Search Results (25)

Background: Secondary epiretinal membrane (ERM) is a common complication of diabetic retinopathy, but data on surgical outcome is limited. The aim of this study was to evaluate anatomical and functional outcomes after pars plana vitrectomy with ERM peeling in eyes with diabetic retinopathy. Methods: A retrospective analysis was conducted on 87 eyes of 87 consecutive patients with diabetic retinopathy who underwent ERM peeling over a ten-year period (04/2013–11/2022). Collected data included demographics, best-corrected visual acuity (BCVA), stage of diabetic retinopathy, and optical coherence tomography parameters such as central subfield retinal thickness (CSRT), macular volume (MV), and presence of hyperreflective foci, subretinal fluid, and intraretinal fluid. Statistical analyses were performed using a paired t-test and the Wilcoxon test. Results: The majority of patients had type 2 diabetes (96.6%), and 69.0% presented with diabetic macular edema (DME). The mean follow-up was 2.2 ± 2.0 years. Significant postoperative reductions were observed in CSRT (from 377.20 ± 99.28 µm to 337.99 ± 113.834 µm; p = 0.008) and MV (from 10.11 ± 1.46 mm³ to 99.28 ± 1.07 mm³; p < 0.001). No significant changes in BCVA were observed across the entire study cohort. ERM recurrence was rare (2.3%), and no major complications occurred. Conclusions: ERM peeling in diabetic eyes leads to significant anatomical improvement, especially in advanced diabetic retinopathy and DME, but with limited functional gains. The surgical indication should be carefully considered. Full article

Background/Objectives: To evaluate the clinical efficacy and safety of combined phacoemulsification, extended depth-of-focus (EDOF) intraocular lens (IOL) implantation, and epiretinal membrane (ERM) peeling during vitrectomy surgery for treating patients with ERM, cataracts, and presbyopia. Methods: Patients with preexisting low-grade ERM who underwent cataract surgery with the implantation of an EDOF IOL were included. Corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), autorefraction and keratometry, manifest refraction, and central foveal thickness (CFT) were measured before surgery and at postoperative months 3 and 6. A monocular defocus curve was measured 6 months postoperatively. Furthermore, patients were instructed to report symptoms of photic phenomena at each visit. Results: In total, 16 eyes of 16 patients (median age, 59.5 years) were included in this study. Compared with those at baseline, the CDVA, UDVA, UIVA, UNVA, and CFT significantly improved at 3 and 6 months postoperatively. The defocus curve revealed that a visual acuity of 0.12 logarithm of the minimal angle of resolution or better was maintained from +0.5 to –1.5 diopters. No patients reported visual disturbances suggestive of photic phenomena, such as glare or halo. Conclusions: EDOF IOL implantation had excellent outcomes, including improved distance and intermediate visual acuity, functional near visual acuity, and absence of visual symptoms in patients who received phacovitrectomy to treat low-grade ERM. Full article

(1) Background: The process of epiretinal membrane peeling (MP) requires precise intraoperative visualization to achieve optimal surgical outcomes. This study investigates the integration of preoperative Optical Coherence Tomography (OCT) images into real-time surgical video feeds, providing a dynamic overlay that enhances the decision-making process during surgery. (2) Methods: Five MP surgeries were analyzed, where preoperative OCT images were first manually aligned with the initial frame of the surgical video by selecting five pairs of corresponding points. A homography transformation was then computed to overlay the OCT onto that first frame. Subsequently, for consecutive frames, feature point extraction (the Shi–Tomasi method) and optical flow computation (the Lucas–Kanade algorithm) were used to calculate frame-by-frame transformations, which were applied to the OCT image to maintain alignment in near real time. (3) Results: The method achieved a 92.7% success rate in optical flow detection and maintained an average processing speed of 7.56 frames per second (FPS), demonstrating the feasibility of near real-time application. (4) Conclusions: The developed approach facilitates enhanced intraoperative visualization, providing surgeons with easier retinal structure identification which results in more comprehensive data-driven decisions. By improving surgical precision while potentially reducing complications, this technique benefits both surgeons and patients. Furthermore, the integration of OCT overlays holds promise for advancing robot-assisted surgery and surgical training protocols. This pilot study establishes the feasibility of real-time OCT integration in MP and opens avenues for broader applications in vitreoretinal procedures. Full article

