11 (3.7%) had severe vision loss. Ten eyes (3.3%) with permanent mild or moderate vision loss and 6 eyes (2.0%) with permanent severe vision loss had no identifiable cause. Significant risk factors for permanent severe unexplained vision loss were preoperative split fixation on visual fields, preoperative number of quadrants with split fixation, and postoperative choroidal effusions with eventual resolution. Transient vision loss occurred in 170 of 301 eyes (56.5%): 79 (26.2%) had mild or moderate vision loss, with a mean time to recovery of 88 days (range, 6-720 days), and 91 (30.2%) had severe vision loss, with a mean time to recovery of 78 days (range, 6-720 days).
Transient vision loss after trabeculectomy is common and may take up to 2 years for recovery. The risk of permanent vision loss is less common but significant. Two percent of our study population experienced permanent severe unexplained vision loss ("snuff-out"), and risk factors included preoperative split fixation on visual fields, preoperative number of quadrants with split fixation, and postoperative choroidal effusions with eventual resolution.
The introduction of spectral-domain optical coherence tomography (SD-OCT) has improved the clinical value for assessment of the eyes with macular disease. This article reviews the advances of SD-OCT for the diagnostic of various macular diseases. These include vitreomacular traction syndrome, cystoid macular edema/diabetic macular edema, epiretinal membranes, full-thickness macular holes, lamellar holes, pseudoholes, microholes, and schisis from myopia. Besides offering new insights into the pathogenesis of macular abnormalities, SD-OCT is a valuable tool for monitoring macular disease.
To determine the prevalence and association of epiretinal membranes (ERMs), as assessed by retinal photography and optical coherence tomography (OCT), in a Chinese population.
The Handan Eye Study is a population-based study of eye disease in rural Chinese aged 30+ years. Eligible residents underwent a detailed ophthalmic examination including retinal photography and Stratus OCT. ERMs were defined by a combination of retinal photographs and OCT and classified as cellophane macular reflex (CMR) or preretinal macular fibrosis (PMF) based on retinal photographs characteristics.
Of the 6830 persons examined, 6565 (96.1%) had gradable retinal photographs and/or OCT. The mean age was 51.7 +/- 11.6 years. ERMs were present in 3.4% (95% CI: 2.9%-3.8%) of participants, bilateral in 20.3% of the cases. CMR was present in 2.2% and PMF in 0.7%, and ERMs were unclassified in 0.5% (detected by OCT only). ERM prevalence was similar in women and men (3.6% vs. 3.1%), strongly associated with increasing age (P for trend < 0.001). After adjustment for age and sex, primary ERM was associated positively with myopia (OR: 1.58, 95% CI: 1.12-2.23) and inversely with current smoking (OR: 0.61, 95% CI: 0.38-0.97, versus never smoked). Best corrected visual acuity was significantly worse in eyes with primary ERMs (mean LogMAR score lower by 0.07, 95% CI: 0.05-0.10) than eyes without ERMs, after adjustment for age, sex, and lens status.
ERMs affect 3.4% of the population 30+ years of age and living in rural China. Idiopathic ERMs were associated with myopia, decreased visual acuity, and inversely associated with smoking.
A prospective study of 440 eyes of 220 patients following successful operations for primary rhegmatogenous retinal detachment (132 eyes) and prophylactic operations for retinal breaks (103 eyes) revealed an incidence of preretinal macular fibrosis (PRMF) of 47% after scleral buckling surgery and 42% after prophylactic laser or cryopexy. The incidence of PRMF was significantly greater in aphakic vs phakic detachments, in detachments with operculated vs horseshoe breaks, in detachments with horseshoe breaks vs lattice degeneration, in detachments involving the macula, after scleral buckling with cryotherapy vs diathermy, and after prophylactic treatment of retinal breaks of fellow eyes with retinal detachment or retinal breaks that had developed postoperative PRMF Analysis of the data suggests that PRMF is most likely a result of the retinal break, detachment, and subsequent treatment.
To determine the prevalence of epiretinal membranes in the adult Chinese population.
The Beijing Eye Study, a population-based, cross-sectional cohort study, included 4439 subjects out of 5324 subjects invited to participate (response rate 83.4%) with an age of 40+ years. The present investigation consisted of 4378 (98.6%) subjects for whom readable fundus photographs (30 degrees nonstereoscopic colour images) were available. Assessing the fundus photographs, we differentiated two membrane types: cellophane maculopathy and premacular fibrosis.
Prevalence rate of epiretinal membranes was 2.2+/-0.2% (mean+/-SE) (95% confidence interval (CI): 1.9,2.5) per eye or 2.2+/-0.2% (95% CI: 1.8,2.7) per subject. In binary logistic regression analysis, the prevalence of epiretinal membranes was significantly associated with age (P<0.001; 95% CI: 1.07,1.12), visual field loss (P<0.001; 95% CI: 1.03,1.07), hyperopia (P=0.02; 95% CI: 1.01,1.18), and higher education (P<0.001; 95% CI: 1.29,1.74). Cellophane maculopathy showed a prevalence rate of 1.11+/-0.1% (95% CI: 0.9,1.3) per eye and 1.8+/-0.2% (95% CI: 1.4,2.2) per subject. Its prevalence was significantly associated with age (P<0.001; 95% CI: 1.08,1.13), higher education (P<0.001; 95% CI: 1.26,1.92), and visual field loss (P=0.009; 95% CI: 1.01,1.07). Premacular fibrosis had a prevalence rate of 1.06+/-0.1% (95% CI: 0.9,1.3) per eye and 1.8+/-0.2% (95% CI: 1.4,2.2) per subject. It was significantly associated with age (P<0.001; 95% CI: 1.06,1.11), higher level of education (P<0.001; 95% CI: 1.15,1.74), and visual field loss (P=0.001; 95% CI: 1.02,1.08).
In adult Chinese in Greater Beijing, epiretinal membranes including cellophane maculopathy and premacular fibrosis occur in a relatively low frequency which may be lower than in Western countries. Epiretinal membranes including its subtypes of cellophane maculopathy and epiretinal fibrosis were associated with age and hyperopic refractive error.
To establish the efficacy and safety of nonpenetrating deep sclerectomy versus trabeculectomy in primary open-angle glaucoma.
Prospective randomized trial.
Thirty-nine patients (78 eyes) with bilateral primary open angle glaucoma were included in the study.
Eyes were randomly assigned to receive deep sclerectomy in one eye and trabeculectomy in the other eye.
Mean intraocular pressure (IOP), postoperative medications, visual acuity, success rate, and complications.
At 12 months, mean IOP reduction was 12.3 +/- 4.2 (sclerectomy) versus 14.1 +/- 6.4 mmHg (trabeculectomy) (P = 0.15), and an IOP </= 21 mmHg was achieved in 36 (92.3%) and 37 eyes (94.9%) (P = 0.9), respectively. Complications included three (7.7%) flat/shallow anterior chambers and one (2.6%) hypotony (trabeculectomy), whereas internal iris incarceration was encountered in two eyes (5.1%) (sclerectomy).
Deep sclerectomy may provide comparable IOP reduction with fewer complications in management of primary open angle glaucoma.
Purpose:
To assess eye-specific epiretinal membrane (ERM) incidence 3 years after phacoemulsification surgery, and ERM detection bias attributable to cataract.
Design:
Cohort study.
Methods:
We recruited 1932 cataract surgical patients aged ≥64 years at Westmead Hospital (2004-2007). The surgical eye of each patient was assessed for presence of cellophane reflex or preretinal fibrosis at preoperative and 1-month-postoperative visits, and annually thereafter, using retinal image grading. Agreement on ERM detection between preoperative and 1-month-postoperative visits was assessed using kappa statistics. Cumulative incidence of ERM from 1 month to 3 years postoperatively was estimated using Kaplan-Meier methods and compared to the 5-year incidence of idiopathic ERM in right eyes of age-matched Blue Mountains Eye Study (BMES) participants.
Results:
ERM prevalence was 13.9% among 1394 participants with retinal photographs taken 1 month postoperatively. Of 1040 participants with retinal photographs from both preoperative and 1-month-postoperative visits, ERM was detected in 3.1% and 14.8%, respectively, with low diagnostic agreement (kappa = 0.17). Of 1119 subjects without ERM 1 month post surgery, the 3-year cumulative incidence of ERM was 11.2% (95% confidence interval [CI], 9.4%-13.4%; cellophane reflex 6.6%; preretinal fibrosis 4.2%). The age-standardized 3-year incidence of ERM in the surgical cohort (12.1%, 95% CI 8.6%-16.9%) was higher than the 5-year incidence of the BMES subsample (4.4%, 95% CI 3.0%-6.0%).
