Clinical effect of non-vitrectomy in the treatment of idiopathic macular epiretinal membranes_Chinese Journal of Ocular Fundus Diseases

Authors：

Liu Jiandong ¹ , Gao Rongyu ² , Xu Xinyan ² , Zhang Jie ² , Zhu Fangxing ² ,  Sun Xianyong ² , Yang Juanjuan ¹

1. Weifang Medical University, Weifang 261000, China;
2. Weifang Eye Hospital, Weifang 261000, China;

Corresponding author：

Sun Xianyong, Email: xianyongs1968@aliyun.com

Keywords：

Macula lutea; Membranes; Vitrectomy; Non-vitrectomy

DOI：

10.3760/cma.j.cn511434-20191011-00322

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Objective To observe the effect of non-vitrectomy in the treatment of idiopathic macular epiretinal membranes (IMEM).Methods This study is a randomized controlled trial. From December 2017 to December 2018, 60 IMEM patients (60 eyes) diagnosed in Weifang Eye Hospital were included in the study. BCVA, intraocular pressure (IOP) and OCT were performed in all patients. The BCVA examination was performed using the international standard visual acuity chart, which was converted to logMAR. The CMT was measured by OCT. According to the surgical methods, the patients were divided into non-vitrectomy group and control group, 30 patients (30 eyes) in each group. The age (t=1.723), logMAR BCVA (t=1.703), CMT (t=-0.956), IOP (t=-1.434) were not significantly different between the two groups (P=0.090, 0.094, 0.343, 0.157). 23G vitreous cutting system was used in all eyes. The macular epiretinal membranes was removed by non-vitrectomy in the non-vitrectomy group and by vitrectomy in the control group. The relevant examination with the same equipment and methods before the operation at 1 week and 1, 3, 6 months after operation. The time of surgery, the changes of BCVA, CMT and postoperative complications in the two groups were observed comparatively. Variance analysis of repeated measurements was performed for the comparison of BCVA, CMT and IOP after surgery in the two groups. Wilcoxon rank sum test of two independent samples was performed for the degree of vision improvement. The incidence of postoperative complications was compared by χ² test.Results At 6 months after operation, BCVA increased in 24 eyes (80%) and unchanged in 6 eyes (20%) in the non-vitrectomy group. Compared with preoperative BCVA, the difference was statistically significant (P＜0.05). BCVA increased in 25 eyes (83.4%), unchanged in 4 eyes (13.3%) and decreased in 1 eye (3.3%) in the control group. Compared with preoperative BCVA, the difference was statistically significant (P＜0.05). There was no significant difference between the two groups in BCVA improvement degree after operation (Z=－0.26, P＞ 0.05). At 6 months after operation, the average logMAR BCVA was statistically significant compared with the preoperative in the non-vitrectomy group (P=0.002, 0.005) and control group (P=0.004, ＜0.001). Visual stability occurred 1 month after operation in the non-vitrectomy group and 3 months after operation in the control group. The effective operative time of the non-vitrectomy group and control group was 4.50±1.41 and 15.50±2.33 min, respectively. The difference of effective operation time between the two groups was statistically significant (t=－22.12, P＜0.05). After surgery, no significant complications were found in the non-vitrectomy group. In the control group, there were 3 eyes with low IOP and 1 eye with macular hole during operation.Conclusions Non-vitrectomy and vitrectomy have similar effects on IMEM. Non-vitrectomy has short effective operation time, faster recovery after surgery and no obvious complications.

