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Concept: Epiretinal membrane

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The purpose of this study is to report two cases of idiopathic uveitis with secondary epiretinal membrane (ERM) formation in order to describe histologic and immunohistochemical features that may help distinguish uveitic from idiopathic ERMs.

Concepts: Medical terms, Cell membrane, Histology, Immunohistochemistry, Epiretinal membrane, Membrane

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PurposeTo evaluate the effects of intravitreal autologous plasmin enzyme (APE) in patients with focal vitreomacular traction (VMT).MethodsAPE was obtained by incubation of patient-derived purified plasminogen with streptokinase, and intravitreally injected 5-12 days later. Twenty-four hours after injection, in case of incomplete VMT release, a pars plana vitrectomy was performed. The hyaloid internal limiting membrane adherence and removal of the posterior hyaloid were intraoperatively evaluated.ResultsThirteen patients were recruited. During preparation of APE, five patients had spontaneous release of VMT. Eight patients received APE injection (2 IU). In five patients, spontaneous resolution of VMT occurred before APE administration. Twenty-four hours after injection, persistence of VMT was detected in all the eight treated patients. Best-corrected visual acuity was 0.51±0.37 LogMAR at baseline, improving to 0.23±0.14 LogMAR at 6 months (P=0.002). Foveal thickness was 464±180 μm at baseline, reducing to 246±59 μm at 6 months (P<0.001). Hyaloid was intraoperatively judged 'partially detached' in seven cases and 'totally detached' in one case. Hyaloid peeling was evaluated 'easy' in six eyes and 'very easy' in two eyes.ConclusionsIn the current study, there was a large percentage of spontaneous resolution of VMT before an APE administration. A single intravitreal APE injection seems insufficient to induce a complete posterior vitreous detachment in these patients.Eye advance online publication, 14 December 2012; doi:10.1038/eye.2012.248.

Concepts: Eye, Visual acuity, Ophthalmology, Vitrectomy, Retinal detachment, Vitreous humour, Epiretinal membrane, Posterior vitreous detachment

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PURPOSE: To report the optical coherence tomography (OCT) and fundus fluorescein angiography (FFA) results of the Macular Epiretinal Brachytherapy in Treated Age-Related Macular Degeneration study. DESIGN: Prospective, multicenter, interventional, noncontrolled clinical trial. PARTICIPANTS: Fifty-three eyes of 53 participants with chronic, active neovascular age-related macular degeneration (AMD) requiring frequent anti-vascular endothelial growth factor retreatment. METHODS: Participants underwent pars plana vitrectomy with a single 24-gray dose of epimacular brachytherapy (EMB), delivered with an intraocular, handheld, cannula containing a strontium 90/yttrium 90 source positioned over the active lesion. Participants were retreated with ranibizumab administered monthly as needed, using predefined retreatment criteria. Patients underwent FFA at baseline, month 1, and month 12. Patients underwent optical coherence tomography (OCT) at baseline and then monthly for 12 months. The FFA and OCT images were evaluated by independent, central reading facilities. MAIN OUTCOME MEASURES: Change in OCT centerpoint thickness and angiographic lesion size 12 months after EMB. RESULTS: Mean centerpoint thickness increased by 50 μm, from 186 to 236 μm (P = 0.292), but 70% of participants had an increase of less than the mean, with a median increase of only 1.8 μm. The FFA total lesion size increased slightly by 0.79 mm(2), from 14.69 to 15.48 mm(2) (P = 0.710). Total choroidal neovascularization (CNV) area increased by 1.17 mm(2), from 12.94 to 14.12 mm(2) (P = 0.556). The classic CNV area decreased substantially by 3.70 mm(2), from 3.90 to 0.20 mm(2) (P<0.01). Predominantly classic lesions showed the greatest response, with mean Early Treatment Diabetic Retinopathy Study visual acuity improving by 1.5 letters (versus -4.0 for all participants combined); mean centerpoint thickness decreased by 43 μm (P = 0.875). The angiographic and OCT response did not correlate with lesion size at baseline. CONCLUSIONS: In chronic, active, neovascular AMD, EMB is associated with nonsignificant changes in centerpoint thickness and FFA total lesion size over 12 months. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Concepts: Retina, Ophthalmology, Vitrectomy, Diabetic retinopathy, Optical coherence tomography, Macular degeneration, Epiretinal membrane, Fluorescein angiography

