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Elona Dhrami Gavazi, Rosa Dolz-Marco, Quan V Hoang, Roberto Gallego-Pinazo, Stanley Chang; Clinical Significance Of Inner Nuclear Layer Cystic Changes After Internal Limiting Membrane Peeling For Epiretinal Membrane. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1150.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the prevalence and significance of inner nuclear layer (INL) cystic changes after internal limiting membrane (ILM) peeling for epiretinal membrane (ERM) surgery.
A retrospective review was performed on a consecutive series of patients with idiopathic ERM who had pars plana vitrectomy (PPV) (Group 1), or combined cataract surgery and PPV (Group 2) by a single surgeon (SC) over a two-year period. Comprehensive clinical examination as well as quantitative and qualitative analysis of optical coherence tomography (OCT) images at baseline and 6 months postoperative were assessed. Best-corrected visual acuity (BCVA) expressed in logarithm of the minimal angle of resolution (logMAR) and OCT central subfield retinal thickness (CST) were compared between patients who did and did not develop postoperative INL cystic changes, separately and jointly in Groups 1 and 2.
Sixty-four eyes of 62 patients were included. Group 1 included 32 eyes (16 males, 16 females; mean age: 72.1 years); Group 2 included 32 eyes (19 males, 13 females; 73.6 years). Two cases (6.3%) in Group 1 and 8 cases (25%) in Group 2 developed INL cystic changes that were not present on baseline OCT (p= 0.039). BCVA at 6-month follow-up was 0.23+/- 0.22 logMAR in Group 1 (mean+/- standard deviation) and 0.18+/- 0.15 in Group 2 (p= 0.286). Also, BCVA at 6-month visit was 0.17+/- 0.15 in patients with INL cystic changes, and 0.21+/- 0.25 in patients without INL cysts (p= 0.583). Sub-analysis of the BCVA between the 10 patients with new INL cysts (2 in Group 1 and 8 in Group 2) and those without INL cysts, evidenced no statistically significant differences at the two postoperative time points (two-tailed t-test). The mean OCT CST at 6-month follow-up was 395.33+/- 75.0 in Group 1, and 379.60+/- 57.29 in Group 2 (p= 0.446). Furthermore, the mean CST at 6-month follow-up was 386.89+/- 113.81 in patients showing development of new INL cysts, and 388.51+/- 72.98 in patients without cystic degeneration (p= 0.949).
The development of new INL cystic changes following ILM peeling during ERM surgery may be a relatively frequent finding, but does not appear to be associated with significant functional or anatomical macular impairment. The combination of PPV with cataract extraction may increase the risk of INL cystic changes. Further studies are warranted to confirm these findings.
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