Citation： Liu Jiandong, Gao Rongyu, Xu Xinyan, Zhang Jie, Zhu Fangxing, Sun Xianyong, Yang Juanjuan. Clinical effect of non-vitrectomy in the treatment of idiopathic macular epiretinal membranes. Chinese Journal of Ocular Fundus Diseases, 2020, 36(5): 379-383. doi: 10.3760/cma.j.cn511434-20191011-00322 Copy

1.	Wiznia RA. Posterior vitreous detachment and idiopathic preretinal macular gliosis[J]. Am J Ophthalmol, 1986, 102(2): 196-198. DOI: 10.1016/0002-9394(86)90144-3.
2.	房国凤, 高荣玉, 徐鑫彦. 黄斑前膜的研究现状[J]. 国际眼科杂志, 2017, 17(8): 1669-1672. DOI: 10.3980/j.issn.1672-5123.2017.8.17.Fang GF, Gao RY, Xu XY. Current research status of macular epiretinal membrane[J]. Int Eye Sci, 2017, 17(8): 1669-1672. DOI: 10.3980/j.issn.1672-5123.2017.8.17.
3.	Charles S. Vitreous microsurgery[M]. 2nd ed. Baltimore: Williams&Wilkins, 1987: 153-157.
4.	Sakaguchi H, Oshima Y, Tano Y. 27-gauge transconjunctival nonvitrectomizing vitreous surgery for epiretinal membrane removal[J]. Retina, 2007, 27(9): 1302-1304. DOI: 10.1097/IAE.0b013e31813e0c03.
5.	曾苗, 陈晓, 洪玲, 等. 特发性黄斑前膜患者中心凹无血管区面积与中心凹形态相关性研究[J]. 中华眼底病杂志, 2019, 35(1): 15-19. DOI: 10.3760/cma.j.issn.1005-1015.2019.01.004.Zeng M, Chen X, Hong L, et al. Correlation between foveal avascular zone size and foveal morphology in patients with idiopathic macular epiretinal membrane[J]. Chin J Ocul Fundus Dis, 2019, 35(1): 15-19. DOI: 10.3760/cma.j.issn.1005-1015.2019.01.004.
6.	Bu SC, Kuijer R, Li XR, et al. Idiopathic epiretinal membrane[J]. Retina, 2014, 34(12): 2317-2335. DOI: 10.1097/IAE.0000000000000349.
7.	Saito Y, Lewis JM, Park I, et al. Nonvitrectomizing vitreous surgery:a strategy to prevent postoperative nuclear sclerosis[J]. Ophthalmology, 1999, 106(8): 1541-1545. DOI: 10.1016/S0161-6420(99)90451-7.
8.	Sawa M, Ohji M, Kusaka S, et al. Nonvitrectomizing vitreous surgery for epiretinal membrane[J]. Ophthalmology, 2005, 112(8): 1402-1408. DOI: 10.1016/j.ophtha.2005.02.014.
9.	Reibaldi M, Longo A, Avitabile T, et al. Transconjunctival nonvitrectomizing vitreous surgery versus 25-gauge vitrectomy in patients with epiretinal membrane: a prospective randomized study[J]. Retina, 2015, 35(5): 873-879. DOI: 10.1097/IAE.0000000000000459.
10.	温晓英, 陈娜, 杨娜, 等. 不同手术方法治疗继发性黄斑前膜效果的观察[J]. 中华眼科医学杂志(电子版), 2018, 8(2): 64-69. DOI: 10.3877/cma.j.issn.2095-2007.2018.02.003.Wen XY, Chen N, Yang N, et al. Effect of different surgical methods on secondary macular epiretinal membrane[J]. Chin J Ophthalmol Med(Electronic Edition), 2018, 8(2): 64-69. DOI: 10.3877/cma.j.issn.2095-2007.2018.02.003.
11.	Park SW, Byon IS, Lee JE, et al. Analysis of the ganglion cell layer and photoreceptor layer using optical coherence tomography after idiopathic epiretinal membrane surgery[J]. Graefe's Arch Clin Exp Ophthalmol, 2015, 253(10): 1829-1830. DOI: 10.1007/s00417-015-3003-5.
