| ObjectiveThe macular epiretinal membrane is a nonvascular fibrous tissue proliferating membrane located at the vitreoretinal junction in macular area.The formation of the idiopathic macular epiretinal membrane is closely related to the posterior vitreous detachment,while the secondary macular epiretinal membrane is secondary to various intraocular diseases,and its difference from the idiopathic macular epiretinal membrane lies in the clear intraocular medical history.The diversity of etiology and the complexity of the conditions of secondary epiretinal macular membrane make the clinical treatment more difficult.Because the occurrence of secondary macular epiretinal membrane is closely related to intraocular primary disease,the clinical treatment is often more complicated.Peripheral retinopathy is often found on close examination in patients diagnosed preoperatively with idiopathic macular epiretinal membrane,which significantly increases the risk of intraoperative and postoperative retinal detachment of the macular epiretinal membrane and suggests the need for a complete ocular examination of the macular epiretinal membrane and the identification of the etiology.It also bring us new ideas for the diagnosis and treatment of secondary macular epiretinal membrane.In this study,the primary disease of secondary macular epiretinal membrane was carefully screened preoperatively,and the active primary disease was treated with consolidation followed by surgery,so as to observe the clinical treatment effect.Materials and methodA total of 129 patients(129 eyes)with ERM were collected from the first group of fundus diseases in the Second Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University from June 2019 to December 2020,44 cases of idiopathic ERM were excluded.Clinical data included in this study were 85 cases(85 eyes)with secondary ERM.There were 29 males and 56 females.The age ranged from 15 to 77 years,with an average age of(58.24±13.63)years.The course of disease ranged from 15 days to 60 months,and the mean course of disease was(13.24±15.26)months.Follow-up duration ranged from 3 to 16 months,with an average follow-up of(12.32±1.86)months.All patients included in this study,when first diagnosed as ERM,needed to receive a complete ophthalmic examination due to their condition such as intraocular pressure,OCT,slit lamp combined with+90D fundus preset lens,Scanning Laser Fundus Examination(SLO),Total retinoscopy,optometry,Fundus Fluorescein Angiography(FFA),and Microperimetry(MP),to clear the primary disease in eyes.For patients with active primary disease found at the first diagnosis,the primary disease should be treated first.For patients without identified primary disease,the peripheral retina should be carefully examined.If the peripheral retinal disease is found,the corresponding treatment should be given to the lesion site first.Then surgical treatment should be considered after the primary disease and peripheral retinopathy have stabilized.Among the patients included in this study,1 patient with epiretinal membrane was found with subnasal peripheral hemangioma and underwent retinal laser photocoagulation treatment around the hemangioma,the ERM treated by itself without surgical treatment,the remaining 84 patients underwent vitrectomy combined with internal limiting membrane peeling.The incidence and etiology of different secondary epiretinal macular membranes were classified and compared,and the types of peripheral retinal lesions and the time of their discovery were recorded(if the lesions were detected preoperatively,retinal laser photocoagulation was given first;if the lesions were detected intraoperatively,they were treated together intraoperatively).The improvement of postoperative visual acuity in different etiological groups was recorded,the changes of preoperative and postoperative best corrected visual acuity(BCVA)、central macular retinal thickness(CMT)、IS/OS layer integrity、retinal mean light sensitivity(MLS)were recorded and compared,84 patients receiving surgical treatment were divided into IS/OS layer complete group and IS/OS layer incomplete group,and the differences of preoperative and postoperative BCVA,CMT and MLS between the two groups were compared.SPSS 22.0 was used for statistical analysis in this study.Measurement data were expressed as(Mean±SD)and counting data is expressed as(%).Chi-square test was used to compare the preoperative and postoperative best corrected visual acuity and IS/OS layer integrity,preoperative and postoperative central macular thickness(CMT)and mean retinal light sensitivity(MS)were compared using paired T test,Comparison of IS/OS layer integrity group and IS/OS incomplete group,comparison of preoperative laser treatment group and intraoperative laser treatment group(all of the data met the normal distribution and homogeneity of variance)using independent sample T test.