Purpose: Augmented reality (AR) may allow vitreoretinal surgeons to leverage microscope-integrated digital imaging systems to analyze and highlight key retinal anatomic features in real time, possibly improving safety and precision during surgery. By employing convolutional neural networks (CNNs) for retina vessel segmentation, a retinal coordinate system can be created that allows pre-operative images of capillary non-perfusion or retinal breaks to be digitally aligned and overlayed upon the surgical field in real time. Such technology may be useful in assuring thorough laser treatment of capillary non-perfusion or in using pre-operative optical coherence tomography (OCT) to guide macular surgery when microscope-integrated OCT (MIOCT) is not available. Methods: This study is a retrospective analysis involving the development and testing of a novel image-registration algorithm for vitreoretinal surgery. Fifteen anonymized cases of pars plana vitrectomy with epiretinal membrane peeling, along with corresponding preoperative fundus photographs and optical coherence tomography (OCT) images, were retrospectively collected from the Mayo Clinic database. We developed a TPU (Tensor-Processing Unit)-accelerated CNN for semantic segmentation of retinal vessels from fundus photographs and subsequent real-time image registration in surgical video streams. An iterative patch-wise cross-correlation (IPCC) algorithm was developed for image registration, with a focus on optimizing processing speeds and maintaining high spatial accuracy. The primary outcomes measured were processing speed in frames per second (FPS) and the spatial accuracy of image registration, quantified by the Dice coefficient between registered and manually aligned images. Results: When deployed on an Edge TPU, the CNN model combined with our image-registration algorithm processed video streams at a rate of 14 FPS, which is superior to processing rates achieved on other standard hardware configurations. The IPCC algorithm efficiently aligned pre-operative and intraoperative images, showing high accuracy in comparison to manual registration. Conclusions: This study demonstrates the feasibility of using TPU-accelerated CNNs for enhanced AR in vitreoretinal surgery. Full article

Background and Aim: Despite the abundant literature, internal limiting membrane (ILM) peeling remains a controversial topic, especially in diabetic eyes. We compared the safety and effectiveness of intraoperative optical coherence tomography (iOCT)-assisted selective epiretinal membrane (ERM) peeling with dye-assisted ERM and ILM peeling, for the treatment of tractional diabetic macular edema (tDME). Material and Methods: In this single-center retrospective study, we evaluated consecutive patients with tDME who underwent iOCT-assisted selective ERM peeling (Group A) or “dual blue” dye-assisted ERM and ILM peeling (Group B). Best corrected visual acuity (BCVA) and central macular thickness (CMT) were compared over a 12-month follow-up. A linear mixed model analysis was performed. Results: At baseline, the two groups were comparable in terms of their demographic and clinical outcomes. No significant difference between BCVA and CMT was observed among the groups. Both groups showed significant improvement in outcomes at the last follow-up (p < 0.001), although only iOCT-assisted ERM peeling ensured significant visual gain and macular thinning (p < 0.001) one month after surgery. A significant effect of time on both outcomes (p < 0.001) and of time–treatment interaction on visual change (p = 0.02) were observed. In eight patients, macular edema recurred (Group A: two patients; Group B: six patients) and was managed with an intravitreal dexamethasone implant. In Group A, one patient developed a recurrence of ERM without the need for reoperation. Conclusions: iOCT-assisted ERM removal may be as effective as dye-assisted ERM and ILM peeling to treat tDME. Additionally, it ensures a quicker recovery of visual function and macular thickness. The observed ERM recurrence within the 1-year follow-up was mild and did not necessitate additional surgery. Full article

Background: The present study compares the anatomical and functional outcomes (best-corrected visual acuity (BCVA) and central macular thickness (CMT)) among membrane peeling with or without SF6 tamponade in patients with epiretinal membrane. Methods: We retrospectively reviewed patients diagnosed with macular pucker who underwent pars plana vitrectomy and membrane peeling in a tertiary center in Taiwan from January 2021 to December 2022. Subjects were categorized into with or without SF6 tamponade groups (SF6 group and BSS group). Postoperative intraocular pressure and complications were documented. Logistic regression analyses were performed to identify the prognostic factors during follow-up. Results: A total of 89 eyes were enrolled, including 34 eyes in the BSS group and 55 eyes in the SF6 group. The mean age was 66 years old, and a female predilection was demonstrated. Both groups possessed statistically significant improvement in BCVA and CMT after the operation. There was no significant difference in CMT between the groups at any time of observation, yet we observed significant differences in baseline BCVA and BCVA at last follow-up among the two groups. Both groups yielded an approximate enhancement of LogMAR 0.3 in BCVA postoperatively. There was no significant difference noted in postoperative IOP between the two groups. Conclusion: Membrane peeling with or without SF6 tamponade yields comparable outcomes anatomically and functionally. This may indicate that SF6 tamponade for idiopathic macular pucker surgery may not provide extra benefit, and therefore warrants reconsideration as standard procedure. Full article