12.	Gao M, Wang Y, Liu W, et al. Assessment of macular functio in patients with idiopathic epiretinal membrane by multifocal Electroretinography:correlation with visual acuity and optical coherence tomography[J]. BMC Ophthalmology, 2017, 17(1): 221. DOI: 10.1186/s12886-017-0621-1.
13.	Almony A, Holekamp NM, Bai F, et al. Small-gauge vitrectomy does not protect against nuclear sclerotic cataract[J]. Retina, 2012, 32(3): 499-505. DOI: 10.1097/IAE.0b013e31822529cf.
14.	Holekamp NM, Shui YB, Beebe DC. Vitrectomy surgery increases oxygen exposure to the lens: a possible mechanism for nuclear cataract formation[J]. Am J Ophthalmol, 2005, 139(2): 302-310. DOI: 10.1016/j.ajo.2004.09.046.
15.	Sawa M, Saito Y, Hayashi A, et al. Assessment of nuclear sclerosis after nonvitrectomizing vitreous surgery[J]. Am J Ophthalmol, 2001, 132(3): 356-362. DOI: 10.1016/s0002-9394(01)01025-x.
16.	Savastano A, Savastano MC, Barca F, et al. Combining cataract surgery with 25-gauge high-speed pars plana vitrectomy: results from a retrospective study[J]. Ophthalmology, 2014, 121(1): 299-304. DOI: 10.1016/j.ophtha.2013.06.022.
17.	周静, 刘武, 李倩, 等. 特发性黄斑前膜手术前后黄斑厚度与功能的相关性研究[J]. 中华眼科杂志, 2012, 48(2): 119-123. DOI: 10.3760/cma.j.issn.0412-4081.2012.02.006.Zhou J, Liu W, Li Q, et al. A comparative study of macular thickness and function before and after idiopathic macular epiretinal membrane surgery[J]. Chin J Ophthalmol, 2012, 48(2): 119-123. DOI: 10.3760/cma.j.issn.0412-4081.2012.02.006.
18.	Tarantola RM, Tsui JY, Graff JM, et al. Intraoperative sclerotomy-related retinal breaks during 23-gauge pars plana vitrectomy[J]. Retina, 2013, 33(1): 136-142. DOI: 10.1097/IAE.0b013e31825e1d62.
19.	Ehrlich R, Goh YW, Ahmad N, et al. Retinal breaks in small-gauge pars plana vitrectomy[J]. Am J Ophthalmol, 2012, 153(5): 868-872. DOI: 10.1016/j.ajo.2011.10.015.
20.	Hikichi T, Kosaka S, Takami K, et al. Incidence of retinal breaks in eyes undergoing 23-gauge or 20-gauge vitrectomy with induction of posterior vitreous detachment[J]. Retina, 2012, 32(6): 1100-1105. DOI: 10.1097/IAE.0b013e3182349449.
21.	Nakano T, Uemura A, Sakamoto T. Incidence of iatrogenic peripheral retinal breaks in 23-gauge vitrectomy for macular diseases[J]. Retina, 2011, 31(10): 1997-2001. DOI: 10.1097/IAE.0b013e31820f49ea.
22.	Liu H, Zuo S, Ding C, et al.Comparison of the effectiveness of pars plana vitrectomy with and without internal limiting membrane peeling for idiopathic retinal membrane removal: a meta-analysis[J/OL].J Ophthalmol, 2015, 2015: 974568[2015-11-26]. https://doi.org/10.1155/2015/974568. DOI:10.1155/2015/974568..
23.	杨小琴, 李拓. 玻璃体切割联合双层膜剥除治疗特发性斑前膜[J]. 国际眼科杂志, 2018, 18(11): 2011-2015. DOI: 10.3980/j.issn.1672-5123.2018.11.15.Yang XQ, Li T. Vitrectomy combine with double membranes peeling for idiopathic epiretinal membrane[J]. Int Eye Sci, 2018, 18(11): 2011-2015. DOI: 10.3980/j.issn.1672-5123.2018.11.15.
24.	Mizutani Y, Sato Y, Shimda H. Outcome of nonvitrectomizing vitreous surgery for epimacular membranes[J]. Folia Ophthalmol Jpn, 2001, 52(1): 302-306.

