Combined surgery for the treatment of severe pathologies of posterior segment of the eye (Doctoral thesis)

Χριστοδούλου, Ελένη

Introduction: The Thesis concerns combined surgery in severe pathologies of posterior segment of the eye and especially epiretinal membranes (ERMs). We studied the efficacy of applied surgical procedures for the treatment of patients with ERM. Purpose: To evaluate the anatomical and functional results of the procedures and their duration after a period of time. Material and methods: We studied 51 eyes of 47 patients with idiopathic epiretinal membrane. We assessed the anatomical restoration of the macula and the improvement of visual acuity after the operation. We assessed the vitreoretinal interface of the fellow eye of 67 patients with epiretinal membrane. EDI-OCT was performed in both eyes of 32 patients with idiopathic epiretinal membrane and in a control group. Optical coherence tomography angiography was performed in 22 eyes. We performed histopathologic examination of epiretinal membrane and internal limiting membrane. The specimens were compared to secondary membranes using immunochemistry. We conducted a meta-analysis of 16 published studies as well as our series comparing the results of surgical removal of epiretinal membrane, with or without ILM peel, in terms of visual acuity and anatomical restoration of the macula Results: Mean pre-operative best corrected visual acuity (BCVA) was 0.55+/-0.30 in LogMAR and mean central foveal thickness (CFT) was 422.29 μm +/-109.62. Final BCVA was 0.34 +/- 0.28 and final CFT was 365.75 +/- 72.16 μm. The differences were statistically significant. Postoperative cystoid macular edema was observed in three patients. Twenty two patients had similar pathology in the fellow eye as well. Central foveal choroidal thickness (CFCT) was found to be 266 +/- 33 μm in eyes with epiretinal membrane, 300 +/- 29 in normal fellow eyes and 302 +/- 40 μm in healthy controls. More severe cases had a higher level of vessel distortion and tortuosity and both plexuses were affected. Also the level of distortion was related to worse BCVA. Idiopathic ERMs are simple cellular membranes that consist of glial cells, fibrocytes and few vessels whereas secondary membranes are more cellular with inflammatory cells and profound vessels. There was a consistency in results for after/baseline BCVA and CFT levels in both groups of patients (with or without ILM peel). In all cases, we found a statistically significant increase (p<0.05) in after BCVA and decrease (p<0.05) in after CFT levels versus baseline levels. Conclusions: Best corrected visual acuity improvement and central foveal thickness decrease are statistically significant. Epiretinal membrane is very often is a bilateral pathology. Choroidal thickness was measured to be decreased in patients with ERM. Tractional forces result in retinal vessel distortion which can be measured by OCT-A. Vitrectomy for the removal of ERM combined with ILM peeling is an effective method for the treatment of patients with idiopathic ERM.
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Subject classification: Οφθαλμός -- Χειρουργική
Keywords: Συνδυασμένες επεμβάσεις,Επιαμφιβληστροειδική μεμβράνη,Έσω αφοριστική μεμβράνη,Οπτική τομογραφία συνοχής,Combined surgery,Epiretinal membrane,Internal limiting membrane,Optical coherence tomography
URI: https://olympias.lib.uoi.gr/jspui/handle/123456789/29360
http://dx.doi.org/10.26268/heal.uoi.3552
Appears in Collections:Διδακτορικές Διατριβές

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