Background: To investigate anatomical and functional changes of the macula caused by epiretinal membrane (ERM) peeling procedures in patients with or without posterior vitreous detachment (PVD). Methods: This is a multicentric prospective observational study on thirty-seven (37) patients affected by symptomatic ERM who underwent 25-gauge pars plana vitrectomy (PPV), induction of a PVD (as needed) and peeling of both the internal limiting membrane (ILM) and ERM. Optical coherence tomography–angiography (OCT-A) (RS 3000, Nidek, Japan) and microperimetry (MP-3, Nidek, Japan) were performed; central retinal thickness (CRT), foveal avascular zone (FAZ) area and perimeter, vessel density and perfusion density, retinal sensitivity and fixation stability (as a total mean retinal sensitivity (MRS), and MRS in the ellipse area and bivariate contour ellipse area (BCEA)) were recorded at baseline and up to postoperative month 3. Results: Eyes were classified as having complete PVD (51.4%) or incomplete PVD (48.6%). At baseline, patients with incomplete PVD had worse best-corrected distance visual acuity (BCDVA), total MRS, MRS in the ellipse area and BCEA, and higher CRT than patients with complete PVD. At month 3, the differences in BCDVA between the two groups remained statistically significant, with patients with incomplete PVD having worse results (difference: 0.199 logMAR, p < 0.001). The difference in the MRS in the ellipse area was statistically significant at month 3 (−3.378 Db, p = 0.035), with greater improvement in patients with complete PVD. Conclusions: Our study shows that patients with incomplete PVD have worse conditions at baseline than patients with complete PVD, and the differences in visual acuity and retinal sensitivity were maintained postoperatively. Full article

This study investigated the long-term effects of epiretinal membrane (ERM) surgery on peripapillary retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT) images. We included 30 patients with idiopathic ERM who underwent a vitrectomy for ERM removal with internal limiting membrane peeling. The patients were followed up for 5 years after surgery, and their medical records were reviewed for best-corrected visual acuity (BCVA) and OCT parameters. The study population comprised 24 females (80.0%), and the mean age was 65.4 ± 7.2 years. The baseline BCVA significantly improved from 0.28 ± 0.24 to 0.12 ± 0.09 logMAR (p < 0.001) 1 year after surgery and continued to improve for 5 years after surgery. The peripapillary RNFL thickness initially increased after surgery and then gradually decreased. The peripapillary RNFL thicknesses of the global and temporal sectors showed significant reductions 2 years after surgery, whereas those of the nasal sectors did not significantly change. The peripapillary RNFL thickness was thinner in the global and temporal areas of the operated eyes than in those of the fellow eyes 4 and 5 years after surgery. In conclusion, peripapillary RNFL thicknesses decreased in the global and temporal areas after ERM surgery, whereas peripapillary RNFL thicknesses in the nasal sectors did not change significantly during the long-term follow-up. Full article

Introduction: Epiretinal membrane (ERM) is a relatively common condition affecting the macula. When symptoms become apparent and compromise a patient’s quality of vision, the only therapeutic approach available today is surgery with a vitrectomy and peeling of the ERM. Angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACE-Is) reduce the effect of angiotensin II, limit the amount of fibrosis, and demonstrate consequences on fibrinogenesis in the human body. Case Description and Materials and Methods: A rare case of spontaneous ERM resolution with concomitant administration of ARB is reported. The patient was set on ARB treatment for migraines and arterial hypertension, and a posterior vitreous detachment was already present at the first diagnosis of ERM. The scientific literature addressing the systemic relationship between ARB, ACE-Is, and fibrosis in the past 25 years was searched in the PubMed, Medline, and EMBASE databases. Results: In total, 38 and 16 original articles have been selected for ARBs and ACE-Is, respectively, in regard to fibrosis modulation. Conclusion: ARBs and ACE-Is might have antifibrotic activity on ERM formation and resolution. Further clinical studies are necessary to explore this phenomenon. Full article

