First Author: S.W.Cho SOUTH KOREA
Co Author(s): S.G. Yoo C.G. Kim 0 0 0 0 0 0 0 0 0
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During ERM surgery, we experience two types of membrane. The first type of membrane is separated easily from the retina. However some membranes stick too firm to the retina, makes it hard to peel without damage to the retinal nerve fiber layer (RNFL). This study plans to explain that SD-OCT can recognize the types of ERM preoperatively.
Retrospective case series.
The study period was a year, from October 2012 to October 2013. The data of patients who had been operated to treat ERM within that period were analyzed retrospectively. Only idiopathic ERM cases were included. We excluded secondary ERM cases like cases with vitreous hemorrhage, uveitis, retinal detachment and previous vitreoretinal surgery. All of the operations had been done by one surgeon (S.W.C.) using 25G system. Both ERM and internal limiting membrane (ILM) had been peeled using Triamcinolone and Indocyanine green stain. During membrane peeling, according to the clinical appearance, the membranes had been classified under two types and documented into operation records by the surgeon. The membranes separated easily without damage to retina had been classified under type 1. The sticky membranes causing RNFL damage such as thread-like stretching had been classified under type 2. The preoperative SD-OCT data of the cases were analyzed. The analysis objects included ERM, RNFL, ganglion cell-inner plexiform layer, inner nuclear layer, outer plexiform-external limiting membrane, IS/OS line, COST line, foveal bulge, RPE line and central retinal thickness (ILM-RPE line).
Total 20 eyes were included in this study. Type 1 membranes were 14 of 20 eyes (70%). Type 2 was 6 of 20 eyes (30%). In type 1 group, the mean age was 62.6 year old (42~80). 8 of 14eyes were female. The mean central retinal thickness (CRT) was 488.9±83.1㎛. ERM disruption existed in 3 eyes. Inner layer disruption was showed in 4 eyes. In type 2 group, the mean age was 69.2 year old (63~78). 5 of 6 eyes were female. The mean CRT was 581.5±113.7㎛. ERM disruption existed in 4 eyes. Inner layer disruption was showed in 5 eyes. Inner layer disruption was related to the CRT. (Spearman, rho=0.793, p=0.000)
Preoperative SD-OCT could give clues to distinguish the ERM types. In preoperative SD-OCT, a thicker membrane, a surface-broken membrane and an inner retinal layer blurring were findings suggesting that the ERM would be sticky to retinal tissue. In these circumstances, membrane peeling must be done under great care for avoiding damage to retina.