EPIMACULAR MEMBRANES: ULTRASTRUCTURAL CHARACTERISTICS AND CLINICOPATHOLOGICAL CORRELATIONS AND VISUAL RESULTS IN PSEUDOPHACIC EYES AFTER SURGICAL REMOVAL OF EPIMACULAR MEMBRANES

Etienne Bovey (Lausanne)

Conference no 1
Title: Should we peel the internal limiting membrane (ILM) during surgery for epimacular membrane?

Purpose: 1) to review the litterature on this subject and 2) determine in a series of 119 cases of epimacular membranes (EMM) surgically removed and analyzed in electron microscopy the various factors that are correlated with ILM peeling. Design: prospective study.

Methods: the presence of ILM and the aspects of collagen and cells were analyzed. The clinical features of the EMM, preoperative and final visual acuities were recorded.

Results: The ILM was peeled in 74 % of cases. In 2/3 of cases, the ILM was part of the EMM, and in 1/3 of cases, it was peeled separately after the EMM removal. ILM removal was significantly associated with a better final visual acuity, and decreased residual/recurrent postoperative EMM or retinal folds.

Conclusion: ILM peeling seems to improve the postoperative functional results after surgery for epimacular membrane.


Conference no 2
Title: Surgery for epimacular membranes: functional results in 184 pseudophakic eyes.

Purpose: to answer two questions: 1) what are the functional results after surgery for epimacular membranes and cataract operation? 2) with regard to the indications for surgery, what should be the upper limit for a preoperative visual acuity (VA)?

Methods: we reviewed the charts of all eyes operated on for epimacular membrane and that were pseudopha-kic at the final examination. The exclusion criteria were: macular involvement due to other pathologies, vitreous or corneal opacities. Indications for surgery were: metamorphopsia and/or a decreased VA (</- 0.8). The mean follow-up was 25 months (range: 6 - 71 mo).

Results: 63 pseudophakic eyes (group I) and 121 phakic eyes (group II) underwent vitrectomy and peeling of epimacular membrane. In the group II, secondary cataract was operated on after a mean time of 18 months. Preoperative and final mean VA was respectively 0.3 and 0.66 in the group I, 0.4 and 0.8 in the group II. The final VA was directly correlated with the preoperative VA only in eyes with a preoperative VA of 0.4 or more. The chance to have of a final VA >/- 0.8 was 86.7 % if preoperative VA was >/- 0.66. It was 58.1 % if preoperative VA ranged from 0.4 to 0.66. It was < 41 % if preoperative VA was < 0.4.

Conclusion: given the high chances to obtain a good final VA if preoperative VA is >/- 0.4, waiting for a decreased VA under 0.4 should not be necessary before proposing surgery. Consequently, the global patient's discomfort is a better indication for surgery than preoperative VA.


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