RESIDUAL CELLULAR PROLIFERATION ON THE INTERNAL LIMITING MEMBRANE IN MACULAR PUCKER SURGERY

Purpose To describe the occurrence of massive macular edema and visual loss after indocyanine green-assisted (ICG) macular pucker surgery. Methods/Results A 74 years old female presented with a macular pucker and a hypertrophy of the retinal pigment epithelium (RPE) in her left eye. The preoperative visual acuity (VA) was 20/100. Surgery consisted of cataract extraction, lens implantation and standard pars plana vitrectomy with peeling of epiretinal tissue followed by the removal of the internal limiting membrane (ILM) remnants stained using a 0.05% ICG solution. One day after surgery, VA was counting fingers. There was an extensive macular edema and retinal thickening with hyperfluorescence during fluorescein angiography and pronounced autofluorescence using ICG filters. During follow up, the macular edema resolved completely, but VA decreased to 20/800 at six months postoperatively. There was a central scotoma and unstable fixation seen during microperimetry. Discussion This case report indicates that ICG might come into contact with bare retina if injected following removal of epiretinal membranes. Whether the observed RPE hypertrophy might have contributed to the pathogenesis of the adverse effect described remains hypothetical.

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Outer Plexiform Layer Angle: A Prognostic Factor for Idiopathic Macular Pucker Surgery

Journal of Ophthalmology ◽

10.1155/2020/8879212 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Ding-Ying Liao ◽

Jorn-Hon Liu ◽

Yu-Ping Zheng ◽

Jian-Ming Wang ◽

Hsiao-Ming Chao

Keyword(s):

Visual Acuity ◽

Prognostic Factor ◽

Indocyanine Green ◽

Plexiform Layer ◽

Internal Limiting Membrane ◽

Outer Plexiform Layer ◽

Macular Pucker ◽

Small Gauge ◽

23 Gauge

Purpose. To investigate the efficacy of idiopathic macular pucker (epimacular membrane) surgery and to identify the possible prognostic factor. Methods. This was a retrospective study which enrolled 38 patients with idiopathic macular pucker who underwent 23-gauge pars plana vitrectomy (PPV) with indocyanine green-assisted peeling of epiretinal membrane (ERM) and internal limiting membrane (ILM). Visual outcomes were assessed at the baseline and during the follow-up including best-corrected visual acuity (BCVA) and metamorphopsia score, as well as outer plexiform layer (OPL) angle and central retinal thickness (CRT) using spectral-domain optical coherence tomography (SD-OCT). A comparison was made between patients with the prepeeling CRTs ≥500 μm and those <500 μm. A comparison was also made between patients with the prepeeling OPL angles ≥130° and those <130°. Based on the prepeeling parameters, the correlations between various prepeeling and postpeeling visual functions were analyzed. Results. Mean follow-up was 36.07 ± 4.62 months (range 1.30–96.70 months). BCVA was significantly improved from 0.26 ± 0.03 to 0.67 ± 0.04 p < 0.001 ; metamorphopsia score was significantly reduced from 1.42 ± 0.16 to 0.61 ± 0.08 p < 0.001 ; CRT was significantly decreased from 519.62 ± 13.41 μm to 385.37 ± 8.97 μm p < 0.001 . Greater prepeeling OPL angle (≥130°) was associated with significantly greater BCVA improvement (Snellen E/LogMAR: p = 0.01 / 0.03 ) and greater metamorphopsia reduction p = 0.03 , as compared to smaller OPL angle (<130°) with less BCVA improvement and less metamorphopsia reduction. However, the final BCVA improvement and metamorphopsia reduction relevant to the prepeeling smaller CRT (<500 μm) did not significantly differ from that relevant to the prepeeling greater CRT (≥500 μm; p > 0.05 ). Endophthalmitis, retinal tear, or retinal detachment was not observed after peeling. Conclusion. Indocyanine green-assisted ERM/ILM peeling combined with small gauge vitrectomy is associated with significant visual acuity improvement and metamorphopsia reduction in patients with idiopathic macular pucker. Greater prepeeling OPL angle rather than CRT might act as a useful prognostic factor in predicting better final visual functional outcomes.

