September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
The effect of spontaneous vs. surgical posterior vitreous detachment (PVD) on epiretinal membrane (ERM) formation in patients undergoing pars plana vitrectomy (PPV) for symptomatic vitreous opacities
Author Affiliations & Notes
  • Olga Shif
    Ophthalmology, Krieger Eye Institute at Sinai Hospital of Baltimore, Baltimore, Maryland, United States
  • Philip H. Scharper
    Ophthalmology, Krieger Eye Institute at Sinai Hospital of Baltimore, Baltimore, Maryland, United States
  • Mohamed Ahmed
    Ophthalmology, Wilmer Eye Institute at Johns Hopkins, Baltimore, Maryland, United States
  • Footnotes
    Commercial Relationships   Olga Shif, None; Philip Scharper, None; Mohamed Ahmed, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 4059. doi:
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      Olga Shif, Philip H. Scharper, Mohamed Ahmed; The effect of spontaneous vs. surgical posterior vitreous detachment (PVD) on epiretinal membrane (ERM) formation in patients undergoing pars plana vitrectomy (PPV) for symptomatic vitreous opacities. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4059.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : The pathogenesis of ERM formation is the subject of much debate. Some suggest that ERM develops due to microscopic retinal trauma caused by a spontaneous PVD. Others hypothesize that vitreoschisis due to the vitreous collapse leaves an outermost layer of the vitreous attached to the retinal surface resulting in the ERM. This study explores whether ERM is more likely to develop after a PPV in eyes with a spontaneous PVD occurring preoperatively vs. eyes in which the PVD was surgically induced.

Methods : Retrospective chart review analyzing ERM formation in 45 eyes undergoing 23 gauge PPV (Constellation, Alcon) for symptomatic vitreous opacities over a period of 4 years was performed. 21/45 (47%) eyes had a spontaneous PVD present preoperatively and 24/45 (53%) eyes had PVD surgically induced. Intravitreal triamcinolone was used to visualize the vitreous intraoperatively, both to confirm the presence of the preoperative PVD and to ensure complete separation of the posterior hyaloid. Eyes with prior posterior segment surgeries/lasers were excluded as well as eyes with additional procedures during the surgery. Cataract surgery before or after vitrectomy was not part of the exclusion criteria. Presence of ERM was confirmed with OCT (Cirrus, Zeiss). Relationship between surgical induction of PVD and development of post-PPV ERM was assessed using Pearson’s chi square test and odds ratio. Analysis was performed with IBM SPSS statistical package v.23.

Results : A total of 20/45 (44%) eyes developed ERM after a PPV for symptomatic vitreous opacities. 6/20 (30%) eyes with ERM had a spontaneous PVD occurring preoperatively while 14/20 (70%) had a surgically induced PVD (chi square p=0.45, odds ratio 3.5 with p=0.0489). Average time to ERM formation after PPV was 164 days. Only 3/20 (15%) eyes had cataract surgery after PPV and prior to ERM development.

Conclusions : The results of this study are consistent with the hypothesis of ERM formation due to the microscopic retinal trauma as demonstrated by a higher incidence of ERM formation in patients with surgical PVDs. This leads to the question whether precautionary measures, such as internal limiting membrane (ILM) removal, should be considered in patients undergoing surgical PVDs in order to prevent ERM formation. Additional prospective studies are necessary.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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