Conclusions:
A substantial under-detection of ERM in eyes before cataract surgery could incorrectly contribute to ERM incidence after surgery. Over 3 years, ERM developed in >10%, including preretinal fibrosis in 4%, of surgical eyes free of ERM 1 month post surgery.
Purpose of review:
Optical coherence tomography (OCT) has revolutionized the clinical practice of ophthalmology. It is a noninvasive imaging technique that provides high-resolution, cross-sectional images of the retina, retinal nerve fiber layer and the optic nerve head. This review discusses the present applications of the commercially available spectral-domain OCT (SD-OCT) systems in the diagnosis and management of retinal diseases, with particular emphasis on choroidal imaging. Future directions of OCT technology and their potential clinical uses are discussed.
Recent findings:
Analysis of the choroidal thickness in healthy eyes and disease states such as age-related macular degeneration, central serous chorioretinopathy, diabetic retinopathy and inherited retinal dystrophies has been successfully achieved using SD-OCT devices with software improvements. Future OCT innovations such as longer-wavelength OCT systems including the swept-source technology, along with Doppler OCT and en-face imaging, may improve the detection of subtle microstructural changes in chorioretinal diseases by improving imaging of the choroid.
Summary:
Advances in OCT technology provide for better understanding of pathogenesis, improved monitoring of progression and assistance in quantifying response to treatment modalities in diseases of the posterior segment of the eye. Further improvements in both hardware and software technologies should further advance the clinician's ability to assess and manage chorioretinal diseases.
Purpose:
To determine the prevalence of epiretinal membranes (ERMs) in Melbourne, Australia and its risk factors in this population.
Methods:
The Melbourne Collaborative Cohort Study is a prospective study investigating the role of diet and life style in the causation of common chronic diseases. Eighty-six percent of participants were of Northern European origin born in Australia or United Kingdom and 14% were migrants from Greece or Italy (Southern European origin). Nonmydriatic digital retinal photography was implemented at Melbourne Collaborative Cohort Study follow-up. The ERMs were recorded as cellophane macular reflex without retinal folds or preretinal macular fibrosis (PMF) with retinal folds.
Results:
A total of 22,406 participants had retinal photography, 95% (n = 21,241) were eligible for ERM grading. The ERM prevalence were 8.9% (1,882); cellophane macular reflex, 4.9% (1,047); and preretinal macular fibrosis, 3.9% (835). After adjustment for age, sex, level of education, smoking status, level of cholesterol, body mass index, waist-to-hip ratio, waist measurement, blood pressure, diabetes, and stroke, increasing age and Southern European ethnicity was significantly associated with ERMs. Overall, in Southern Europeans, ERMs odd ratio was 1.97 (95% confidence intervals, 1.67-2.31), P < 0.001; preretinal macular fibrosis was 1.82 (95% confidence intervals, 1.43-2.31), P < 0.001; and cellophane macular reflex was 1.93 (1.57-2.38), P < 0.001.
Conclusion:
In an older Australian population, the prevalence of ERMs was 8.9% and was almost two times higher in participants of Southern European origin than Northern European origin.
The purpose of the study is the evaluation and comparison of the relative incidence of epiretinal membrane in patients undergoing cataract surgery diagnosed with biomicroscopy versus those diagnosed with optical coherence tomography imaging (Stratus).
This prospective study evaluated 146 eyes of patients referred for cataract surgery. Considering biomicroscopic fundus appearance assessed by two examiners and OCT, the following findings were considered to indicate positivity for epiretinal membranes: biomicroscopic evidence of cellophane macular reflex, biomicroscopic evidence of macular pucker, and OCT thickening of the vitreoretinal interface with or without loss of the foveal depression. Positivity (metamorphopsia) to original Amsler test was also noted.