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Three patients had unilateral vitreomacular traction (VMT) syndrome and the diagnosis was confirmed by spectral domain-type optical coherence tomography (OCT). All patients were female aged 51, 55 and 62 years. All denied surgical intervention. In one patient, rapid spontaneous resolution of the vitreomacular traction with a complete posterior vitreous detachment (PVD) and a normal foveal contour was achieved within 15 days. In the remaining two cases a complete PVD could be detected as late as seven months after the initial presentation. In one, though the vitreomacular adhesion released spontaneously, there was a minimal residual epiretinal membrane. In all three eyes, visual acuity was considerably improved. Spontaneous, uneventful resolution has been rarely reported in the natural course of VMT but several recent studies with the aid of OCT have shown that spontaneous resolution might be more common than previously known. In light of our cases, we believe that there is still room to search for OCT clues in eyes with VMT to predict eyes with higher likelihood of spontaneous resolution, thereby avoiding unnecessary pharmacologic and/or surgical intervention.

Concepts: Optics, Retina, Eye, Visual acuity, Ophthalmology, Vitreous humour, Epiretinal membrane, Posterior vitreous detachment

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Abstract Purpose: To describe the course of inflammation and identify predictors of successful outcome in chronic endogenous/autoimmune uveitic patients following 25-gauge vitrectomy. Methods: In this retrospective study, charts of 74 patients (74 eyes) undergoing vitrectomy for complicated uveitis that had a minimum of 12 months follow-up were reviewed. Successful outcome measures were improvement (≥0.3 logMAR) of visual acuity (VA), decreased inflammatory activity (≥1+), and reduction of required drugs (more than one). Logistic regression techniques were used to identify predictors of successful outcomes. Result: A total of 44 (59%) of the 74 patients showed VA improvement, 38 (51%) showed decreased inflammatory activity, and 30 (40%) required fewer drugs following vitrectomy. Independent predictor for VA improvements was accompanying cataract extraction, for postoperative inflammatory decrease was the absence of preoperative cystoid macular edema and greater preoperative activity of inflammation, and for the reduction in the number of required drugs was preoperative presence of epiretinal membrane formation. Conclusion: 25-gauge vitrectomy may be beneficial in patients with complicated chronic endogenous uveitis in terms of VA and control of inflammation. Accompanying cataract extraction, when necessitated, during vitrectomy and the absence of preoperative cystoid macular edema were indicators of better outcomes. Establishing predictors may assist clinicians in better patient selection.

Concepts: Inflammation, Better, Regression analysis, Medical signs, Visual acuity, Ophthalmology, Epiretinal membrane, Macular edema

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The purpose of this study was to determine whether the outer nuclear layer (ONL) deformation detected by spectral-domain optical coherence tomography (SD-OCT) is correlated with visual acuity before and after surgery in patients with idiopathic epiretinal membrane (ERM).

Concepts: Optics, Retina, Eye, Photoreceptor cell, Visual acuity, Ophthalmology, Tomography, Epiretinal membrane

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To investigate the difference in the occurrence of postoperative epiretinal membranes (ERMs) in vitrectomy for rhegmatogenous retinal detachment with and without peeling of the internal limiting membrane (ILM).

Concepts: Cell membrane, Retina, Ophthalmology, Vitrectomy, Retinal detachment, Epiretinal membrane, Membrane

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To determine the efficacy of internal limiting membrane (ILM) peeling during vitrectomy for rhegmatogenous retinal detachment (RRD) regarding post-vitrectomy epiretinal membrane (ERM) development and visual outcomes.

Concepts: Retina, Ophthalmology, Vitrectomy, Retinal detachment, Epiretinal membrane

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Epiretinal membranes (ERM) have been increasingly characterized with the advent of new optical coherence tomographies (OCTs). We intended to perform a systematic review regarding prognostic factors (PF) of ERM after surgery.

Concepts: Optics, Thought experiment, Epiretinal membrane, Advent

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This study compared the postoperative outcomes of 27-gauge (G) and 25-G vitrectomy performed for the treatment of idiopathic epiretinal membrane (ERM).

Concepts: Ophthalmology, Vitrectomy, Epiretinal membrane