1. Wiznia RA. Posterior vitreous detachment and idiopathic preretinal macular gliosis[J]. Am J Ophthalmol, 1986, 102(2): 196-198. DOI: 10.1016/0002-9394(86)90144-3.
2. 房国凤, 高荣玉, 徐鑫彦. 黄斑前膜的研究现状[J]. 国际眼科杂志, 2017, 17(8): 1669-1672. DOI: 10.3980/j.issn.1672-5123.2017.8.17.Fang GF, Gao RY, Xu XY. Current research status of macular epiretinal membrane[J]. Int Eye Sci, 2017, 17(8): 1669-1672. DOI: 10.3980/j.issn.1672-5123.2017.8.17.
3. Charles S. Vitreous microsurgery[M]. 2nd ed. Baltimore: Williams&Wilkins, 1987: 153-157.
4. Sakaguchi H, Oshima Y, Tano Y. 27-gauge transconjunctival nonvitrectomizing vitreous surgery for epiretinal membrane removal[J]. Retina, 2007, 27(9): 1302-1304. DOI: 10.1097/IAE.0b013e31813e0c03.
5. 曾苗, 陈晓, 洪玲, 等. 特发性黄斑前膜患者中心凹无血管区面积与中心凹形态相关性研究[J]. 中华眼底病杂志, 2019, 35(1): 15-19. DOI: 10.3760/cma.j.issn.1005-1015.2019.01.004.Zeng M, Chen X, Hong L, et al. Correlation between foveal avascular zone size and foveal morphology in patients with idiopathic macular epiretinal membrane[J]. Chin J Ocul Fundus Dis, 2019, 35(1): 15-19. DOI: 10.3760/cma.j.issn.1005-1015.2019.01.004.
6. Bu SC, Kuijer R, Li XR, et al. Idiopathic epiretinal membrane[J]. Retina, 2014, 34(12): 2317-2335. DOI: 10.1097/IAE.0000000000000349.
7. Saito Y, Lewis JM, Park I, et al. Nonvitrectomizing vitreous surgery:a strategy to prevent postoperative nuclear sclerosis[J]. Ophthalmology, 1999, 106(8): 1541-1545. DOI: 10.1016/S0161-6420(99)90451-7.
8. Sawa M, Ohji M, Kusaka S, et al. Nonvitrectomizing vitreous surgery for epiretinal membrane[J]. Ophthalmology, 2005, 112(8): 1402-1408. DOI: 10.1016/j.ophtha.2005.02.014.
9. Reibaldi M, Longo A, Avitabile T, et al. Transconjunctival nonvitrectomizing vitreous surgery versus 25-gauge vitrectomy in patients with epiretinal membrane: a prospective randomized study[J]. Retina, 2015, 35(5): 873-879. DOI: 10.1097/IAE.0000000000000459.
10. 温晓英, 陈娜, 杨娜, 等. 不同手术方法治疗继发性黄斑前膜效果的观察[J]. 中华眼科医学杂志(电子版), 2018, 8(2): 64-69. DOI: 10.3877/cma.j.issn.2095-2007.2018.02.003.Wen XY, Chen N, Yang N, et al. Effect of different surgical methods on secondary macular epiretinal membrane[J]. Chin J Ophthalmol Med(Electronic Edition), 2018, 8(2): 64-69. DOI: 10.3877/cma.j.issn.2095-2007.2018.02.003.
11. Park SW, Byon IS, Lee JE, et al. Analysis of the ganglion cell layer and photoreceptor layer using optical coherence tomography after idiopathic epiretinal membrane surgery[J]. Graefe's Arch Clin Exp Ophthalmol, 2015, 253(10): 1829-1830. DOI: 10.1007/s00417-015-3003-5.
12. Gao M, Wang Y, Liu W, et al. Assessment of macular functio in patients with idiopathic epiretinal membrane by multifocal Electroretinography:correlation with visual acuity and optical coherence tomography[J]. BMC Ophthalmology, 2017, 17(1): 221. DOI: 10.1186/s12886-017-0621-1.
