Офтальмохирургия. 2019; : 18-23
Клинико-морфологическая оценка хирургического лечения идиопатических эпиретинальных мембран у пациентов с начальными признаками патологического процесса
https://doi.org/10.25276/0235-4160-2019-2-18-23Аннотация
Хирургическое удаление эпиретинальной мембраны (ЭРМ) остается эффективным методом устранения тракционного воздействия на сетчатку. Но не всегда удается достичь высоких функциональных результатов в послеоперационном периоде. Поэтому вопрос определения срока хирургического лечения с идентификаций морфологических элементов ЭРМ и подтверждением прогрессирования пролиферативного процесса на начальных этапах ее формирования остается актуальным.
Цель. Обосновать и оценить эффективность тактики раннего хирургического лечения иЭРМ у пациентов с высокой остротой зрения.
Материал и методы. Проводили морфофункциональную оценку раннего хирургического лечения идиопатических ЭРМ у 30 пациентов (30 глаз), заключающуюся в динамическом наблюдении за максимально корригируемой остротой зрения (МКОЗ), данных оптической когерентной томографии. С помощью иммуногистохимического исследования образцов эпиретинальных мембран выявляли и визуализировали следующие антигены: глиальнокислый фибриллярный протеин (GFAP), TGF-β1, α-SM актин, клеточный ретинальдегид связывающий протеин (CRALBP), фибронектин, CD68, CD45, а также коллаген II, IV, VI типов.
Результаты. Выявлена статистически значимая разница между предоперационной остротой зрения и остротой зрения на разных сроках наблюдения после операции (р<0,05). С помощью иммуногистохимического исследования преимущественно определили экспрессию GFAP, CRALBP и виментина.
Выводы. Проведенный анализ клинико-функциональных результатов хирургического лечения иЭРМ у пациентов с высокой максимально корригированной остротой зрения подтвердил эффективность раннего хирургического лечения данной патологии.
Список литературы
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2. Сдобникова С.В., Козлова И.В., Дорошенко Е.В. и др. Изменения поля зрения после витреомакулярной хирургии – критерий качества лечения. Вестник Офтальмологии. 2013;5: 114-26.
3. Snead D.R., James S., Snead M.P. Pathological changes in the vitreoretinal junction 1: epiretinal membrane formation. Eye. 2008;22(10): 1310-1317. Available from: doi.org/10.1038/eye.2008.36.
4. Stevenson W., Prospero P., Agarwal D. et al. Epiretinal membrane: optical coherence tomographybased diagnosis and classification. Clin Ophthalmol. 2016;10: 524-537. Available from: doi.org/10.2147/OPTH.S97722.
5. Fraser-Bell S., Guzowski M., Rochtchina E. et al. Five-year cumulative incidence and progression of epiretinal membranes: the Blue Mountains Eye Study. Ophthalmology. 2003;110(1): 34-44.
6. Meyer C., Rodrigues E., Mennel S. et al. Spontaneous separation of epiretinal membrane in young subjects: personal observations and review of the literature. Graefes Arch Clin Exp Ophthalmol. 2004;242(12): 977-985. Available from: doi.org/10.1007/s00417-004-0934-7.
7. Machado L., Furlani B., Navarro R. et al. Preoperative and intraoperative prognostic factors of epiretinal membranes using chromovitrectomy and internal limiting membrane peeling. Ophthalmic Surg Lasers Imaging Retina. 2016;46(4): 457-462. Available from: doi.org/10.3928/23258160-20150422-09.
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9. Berrod J., Poirson A. [Which epiretinal membranes should be operated?]. J Fr Ophtalmol. 2008;31(2): 192-199.
10. Hisatomi T., Enaida H., Sakamoto T. et al. A new method for comprehensive bird’s-eye analysis of the surgically excised internal limiting membrane. Am J Ophthalmol. 2005;139(6): 1121-1122. Available from: doi.org/10.1016/j.ajo.2004.11.051.
11. Schechet S., DeVience E., Thompson J. The effect of internal limiting membrane peeling on idiopathic epiretinal membrane surgery, with a review of literature. Retina. 2017;37(5): 873-880. Available from: doi.org/10.1097/IAE.0000000000001263.
12. Rahman R., Stephenson J. Early surgery for epiretinal membrane preserves more vision for patients. Eye. 2014;28(4): 410-414. Available from: doi.org/10.1038/eye.2013.305.
13. Dawson S., Shunmugam M., Williamson T. Visual acuity outcomes following surgery for idiopathic epiretinal membrane: an analysis of data from 2001 to 2011. Eye (Lond). 2014; 28(2): 219-224. Available from: http://dx.doi.org/10.1038/eye.2013.253.
14. Panos D., Gottrau P. Idiopathic macular epiretinal membrane surgery with simultaneous internal limiting membrane peeling. The experience of the Fribourg Eye Clinic. Swiss Med Wkly. 2013;25(143): 13876. Available from: http://dx.doi.org/10.4414/smw.2013.13876.
15. Massin P., Allouch C., Haouchine B. et al. Optical coherence tomography of idiopathic macular epiretinal membranes before and after surgery. Am J Ophthalmol. 2000;130(6): 732-739.
16. Mazit C., Scholtes F., Rabaut C. et al. Assessment of macular profile using optical coherence tomography after epiretinal membrane surgery. J Fr Ophtalmol. 2008;31(7): 667-672.
17. Romano M., Cennamo G., Amoroso F. et al. Intraretinal changes in the presence of epiretinal traction. Graefes Arch Clin Exp Ophthalmol. 2017;255(1): 31-38. Available from: http://dx.doi.org/10.1007/s00417-016-3413-z.
18. Scheerlinck L. , Valk R., Leeuwen R. Predictive factors for postoperative visual acuity in idiopathic epiretinal membrane: a systematic review. Acta Ophthalmol. 2015;93(3): 203-212. Available from: http://dx.doi.org/10.1111/aos.12537.
19. Banker T., Reilly G., Jalaj S., Weichel E. Epiretinal membrane and cystoid macular edema after retinal detachment repair with small-gauge pars plana vitrectomy. Eur J Ophthalmol. 2015;25(6): 565-570. Available from: http://dx.doi.org/10.5301/ejo.5000609.
20. Kofod M., