W E Smiddy1, W Feuer, G Cordahi. 1. Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA. wsmiddy@med.miami.edu
Abstract
PURPOSE: To evaluate prospectively the ability to peel epiretinal membranes and to correlate the degree of membrane peeling to anatomic success rates. DESIGN: Consecutive, noncomparative, interventional case series. PARTICIPANTS: One hundred ninety-three patients. METHODS: The extent of membrane peeling and other intraoperative features were correlated to endpoints. MAIN OUTCOME MEASURES: Anatomic success (inducing hole closure), visual acuity of 20/50 or better, and visual improvement of two or more Snellen lines. RESULTS: One hundred ninety-three eyes were eligible for the study by virtue of having a minimum follow-up interval of 6 weeks. The overall anatomic success rate was 93% in these cases. There was a two-line or more improvement in 72%; 56% attained 20/50 or better visual acuity. The internal limiting membrane was peeled completely in 23%, partially in 43%, and not at all in 34%. The degree of internal limiting membrane peeling was not correlated with the duration of the hole or rate of two-line visual improvement, but was inversely correlated with the rate of anatomic success (P = 0.045). Final visual acuity was correlated with a better preoperative visual acuity, shorter preoperative duration of macular hole, and more complete internal limiting membrane peeling. CONCLUSIONS: Peeling of the internal limiting membrane is not essential for anatomic or visual success in macular hole surgery, but it may be a means to standardize inducement of the proper degree of gliosis. Excessive, unsuccessful attempts at internal limiting membrane peeling may decrease visual success. Techniques delivering a more reproducible, complete, atraumatic peeling of the internal limiting membrane should be studied.
PURPOSE: To evaluate prospectively the ability to peel epiretinal membranes and to correlate the degree of membrane peeling to anatomic success rates. DESIGN: Consecutive, noncomparative, interventional case series. PARTICIPANTS: One hundred ninety-three patients. METHODS: The extent of membrane peeling and other intraoperative features were correlated to endpoints. MAIN OUTCOME MEASURES: Anatomic success (inducing hole closure), visual acuity of 20/50 or better, and visual improvement of two or more Snellen lines. RESULTS: One hundred ninety-three eyes were eligible for the study by virtue of having a minimum follow-up interval of 6 weeks. The overall anatomic success rate was 93% in these cases. There was a two-line or more improvement in 72%; 56% attained 20/50 or better visual acuity. The internal limiting membrane was peeled completely in 23%, partially in 43%, and not at all in 34%. The degree of internal limiting membrane peeling was not correlated with the duration of the hole or rate of two-line visual improvement, but was inversely correlated with the rate of anatomic success (P = 0.045). Final visual acuity was correlated with a better preoperative visual acuity, shorter preoperative duration of macular hole, and more complete internal limiting membrane peeling. CONCLUSIONS: Peeling of the internal limiting membrane is not essential for anatomic or visual success in macular hole surgery, but it may be a means to standardize inducement of the proper degree of gliosis. Excessive, unsuccessful attempts at internal limiting membrane peeling may decrease visual success. Techniques delivering a more reproducible, complete, atraumatic peeling of the internal limiting membrane should be studied.
Authors: H Hoerauf; H Klüter; E Joachimmeyer; J Roider; C Framme; P Schlenke; H Kirchner; H Lagua Journal: Int Ophthalmol Date: 2001 Impact factor: 2.031