α=0.05,and P<0.05 was considered statistically significant.Results1.IncidenceThere were 29 males and 56 females,10 cases were aged from 15 to 40,27 cases were aged from 41 to 59,and 48 cases were aged from 60 to 77.According to the classification of history etiology,2 cases of retinal vein occlusion,4 patients had a history of uveitis,retinal vasculitis in 3 cases,high myopia in 7 cases,6 cases with secondary cataract surgery,3 patients had a toxocara history of infection,2cases of ocular trauma,diabetes history in 11 cases,11 cases after vitrectomy,31 cases of peripheral retinal lesions found in patients with no previous ocular history,2 case of retinal hemangioma,3 cases of retinal detachment were treated with scleral condensation combined with external pad pressure.2.Peripheral retinal lesionsAmong the 85 cases(85 eyes)in this study,58 cases were found with peripheral retinal lesions,including 30 cases found preoperatively and peripheral retinopathy was found in 28 cases due to incomplete preoperative ophthalmic examination.Lesion distribution in different quadrants of the retina,according to the nasal side,temporal side,above,below,four quadrants,respectively,to record the location of distribution of pathological changes and number,a total of 127 lesions were found(a single eye often contains multiple lesions),22 lesions were found in nasal side(17.32%),33 temporal lesions(25.98%),36 lesions above(28.35%),36 lesions in the lower part(28.35%).The types of lesions are:appearance traction 14(11.02%),3232 holes(25.20%),tlatelike degeneration 19(14.96%),24 sites of atrophy(18.90%),7(5.51%)exudate changes,hemangioma 17 sites(13.39%)and organization cord 14(11.02%).3.The visionThe best corrected visual acuity<0.3 was observed in 48 eyes(57.1%)preoperatively and 22 eyes(26.2%)postoperatively.25 eyes(29.8%)preoperatively and 27 eyes(32.1%)postoperatively in 0.3-0.6 patients.10 eyes(11.9%)preoperatively and 17 eyes(20.2%)postoperatively in 0.6-0.8 patients.In≥0.8 patients,there were 1 eye(1.2%)preoperatively and 18 eyes(21.4%)postoperatively.The difference between the best corrected visual acuity postoperatively and the best corrected visual acuity preoperatively was statistically significant(χ2=26.759,P<0.001).The visual acuity of 60 eyes(70.5%)had improved by 2 lines or more,the higher improvement rate was related to cataract surgery,the poor improvement rate was scleral condensation combined with external pad pressure and infection of tractoascaris.Preoperative BCVA of the IS/OS complete group was(0.90±0.26),postoperative BCVA(LogMAR)was(0.24±0.18),preoperative BCVA of the IS/OS incomplete group was(0.97±0.56),postoperative BCVA of the IS/OS incomplete group was(0.55±0.38),preoperative BCVA of the two groups was not statistically significant(P>0.05),postoperative BCVA of the IS/OS complete group was statistically significant(t=-4.961,P<0.001),the postoperative BCVA of the former was better than that of the latter.The degree of postoperative visual acuity recovery in the IS/OS layer complete group was significantly different from that in the IS/OS layer incomplete group(t=-3.420,P=0.001),the latter recovered better than the former.4.IS/OS layer integrity restorationBefore operation,35 cases(41.7%)had complete IS/OS layer,and 49 cases(58.3%)had incomplete IS/OS layer.After operation,55 cases(65.5%)had intact IS/OS layer,and 29 cases(34.5%)had incomplete IS/OS layer.Preoperative IS/OS layer integrity was significantly different from postoperative IS/OS layer integrity(χ2=9.573,P=0.002).5.Central Macular Thickness(CMT)The central macular thickness was(454.67±95.76)μm preoperatively and(256.26±49.40)μm postopratively.The difference of the preoperative and postoperative central macular thickness was statistically significant(t=23.150,P<0.001).The preoperative and postoperative CMT of the group with complete IS/OS layer were(469.51±95.65)μm and(257.17±38.75)μm respectively.The preoperative and postoperative CMT of the group with incomplete IS/OS layer were(478.35±89.46)μm and(269.89±51.96)μm respectively.There was no statistical significance in the preoperative and postoperative CMT of the two groups(t1=-2.758,P1=0.07)and(t2=-3.306,P2=0.10).6.Mean Light Sensitivity(MLS)Preoperative MLS was(17.86±6.08)dB and postoperative MLS was(21.49±5.68)dB.There were significant differences in preoperative and postoperative MLS(t=13.845,P<0.001).The preoperative and postoperative MLS of the IS/OS layer complete group was(20.64±3.90)dB and(23.81±4.04)dB,and that of the IS/OS layer incomplete group was(15.87±6.59)dB and(19.83±6.13)dB.The preoperative and postoperative MLS of the two groups showed statistically significant differences respectively.(t1=4.152,P1<0.001)and(t2=3.580,P2=0.001).7.Postoperative complicationsIn this study,83cases of secondary ERM were cured.In 2 cases,visual acuity loss or ERM recurrence resulted from the progression of active primary disease.One of the highly myopic eyes had retinal detachment 10 days after surgery,and the retinal was repositioned after scleral pad pressure combined with condensation and gas injection.One eye was infected with trachoroundis,and one year after the operation,due to the uncontrolled primary active inflammation,fundus proliferation appeared again.After the second membrane-peeler operation and the intraocular injection of Ozurdex,the intraocular inflammation was controlled,and the condition was stable,in the last follow-up,there was no recurrence of the anterior macular membrane.Conclusion1.Carefully screening the primary disease of secondary macular epiretinal membrane to consolidate the active primary diseases,and combined with vitrectomy for the treatment of secondary macular epiretinal membrane,which can effectively improve visual acuity and macular mean light sensitivity,reduce CMT and postoperative complications.2.Peripheral retinopathy of secondary macular epiretinal membrane is mostly located in the upper and lower peripheral retina,with hiatus and atrophy as the most common types.3.In addition to careful examination of the peripheral retina before operation,,it is still necessary to carefully examine the peripheral retina during the operation or before the operation to improve the success rate of virectomy,reduce postoperative complications. |
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