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Elnaz Emrani, Juliane Matlach, Rainer Guthoff, Winfried Goebel; Morphologic and functional outcome of epiretinal membrane surgery with and without gas tamponade - a pilot study. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3829.
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To evaluate the difference of epiretinal membrane surgery with and without gas tamponade concerning visual function and macular morphology.
69 eyes of 69 consecutive patients who had undergone pars plana vitrectomy with peeling of epiretinal membranes from 2009 to 2011 at the University Eye Hospital of Wuerzburg and had a pre-operative measurement with spectral domain optical coherence tomography (Cirrus® OCT, Carl Zeiss Meditec), were included in this study. In 43 cases, a gas tamponade (air or non-expanding SF6/air or C3F8/air mixture) was used during surgery whereas in 26 cases the surgery was done without gas. Best-corrected visual acuity (BCVA) was determined and retinal thickness was measured using OCT before epiretinal membrane surgery, as well as in a follow-up examination at least 6 months after surgery. Primary outcome measure was the correlation between functional and morphological changes for both groups.
Overall, BCVA improved in 58 eyes (84,1%), remained stable in 10 eyes (14,5%), and deteriorated in only one eye (1,4%). In 35 of 43 eyes without gas tamponade (81,4%) BCVA improved, remained stable in 7 of 43 eyes (16,3%) and deteriorated in one eye (2,3%). In the gas tamponade group, BCVA improved in 23 of 26 patients (88,5%), remained stable in 3 cases (11,5%), and was reduced in none of the patients. Foveal retinal thickness decreased in 89,9% of all patients, 96,2% and 86,0% in patients with and without gas tamponade, respectively. The reduction in foveal thickness compared to baseline was highly significant in both groups. There was a significant greater reduction in retinal thickness in patients with gas tamponade and also a trend towards a slightly greater increase of visual acuity. The preoperative statistically significant correlation between foveal retinal thickness and visual acuity is postoperatively not significant anymore.
The use of a gas tamponade during epiretinal membrane surgery shows a statistically significant improvement in morphologic outcome and also a tendency towards a better functional outcome. Although the effect on visual acuity is not statistically significant, this trend is of particular interest because a gas tamponade was primarily used in eyes with more pronounced retinal folds and additional vitreoretinal traction.
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