Document Detail


Retinal adherence and fibrillary surface changes correlate with surgical difficulty of epiretinal membrane removal.
MedLine Citation:
PMID:  22137206     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To correlate surgical difficulty of epiretinal membrane (ERM) removal with characteristics of ERM adherence seen by spectral-domain optical coherence tomography (SD-OCT).
DESIGN: Prospective observational case series.
METHODS: Surgical difficulty was correlated with extent of ERM adherence by SD-OCT using masked observers in consecutive eyes undergoing ERM removal (N=31). Surgical videos were analyzed and difficulty of ERM removal (grade 1-3) was determined in 4 quadrants as well as the fovea by consensus of observers masked to SD-OCT findings. Extent of ERM adhesion was categorized (focal, broad, or complete) by masked observers using SD-OCT. The presence of fibrillary changes between the ERM and retinal nerve fiber layer (RNFL) was also evaluated. Surgical difficulty of ERM removal for each quadrant and fovea was compared to extent of ERM adherence and presence of fibrillary changes.
RESULTS: Assessment of ERM adherence using SD-OCT between masked observers was highly concordant (kappa=0.9178). Surgical difficulty of ERM removal was strongly associated with more extensive ERM adherence to the retina observed by SD-OCT. Complete ERM adherence correlated with an 8.6-fold increased surgical difficulty of ERM removal compared to focal adherence (P<.0001). The presence of fibrillary changes between the ERM and RNFL also correlated with a 25.5-fold increased difficulty of surgical removal compared to the absence of fibrillary changes (P<.0001).
CONCLUSION: Extent of ERM-retinal adhesion and presence of fibrillary changes determined by SD-OCT provide reliable preoperative assessment of surgical difficulty. Furthermore, SD-OCT analysis may help localize surgically advantageous coordinates to initiate ERM removal.
Authors:
Jae Suk Kim; Jay Chhablani; Candy K Chan; Lingyun Cheng; Igor Kozak; Kathrin Hartmann; William R Freeman
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Publication Detail:
Type:  Case Reports; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-12-03
Journal Detail:
Title:  American journal of ophthalmology     Volume:  153     ISSN:  1879-1891     ISO Abbreviation:  Am. J. Ophthalmol.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-26     Completed Date:  2012-05-09     Revised Date:  2013-04-03    
Medline Journal Info:
Nlm Unique ID:  0370500     Medline TA:  Am J Ophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  692-7, 697.e1-2     Citation Subset:  AIM; IM    
Copyright Information:
Published by Elsevier Inc.
Affiliation:
Department of Ophthalmology, Jacobs Retina Center at Shiley Eye Center, University of California, San Diego, La Jolla, California 92093-0946, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Epiretinal Membrane / diagnosis*,  surgery
Female
Fluorescein Angiography
Humans
Male
Middle Aged
Nerve Fibers / pathology*
Ophthalmologic Surgical Procedures
Prospective Studies
Retinal Ganglion Cells / pathology*
Surface Properties
Tissue Adhesions
Tomography, Optical Coherence
Visual Acuity / physiology
Grant Support
ID/Acronym/Agency:
EY07366/EY/NEI NIH HHS; R01 EY007366-24/EY/NEI NIH HHS

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