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COMPARATIVE ANALYSIS OF RETINAL REATTACHMENT SURGERY WITH OR WITHOUT INTERNAL LIMITING MEMBRANE PEELING TO PREVENT POSTOPERATIVE MACULAR PUCKER

Retina ◽

10.1097/iae.0000000000001775 ◽

2018 ◽

Vol 38 (9) ◽

pp. 1770-1776 ◽

Cited By ~ 14

Author(s):

Matteo Forlini ◽

Purva Date ◽

Luisa Micelli Ferrari ◽

Massimo Lorusso ◽

Gabriella Lecce ◽

...

Keyword(s):

Comparative Analysis ◽

Internal Limiting Membrane ◽

Macular Pucker ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Retinal Reattachment

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Internal limiting membrane peeling or not: a systematic review and meta-analysis of idiopathic macular pucker surgery

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2016-309768 ◽

2017 ◽

Vol 101 (11) ◽

pp. 1535-1541 ◽

Cited By ~ 13

Author(s):

Xiao-Ling Fang ◽

Yao Tong ◽

Ya-Li Zhou ◽

Pei-Quan Zhao ◽

Zhao-Yang Wang

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Internal Limiting Membrane ◽

Macular Pucker ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling

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Foveal regeneration after resolution of cystoid macular edema without and with internal limiting membrane detachment: presumed role of glial cells for foveal structure stabilization

International Journal of Ophthalmology ◽

10.18240/ijo.2021.06.06 ◽

2021 ◽

Vol 14 (6) ◽

pp. 818-833

Author(s):

Andreas Bringmann ◽

◽

Jan Darius Unterlauft ◽

Thomas Barth ◽

Renate Wiedemann ◽

...

Keyword(s):

Macular Edema ◽

Cystoid Macular Edema ◽

Internal Limiting Membrane ◽

Müller Cell ◽

Macular Pucker ◽

Fiber Layer ◽

Photoreceptor Layer ◽

Muller Cell ◽

Structure Stabilization

AIM: To document with spectral-domain optical coherence tomography the morphological regeneration of the fovea after resolution of cystoid macular edema (CME) without and with internal limiting membrane (ILM) detachment and to discuss the presumed role of the glial scaffold for foveal structure stabilization. METHODS: A retrospective case series of 38 eyes of 35 patients is described. Of these, 17 eyes of 16 patients displayed foveal regeneration after resolution of CME, and 6 eyes of 6 patients displayed CME with ILM detachment. Eleven eyes of 9 patients displayed other kinds of foveal and retinal disorders associated with ILM detachment. RESULTS: The pattern of edematous cyst distribution, with or without a large cyst in the foveola and preferred location of cysts in the inner nuclear layer or Henle fiber layer (HFL), may vary between different eyes with CME or in one eye during different CME episodes. Large cysts in the foveola may be associated with a tractional elevation of the inner foveal layers and the formation of a foveoschisis in the HFL. Edematous cysts are usually not formed in the ganglion cell layer. Eyes with CME and ILM detachment display a schisis between the detached ILM and nerve fiber layer (NFL) which is traversed by Müller cell trunks. ILM detachment was also found in single eyes with myopic traction maculopathy, macular pucker, full-thickness macular holes, outer lamellar holes, and glaucomatous parapapillary retinoschisis, and in 3 eyes with Müller cell sheen dystrophy (MCSD). As observed in eyes with MCSD, cellophane maculopathy, and macular pucker, respectively, fundus light reflections can be caused by different highly reflective membranes or layers: the thickened and tightened ILM which may or may not be detached from the NFL, the NFL, or idiopathic epiretinal membranes. In eyes with short single or multiple CME episodes, the central fovea regenerated either completely, which included the disappearance of irregularities of the photoreceptor layer lines and the reformation of a fovea externa, or with remaining irregularities of the photoreceptor layer lines. CONCLUSION: The examples of a complete regeneration of the foveal morphology after transient CME show that the fovea may withstand even large tractional deformations and has a conspicuous capacity of structural regeneration as long as no cell degeneration occurs. It is suggested that the regenerative capacity depends on the integrity of the threedimensional glial scaffold for foveal structure stabilization composed of Müller cell and astrocyte processes. The glial scaffold may also maintain the retinal structure after loss of most retinal neurons as in late-stage MCSD.

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