Purpose: The Preceyes Surgical System (PSS) is a robotic assistive device that may enhance surgical precision. This study assessed pre- and intra-operative times and surgeons’ perceptions of robot-assisted epiretinal membrane peeling (RA-MP). Methods: We analyzed the time requirement of three main tasks: the preparation of the PSS (I), patient preparation (II), and surgery (III). Following surgery, the surgeons were asked questions about their experience. Results: RA-MP was performed in nine eyes of nine patients. Task I required an average time of 12.3 min, initially taking 15 min but decreasing to 6 min in the last surgery. Task II showed a mean time of 47.2 (range of 36–65) min. Task III had a mean time of 72.4 (range of 57–100) min. A mean time of 27.9 (range of 9–46) min was necessary for RA-MP. The responses to the questionnaire revealed a trend towards increasing ease and reduced stress as familiarity with the PSS increased. Conclusions: A substantial reduction in pre- and intra-operative times, decreasing to a total of 115 min, was demonstrated. RA-MP was positively anticipated by the surgeons and led to no hand or arm strain while being more complex than manual MP. Full article

The aim of this study was to evaluate the long-time results of highly concentrated autologous platelet-rich plasma (PRP) used as an adjunct in lamellar macular hole (LMH) surgery. Nineteen eyes of nineteen patients with progressive LMH were enrolled in this interventional case series, on which 23/25-gauge pars plana vitrectomy was performed and 0.1 mL of highly concentrated autologous platelet-rich plasma was applied under air tamponade. Posterior vitreous detachment was induced, and the peeling of tractive epiretinal membranes, whenever present, was performed. In cases of phakic lens status, combined surgery was carried out. Postoperatively, all patients were instructed to remain in a supine position for the first two postoperative hours. Best-corrected visual acuity (BCVA) testing, microperimetry, and spectral domain optical coherence tomography (SD-OCT) were carried out preoperatively and at minimum 6 months (in median 12 months) postoperatively. Foveal configuration was postoperatively restored in 19 of 19 patients. Two patients who had not undergone ILM peeling showed a recurring defect at 6-month follow-up. Best-corrected visual acuity improved significantly from 0.29 ± 0.08 to 0.14 ± 0.13 logMAR (p = 0.028, Wilcoxon signed-rank test). Microperimetry remained unchanged (23.38 ± 2.53 preoperatively; 23.0 ± 2.49 dB postoperatively; p = 0.67). No patients experienced vision loss after surgery, and no significant intra- or postoperative complications were observed. Using PRP as an adjunct in macular hole surgery significantly improves morphological and functional outcomes. Additionally, it might be an effective prophylaxis to further progression and also the formation of a secondary full-thickness macular hole. The results of this study might contribute to a paradigm shift in macular hole surgery towards early intervention. Full article

Proliferative vitreoretinal diseases (PVDs) encompass proliferative vitreoretinopathy (PVR), epiretinal membranes, and proliferative diabetic retinopathy. These vision-threatening diseases are characterized by the development of proliferative membranes above, within and/or below the retina following epithelial-mesenchymal transition (EMT) of the retinal pigment epithelium (RPE) and/or endothelial-mesenchymal transition of endothelial cells. As surgical peeling of PVD membranes remains the sole therapeutic option for patients, development of in vitro and in vivo models has become essential to better understand PVD pathogenesis and identify potential therapeutic targets. The in vitro models range from immortalized cell lines to human pluripotent stem-cell-derived RPE and primary cells subjected to various treatments to induce EMT and mimic PVD. In vivo PVR animal models using rabbit, mouse, rat, and swine have mainly been obtained through surgical means to mimic ocular trauma and retinal detachment, and through intravitreal injection of cells or enzymes to induce EMT and investigate cell proliferation and invasion. This review offers a comprehensive overview of the usefulness, advantages, and limitations of the current models available to investigate EMT in PVD. Full article

Background: Idiopathic epiretinal membrane (iERM) surgery is one of the most commonly performed vitreoretinal surgeries, and the issue of internal limiting membrane (ILM) peeling in ERM surgery is still controversial. The aims of this study are to evaluate the changes in retinal vascular tortuosity index (RVTI) after pars plana vitrectomy for the iERM using optical coherence tomography angiography (OCTA) and to assess whether ILM peeling has an additional effect on RVTI reduction. Methods: This study included25 eyes of 25 iERM patients who underwent ERM surgery. The ERM was removed without ILM peeling in 10 eyes (40.0%), and the ILM was peeled in addition to the ERM in 15 eyes (60.0%). The existence of the ILM after ERM peeling was checked with second staining in all eyes. Best corrected visual acuity (BCVA) and 6 × 6 mm en-face OCTA images were recorded before surgery and at the first month postoperatively. A skeleton model of the retinal vascular structure was created following Otsu binarization of en-face OCTA images using ImageJ software (1.52U). RVTI was calculated as the ratio of each vessel length to its Euclidean distance on the skeleton model using the Analyze Skeleton plug-in. Results: The mean RVTI declined from 1.220 ± 0.017 to 1.201 ± 0.020 (p = 0.036) in eyes with ILM peeling and from 1.230 ± 0.038 to 1.195 ± 0.024 in eyes without ILM peeling (p = 0.037). There was no difference between the groups in terms of postoperative RVTI (p = 0.494). A statistically significant correlation was found between postoperative RVTI and postoperative BCVA (rho = 0.408, p = 0.043). Conclusions: The RVTI is an indirect indicator of the traction created by the iERM on retinal microvascular structures, and it was effectively reduced after iERM surgery. The postoperative RVTIs were similar in cases who underwent iERM surgery with or without ILM peeling. Therefore, ILM peeling may not have an additive effect on the loosening of microvascular traction and thus may be reserved for recurrent ERM surgeries. Full article

