Abstract
Purpose :
Post vitrectomy premacular membranes can cause significant anatomical changes to the macula, leading to functional deficits including decreased visual acuity and metamorphopsia. The traction effect created by these membranes lead to retinal thickening, wrinkling, schesis, detachment and even macular hole. For a very long time, post-operative premacular membranes were considered to be macular pucker, known also as ERM. Recent reports showed that these membranes are a localized presentation of PVR. The purpose of this study was to describe clinical and histological features of macular PVR formed within weeks following pars plana vitrectomy (PPV) surgery.
Methods :
In this retrospective observational case series we report 4 cases with severe macular PVR that developed following uneventful PPV and were followed up to 32 months in Hadassah-Hebrew University Medical Center, Jerusalem, between October 2016 and June 2019.
Results :
The mean age at presentation was 53 years old. 3 males and 1 female . None of the patients had any previous ocular pathology. All patients underwent PPV for retinal detachment repair. One of them presented with macula-off while the others were macula-on. The mean Best Corrected Visual Acuity (BCVA) at presentation was 0.675 LogMAR. The mean duration of the detachment till the time of the primary surgery was 2.5 days. The mean interval time from last normal post vitrectomy exam to first symptom or diagnosis of PVR was 21 days (range 14-28), but can develop in as fast as 2 weeks. BCVA dropped from a mean of 0.275 LogMAR before the PVR development to a mean of 0.95 LogMAR following its development.
Ocular examination for all the patients showed flat retina and a thick macular PVR membrane, confirmed by optical coherence tomography (OCT) images with a mean central macular thickness (CMT) of 716 microns .
All patients underwent PPV and stripping of membranes. The mean BCVA improved to 0.50 LogMAR and the OCT showed a reduction of mean CMT to 356 microns.
Histological study of the membrane in one patient confirmed the diagnosis of PVR with a proliferation of retinal pigment epithelium cells.
Conclusions :
Short-term macular PVR seems to be a different entity from ERM in terms of rapid development, structural distortion, visual compromise and patho-histology. Surgical treatment restores significantly macular function and anatomy.
This is a 2020 ARVO Annual Meeting abstract.