Patient mean age was 72.8 ± 9.1 years. Optical coherence tomography revealed 17 eyes with macular pucker (11.6%) and 21 with cellophane macular reflex (14.4%) and, hence, a total of 38 eyes with epiretinal membrane (26%; confidence interval, 18.9-33.1%). Biomicroscopy evaluation overlooked 14 affected eyes, or 9.6% of the eyes examined. False negatives, that is, eyes affected by epiretinal membrane (cellophane macular reflex or macular pucker) and not detected biomicroscopically were 36.8% (confidence interval, 21.5-52.2.7%) and false positives were 1.9% (confidence interval, 0-4%). Amsler test was positive in 7 (18.4%) of the 38 affected eyes.
This study finds that patients undergoing cataract surgery may present with epiretinal membrane that are better detected by optical coherence tomography rather than by biomicroscopy. Optical coherence tomography was more sensitive both for eyes with cellophane macular reflex and for those with macular pucker. The use of this instrument before surgery can therefore be considered.
To describe the prevalence of and risk factors for epiretinal membrane (ERM) in a multi-ethnic population and to evaluate possible racial or ethnic differences.
Cross-sectional study.
Participants of the Multi-Ethnic Study of Atherosclerosis (MESA), examined at the second visit of the MESA when retinal photography was performed.
Data on 5960 participants aged 45 to 84 years from MESA, including white, black, Hispanic, and Chinese persons from 6 United States communities, were analyzed. Epiretinal membrane was assessed from digital nonstereoscopic fundus photographs and was defined as cellophane macular reflex (CMR) without retinal folds or preretinal macular fibrosis (PMF) with retinal folds. Risk factors were assessed from standardized interviews, clinical examinations, and laboratory investigations.
Epiretinal membrane prevalence by ethnic or racial group and risk factors associated with ERM.
The prevalence of any ERM was 28.9%, of which 25.1% were CMR cases and 3.8% were PMF cases. The prevalence of ERM was significantly higher in Chinese persons (39.0%), compared with Hispanic (29.3%), white (27.5%), or black (26.2%; P<0.001) persons. In multivariate models, increasing age (odds ratio [OR], 1.19; 95% confidence interval [CI], 1.06-1.34, per year increase in age), diabetes (OR, 1.92; 95% CI, 1.39-2.65), and hypercholesterolemia (OR, 1.33; 95% CI, 1.04-1.69) were significantly associated with CMR.
This study showed that ERM was significantly more common in Chinese persons compared with whites, blacks, and Hispanics. Risk factors for ERM were increasing age, presence of diabetes, and hypercholesterolemia.
The records of 187 consecutive patients (206 eyes) with a diagnosis of secondary premacular fibrosis were reviewed. The mean patient age was 63.2 years; 96 (51.3%) patients were men. The most common surgical causes in 175 eyes were cataract extraction with or without implant, 73 (41.7%); scleral buckle, 33 (18.9%); both cataract extraction with implant and scleral buckle (in separate surgical sessions), 20 (11.4%); argon laser procedures, 17 (9.7%); and retinal cryopexy, 14 (8.0%). The most common nonsurgical causes in 31 eyes were blunt ocular trauma, 12 (38.7%); uveitis, 9 (29.0%); and retinal vein occlusion, 5 (16.1%). Initial visual acuity was 20/100 or better in 120 of the 206 eyes (58.3%). After a minimum follow-up period of 6 months (mean, 44.2 months), 72 of 101 eyes (71.3%) had stable or improved visual acuity without surgical intervention. Of 32 eyes that underwent vitrectomy with membrane stripping, 25 of 26 eyes (96.2%) followed for a mean period of 24 months (minimum, 6 months) had stable or improved visual acuity. Of 157 eyes that did not undergo vitrectomy, 143 (91.1%) had partial or complete posterior detachment. Fifty-eight of 148 eyes (39.2%) had angiographic cystoid macular edema; however, vitreous traction at the macula was not a significant cause of cystoid macular edema (CME) in these eyes.(ABSTRACT TRUNCATED AT 250 WORDS)
A surgical technique for reducing intraocular pressure in chronic simple glaucoma by relieving trabecular obstruction without intentionally creating external drainage is described. Results are summarized and discussed. The scope and direction of further work along the same lines is suggested.
The authors investigated the aqueous and vitreous pharmacokinetics of mitomycin after postoperative topical administration in rabbits.