13. Almony A, Holekamp NM, Bai F, et al. Small-gauge vitrectomy does not protect against nuclear sclerotic cataract[J]. Retina, 2012, 32(3): 499-505. DOI: 10.1097/IAE.0b013e31822529cf.
14. Holekamp NM, Shui YB, Beebe DC. Vitrectomy surgery increases oxygen exposure to the lens: a possible mechanism for nuclear cataract formation[J]. Am J Ophthalmol, 2005, 139(2): 302-310. DOI: 10.1016/j.ajo.2004.09.046.
15. Sawa M, Saito Y, Hayashi A, et al. Assessment of nuclear sclerosis after nonvitrectomizing vitreous surgery[J]. Am J Ophthalmol, 2001, 132(3): 356-362. DOI: 10.1016/s0002-9394(01)01025-x.
16. Savastano A, Savastano MC, Barca F, et al. Combining cataract surgery with 25-gauge high-speed pars plana vitrectomy: results from a retrospective study[J]. Ophthalmology, 2014, 121(1): 299-304. DOI: 10.1016/j.ophtha.2013.06.022.
17. 周静, 刘武, 李倩, 等. 特发性黄斑前膜手术前后黄斑厚度与功能的相关性研究[J]. 中华眼科杂志, 2012, 48(2): 119-123. DOI: 10.3760/cma.j.issn.0412-4081.2012.02.006.Zhou J, Liu W, Li Q, et al. A comparative study of macular thickness and function before and after idiopathic macular epiretinal membrane surgery[J]. Chin J Ophthalmol, 2012, 48(2): 119-123. DOI: 10.3760/cma.j.issn.0412-4081.2012.02.006.
18. Tarantola RM, Tsui JY, Graff JM, et al. Intraoperative sclerotomy-related retinal breaks during 23-gauge pars plana vitrectomy[J]. Retina, 2013, 33(1): 136-142. DOI: 10.1097/IAE.0b013e31825e1d62.
19. Ehrlich R, Goh YW, Ahmad N, et al. Retinal breaks in small-gauge pars plana vitrectomy[J]. Am J Ophthalmol, 2012, 153(5): 868-872. DOI: 10.1016/j.ajo.2011.10.015.
20. Hikichi T, Kosaka S, Takami K, et al. Incidence of retinal breaks in eyes undergoing 23-gauge or 20-gauge vitrectomy with induction of posterior vitreous detachment[J]. Retina, 2012, 32(6): 1100-1105. DOI: 10.1097/IAE.0b013e3182349449.
21. Nakano T, Uemura A, Sakamoto T. Incidence of iatrogenic peripheral retinal breaks in 23-gauge vitrectomy for macular diseases[J]. Retina, 2011, 31(10): 1997-2001. DOI: 10.1097/IAE.0b013e31820f49ea.
22. Liu H, Zuo S, Ding C, et al.Comparison of the effectiveness of pars plana vitrectomy with and without internal limiting membrane peeling for idiopathic retinal membrane removal: a meta-analysis[J/OL].J Ophthalmol, 2015, 2015: 974568[2015-11-26]. https://doi.org/10.1155/2015/974568. DOI:10.1155/2015/974568..
23. 杨小琴, 李拓. 玻璃体切割联合双层膜剥除治疗特发性斑前膜[J]. 国际眼科杂志, 2018, 18(11): 2011-2015. DOI: 10.3980/j.issn.1672-5123.2018.11.15.Yang XQ, Li T. Vitrectomy combine with double membranes peeling for idiopathic epiretinal membrane[J]. Int Eye Sci, 2018, 18(11): 2011-2015. DOI: 10.3980/j.issn.1672-5123.2018.11.15.
24. Mizutani Y, Sato Y, Shimda H. Outcome of nonvitrectomizing vitreous surgery for epimacular membranes[J]. Folia Ophthalmol Jpn, 2001, 52(1): 302-306.

Chinese Journal of Ocular Fundus Diseases

Clinical effect of non-vitrectomy in the treatment of idiopathic macular epiretinal membranes

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