Effect of Air Tamponade on Postoperative Visual Acuity and Intraretinal Cystoid Changes after Peeling of Idiopathic Epiretinal Membranes in Pseudophakic Patients

Abstract

<b><i>Purpose:</i></b> Epiretinal membrane is a macular disorder leading to metamorphopsia and decreased visual acuity. The aim of the present study was to assess the possible effects of air tamponade, balanced salt solution (BSS), and combined phacoemulsification on functional and anatomical outcomes. <b><i>Procedures:</i></b> This prospective exploratory analysis included 72 eyes with idiopathic epiretinal membranes, scheduled to undergo 23-G pars plana vitrectomy with membrane peeling. Air tamponade or BSS was used in all cases. Optical coherence tomography (OCT) imaging was performed intraoperatively, and follow-up including visual acuity testing and OCT measurements was conducted until 3 months postoperatively. <b><i>Results:</i></b> Mean best-corrected visual acuity improved between +2.1 and +3.1 letters, and mean central subfield thickness of the macula decreased between –29.6 and –76 µm in the examined groups, without significant differences between the air tamponade and BSS groups. There was no significant difference in the presence of intraretinal cystoid changes between the groups. <b><i>Conclusions:</i></b> The use of air tamponade did not show any significant differences in the anatomical and functional postoperative results compared to BSS. Furthermore, phacovitrectomy did not result in significantly more intraretinal cystoid changes 3 months after surgery.

Clinical applications for intraoperative optical coherence tomography: a systematic review

“…On the other hand, no association has been found between increased retinal damage and subsequent alterations when using a specific type of instrument (e.g., pick, loop or duster) during membrane peeling [11,[46][47][48]. During and immediately after peeling the ILM or ERM significant iatrogenic retinal alterations could be detected on the iOCT scans (see Supplementary Table 2), though the detected alterations resolved rapidly after releasing traction or after surgery [44,46,47,[49][50][51][52][53][54][55][56]. The impact of these transient alterations is not yet fully understood, but studies have found no association with long-term worsening of functional or anatomical outcomes [47,49,[52][53][54]57].…”

Surgical Outcomes in Idiopathic Epiretinal Membrane Surgery with or without Gas Tamponade

“…눈 속 가스 충전은 1911년 망막박리의 치료로 처음 눈 속 공 기를 주입하여 성공적인 망막유착을 이뤄낸 이후 망막박리, 황반원공, 근시중심와층간분리 등 다양한 망막 질환의 수술 에 이용되고 있다 [7,8]. 망막앞막에서도 유리체절제술과 망 막앞막 및 내경계막제거술을 시행한 뒤 망막의 상태에 따라 막 제거 중 중심와 견인이 있어 보이거나 혹은 망막의 주름 을 펴고 편평하게 하기 위해 가스 충전술을 시행할 수도 있 다 [9][10][11][12][13]. 이렇듯 다양한 용도로 사용되는 가스 충전술의 효 과에 대해 과거 연구들은 주로 황반원공이나 근시중심와층 간분리 등에 한정되어 있었다 [7,8,14,15].…”

“…망막앞막에 대해서는 2014년 Leitritz et al [11]이 유리체절제술과 망막앞막의 제거 후 평형염액과 공기를 주입한 후 3개월째 수술 결과를 비교한 연구 가 처음이었다. 이후 몇몇 저자들이 망막앞막수술 때 평형염액 과 공기, 공기와 육불화황(sulfur hexafluoride, SF 6 ) 가스를 주 입하고 수술 결과를 비교한 연구들을 보고하였다 [9,10,12]. 이 에 대한 연구는 국내에서 보고된 적이 없고 또한 SF 6 가스 충 전 여부에 따른 결과도 보고된 적 없어 이에 저자들은 특발망 막앞막으로 유리체절제술과 망막앞막제거술을 할 때 SF 6 가 스 충전 여부에 따라 수술 후 시간 경과에 따른 시력과 중심망 막두께(central macular thickness), 망막내층두께(inner retinal thickness), 망막 내 낭포성 변화(intraretinal cystic change) 및 황반부 대칭성의 차이(foveal surface symmetry difference)를 비 교하였다.…”

Effect of Air Tamponade among Patients with Epiretinal Membranes and Intraretinal Cystoid Changes Undergoing Vitrectomy with Membrane Peeling – A Prospective Randomized Trial

“…Leitritz et al berichteten über eine bessere postoperative foveale Kontur und einen Trend für einen besseren Visus in der Gruppe mit Lufttamponade, verglichen mit "balanced salt solution" (BSS) [20]. In unseren eigenen Publikationen konnten wir keine Hinweise auf bessere Visusergebnisse bei Patienten (gemischte Patientengruppe mit und ohne intraretinale zystoide Veränderungen) in der Gruppe mit Lufttamponade verglichen mit BSS finden [9,10] Intraretinale zystoide Veränderungen in der Makula wurden mittels OCT diagnostiziert. Veränderungen der retinalen Dicke wurden mit der "central subfield thickness" des OCT-Gerätes mit einem Durchmesser von 1 mm und die Fovea miteinschließend gemessen.…”

“…1. der Effekt der Tamponade bietet eine Hypothese für bessere postoperative Resultate bei Patienten mit ERM mit intraretinalen zystoiden Veränderungen und 2. die Daten, auf denen die Fallzahlberechnung basiert, zeigten einen Trend für eine bessere Resorption von präoperativen intraretinalen zystoiden Veränderungen in der Gruppe mit Lufttamponade[10].Um ein mögliches Bias bei der Fallzahlberechnung durch den Einfluss der Kataraktoperation auf die Resorption von intraretinalen zystoiden Veränderungen auszuschließen, wurden nur Patienten, die bereits pseudophak zum Zeitpunkt der Vitrektomie mit Membrane Peeling waren, für die Berechnung ausgewählt. Die Fallzahlberechnung erfolgte mit dem Chi-Quadrat-Test aufgrund der nicht metrischen Daten mit der Software BiAS (epsilon Verlag, Deutschland).…”