Filtration surgery was performed in one eye of each rabbit. On the first postoperative day, mitomycin solution (0.4 mg/ml) was administered by either topical drop or cellulose sponge in both eyes of each rabbit. Aqueous and vitreous paracenteses were performed at 0.25, 0.5, 1, 2, 3, and 4 hours thereafter. Three rabbits were tested at each time interval for each type of administration.
After topical drop administration, the peak aqueous concentration was 0.03 +/- 0.02 microgram/ml (mean +/- standard error) in surgical eyes and 0.06 +/- 0.03 microgram/ml in control eyes. After sponge administration, the peak aqueous concentration was 0.10 +/- 0.03 microgram/ml in surgical eyes and 0.08 +/- 0.04 microgram/ml in control eyes. Peak aqueous concentrations from drop and sponge applications were achieved at 1 to 2 hours after administration. Vitreous levels were well below the concentration known to cause retinal toxicity at all time intervals tested.
Postoperative topical administration of mitomycin was successful in delivering mitomycin into the aqueous humor of rabbit eyes. Alternative methods of mitomycin application from the currently popular intraoperative administration may be beneficial in situations in which mitomycin delivery across intact conjunctiva may be desirable.
Purpose:
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.
Methods:
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.
Results:
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).
Conclusions:
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.
To evaluate and compare prospectively the anterior chamber inflammatory response after phacoemulsification cataract surgery and after trabeculectomy with peripheral iridectomy.
Anterior chamber inflammation was measured using the Kowa FM-500 laser flare meter in 131 patients undergoing trabeculectomy and 148 patients undergoing phacoemulsification cataract extraction with intraocular lens implantation. Flare was measured before surgery and on each postoperative visit up to 12 months.
Before surgery there was no significant difference in flare readings between the two groups. Following trabeculectomy flare returned to baseline levels 4 weeks after surgery, while following phacoemulsification cataract extraction it remained significantly higher at week 6 (p<0.006) and month 3 (p<0.05).
Anterior chamber inflammation is more prolonged after cataract surgery than after trabeculectomy. This may have implications for the timing of trabeculectomy in relation to cataract surgery.
To describe the 5-year cumulative incidence and change in epiretinal membranes in a defined older Australian population.
Population-based cohort study.
Three thousand six hundred fifty-four persons 49 years of age or older, living in the Blue Mountains area, west of Sydney, Australia, participated in the baseline survey during 1992 to 1994. The cohort was reexamined after 5 years in 1997 to 1999. Excluding persons (543) who died since the baseline, 75% of survivors (n = 2335) attended the follow-up examination.
All participants underwent a detailed eye examination, including stereo retinal photography. Epiretinal membranes were diagnosed from grading of baseline and 5-year retinal photographs.
Epiretinal membranes were classified as either preretinal macular fibrosis (PMF), with retinal folds, or as a less severe form, termed cellophane macular reflex (CMR), without retinal folds. The incidence of epiretinal membranes was determined if either lesion was found in eyes with no preexisting epiretinal membrane at baseline. Progression was defined if the area of involvement increased by more than 25%, regression if it decreased by more than 25%, and stable if it changed by less than 25%.
Epiretinal membranes developed in the first eye of 108 of 2030 participants who had no sign of this condition in either eye at baseline, 5.3%, 95% confidence interval (CI) 4.4 to 6.4. Five-year cumulative incidence rates for PMF and CMR were 1.5% and 3.8%, respectively. Of those participants with epiretinal membranes in one eye at baseline, 18 of 133 (13.5%) developed this sign in their second eye after 5 years. New epiretinal membranes (mostly CMR) occurred in 15 of 165 subjects (9.1%; CI, 5.2-14.6) who had undergone cataract surgery since the Blue Mountains Eye Study I. This rate was significantly higher than in the nonsurgical group, 92 of 1861 (4.9%; CI, 4.0-6.0) of whom developed epiretinal membranes. Progression from CMR to PMF was observed in 17 of 183 eyes (9.3%). Existing epiretinal membranes progressed, regressed, or remained stable in 28.6%, 25.7%, and 38.8% of eyes, respectively.
This study has documented the 5-year cumulative incidence and the natural history of epiretinal membranes in an older population.
To compare optical coherence tomography (OCT) images of idiopathic epiretinal membranes (ERMs) with those of secondary ERMs.
OCT was performed on 70 eyes of 63 consecutive patients with biomicroscopic evidence of ERMs and 23 eyes of 23 healthy volunteers without ERMs. OCT findings were correlated with the clinical pathogenesis of the ERM.
Evaluation by OCT established that 48 of 70 ERMs were globally adherent to the retina and that 22 of 70 ERMs were focally adherent to the retina. When correlated to clinical pathogenesis, 20% of idiopathic membranes and 52% of secondary membranes were focally attached to the retina. There was a significant difference in the pattern of membrane attachment to the retina in the two pathogenic groups (P = 0.007). Eight of nine eyes with macular pseudoholes were associated with globally adherent membranes.
Secondary ERMs are more likely to be characterized by focal retinal adhesion than are primary ERMs. Primary ERMs tend to be globally adherent. This finding may contribute to understanding the underlying mechanisms of ERM formation in different clinical settings.
To determine age- and gender-specific prevalence and associations of epiretinal membranes (ERMs) in adult Latinos.
The Los Angeles Latino Eye Study (LALES) is a population-based study of eye disease among Latinos aged 40 or more years. Complete ophthalmic examinations included stereoscopic fundus photography. Masked photographic grading was used to identify and classify ERMs as cellophane macular reflex (CMR) without retinal folds or preretinal macular fibrosis (PMF) with folds.
Of the 6142 persons examined at the clinic, 5982 (97%) had gradable retinal photographs. The mean age of the participants was 54.7 +/- 10.7 years; 58% were women. ERMs were present in 18.5% (95% confidence interval [CI]: 17.5%-19.5%) of the participants. Of the participants with ERMs, 19.9% had bilateral ERMs. The prevalence of ERMs increased from 10.1% in persons 40 to 49 years of age to 35.7% in those aged 70 to 79 years and was 22.5% in persons aged 80 years or more. The prevalence was similar in men and women. CMR was present in 16.3% (95% CI: 15.3%-17.2%) and PMF in 2.2% (95% CI: 1.9%-2.6%). Retinal folds involved the fovea in 11% of PMF cases. On average, eyes with central PMF had poorer visual acuity than did eyes without (P < 0.0002). Epiretinal membranes (ERMs) were present in 71% of eyes with macular holes. ERMs were also more common in individuals who had undergone cataract surgery (39.9%), those with proliferative diabetic retinopathy (25.7%), and those with any retinal disease (27.5%).
ERMs occur frequently in Latinos, often bilaterally. The associations of ERMs with proliferative retinopathy, retinal lesions, macular holes, and cataract surgery were confirmed. Central PMF is associated with reduced visual acuity.
To determine the prevalence and factors associated with epiretinal membranes in a random sample of the population aged 40 years and older in Victoria, Australia.
Population-based cross-sectional study.
Detailed eye examinations, including retinal photographs, were conducted in 1992 and 1997 in 3271 people (83% of the eligible) in Melbourne and 1473 (92% of the eligible) in rural Victoria. Eyes present with either cellophane macular reflex (CMR) or preretinal macular fibrosis (PMF) were classified as having epiretinal membranes. Eyes with both CMR and PMF present were classified as having PMF. Age-standardized prevalence rates and 95% confidence limits were calculated by the direct methods using Segi's world population.
Epiretinal membranes were observed in 253 of 4313 participants (6.0%; 95% confidence interval [CI] 5.2 to 6.7), bilaterally in 19%. Prevalence increased significantly by age group (0.5% for 40 to 49 years, 2.6% for 50 to 59 years, 9.4% for 60 to 69 years, 15.1% for 70 to 79 years, and 11.3% for 80 years and older). Prevalence was similar in males and females after adjusting for age. The overall age- and gender-standardized prevalence of CMR was 4.8% (95% CI 4.0 to 5.6) and PMF was 1.7% (95% CI 1.2 to 2.3). A decrease in visual acuity (<6/6) was significantly associated with idiopathic PMF (odds ratio [OR] 1.9; 95% CI 1.0 to 3.6) and CMR (OR 1.5; 95% CI 1.1 to 2.0) after adjusting for age.
The prevalence of epiretinal membranes was similar to that reported in other population-based studies. Population shifts in the age distribution to older ages could lead to an increase in mild visual impairment caused by epiretinal membranes.
Beitrage zur normalen und pathologischen anatomy des auges [Contributions to the normal and pathological anatomy of the eye]
- Iwanoff