Background: The aim of this study is to provide intraoperative data demonstrating a significant difference in the membrane peeling dynamics performed under a perfluorocarbon (PFCL) bubble, compared to normal balanced saline solution (BSS). Methods: This is a prospective, interventional, single-center study on a series of 36 consecutive eyes of 36 patients affected by primary epiretinal membrane (ERM). Eighteen eyes underwent standard ERM peeling, while 18 eyes received a PFCL-assisted procedure. Intraoperative optical coherence tomography (iOCT) B-Scans were collected to evaluate the displacement angle (DA) between the underlying retinal plane and the flap of epiretinal tissue, along with the number of times the surgeon had to grab the flap during the intervention. Follow-up visits were carried out at postoperative week 1 and months 1, 3 and 6. Results: The mean DA was 164.8° ± 4.0 in the PFCL-assisted group and 119.7° ± 8.7 in the standard group, with a statistically significant difference between groups (p < 0.001). Moreover, we found a significant difference in the amount of ERM grabs between the two groups (7.2 ± 2.5 in the PFCL-assisted group vs. 10.3 ± 3.1 in the standard group, p = 0.005). The mean BCVA and metamorphopsia significantly improved in both groups (p < 0.05), with no significant intergroup difference at all follow-up visits. Similarly, CST significantly decreased in both groups, and final CST was similar between the two groups (p = 0.719). Overall, three eyes in the standard group developed postoperative dissociated optic nerve fiber layer (DONFL, 16.6%), compared to none of the PFCL-assisted group. Conclusion: We reported a statistically significant difference in the intraoperative peeling dynamics of the PFCL-assisted group, accounting for a decreased tendency in the tearing of the ERM flap and possibly reduced damage to the fiber layer, with equal effectiveness in improving visual function and foveal thickness. Full article

Purpose-To evaluate the anatomical and functional outcomes of vitrectomy and epiretinal membrane (ERM) peeling in patients with uveitis. Secondarily, we evaluated the effect of internal limiting membrane (ILM) peeling on surgical outcomes, and of surgery on uveitis activity and, thus, therapeutic regime. Methods-Bicentre, retrospective, interventional case series of 29 eyes of 29 consecutive patients affected by uveitis and ERM, that had undergone pars plana vitrectomy with ERM peel between 2012 and 2020, with a minimum postoperative follow-up (FU) of six-months. Demographic data, best-corrected visual-acuity (BCVA), clinical findings, intraoperative and postoperative complications, and macular optical-coherence-tomography scans were reviewed. Results-The mean (standard deviation) duration of follow-up was 32 (22) months. At six-month FU, mean central-retinal-thickness (CRT) significantly improved (from 456 (99) to 353 (86) microns; p < 0.001), and mean BCVA improved from 0.73 (0.3) to 0.49 (0.36) logMAR (p < 0.001), with only one (3%) patient experiencing worsening of vision. The rate of concomitant cystoid macular edema decreased from 19 (66%) eyes at presentation to eight (28%) eyes at final-FU (p = 0.003). Comparing eyes in which ILM peeling was performed in addition to ERM peeling only, BCVA or CRT reduction were comparable. Only a minority of six (21%) eyes had a worsening in uveitis activity requiring additional medications, whereas most patients resumed the same treatment (52%) or received less treatment (28%) (p = 0.673). Conclusions-Vitrectomy with ERM peeling led to favourable anatomical and functional outcomes in patients with uveitis regardless of whether the ILM is peeled or not. As in most patients, no activation of the uveitis requiring additional medications was noted, we do not recommend changes in anti-inflammatory/immunosuppressive therapy postoperatively. Full article