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H.-K. V. Ho, J. Gasperini, A. Walsh, J. Dougall, A. A. Fawzi; Structural Correlation of Pre- and Post-operative Changes in Epi-retinal Membranes with Severe Macular Dystopia. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3256.
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To examine the structural correlates of spectral-domain optical coherence tomography (SD-OCT) findings in patients with epiretinal membranes (ERMs) with severe macular dystopia before and after pars plana vitrectomy (PPV) and membrane peeling (MP).
An observational interventional case series of patients that were undergoing PPV and MP for ERMs with severe macular dystopia by a single surgeon (AAF) at the Doheny Eye Institute from March 2008 through November 2008. Pre- and post-operative assessment included visual acuity (VA), SD-OCT, fundus photography (FP), and flourescein angiography (FA).
Six eyes of 6 patients underwent PPV and MP for ERMs with severe macular dystopia (Figure 1 shows an example of pre-operative OCT). The etiology of the ERM was idiopathic in 4 eyes (1 eye had an associated full-thickness macular hole and 1 eye had a treatment naive choroidal neovascular membrane). Two eyes were previously vitrectomized (1 eye for proliferative diabetic retinopathy with traction retinal detachment and 1 eye for rhegmatogenous retinal detachment). The mean duration of post-operative follow-up was 3.5 months (range from 1 to 7 months). VA ranged from 20/50 to 20/800 pre-operatively, and from 20/40 to 20/100 post-operatively. VA improved on average 2 lines (range from 1 to 4 lines). Pre-operative FP revealed significant structural abnormalities of the macula including significant displacement of the fovea and/or vasculature, fibrotic ERM’s with striae, and macular edema. Post-operatively, these features improved significantly, and the average correction of displacement of the fovea and/or vasculature was 650 microns. The pre-operative OCT revealed macular edema in all 6 eyes and retinal schisis in 2 eyes. Post-operatively, the mean reduction of the macular thickness was 140 microns.
Eyes with macular dystopia from severe ERMs may benefit from PPV and MP with an improvement in anatomic structure, macular edema, and visual acuity in this short term study. Longer term follow-up is needed to determine whether full anatomic and functional recovery is achievable in these eyes.
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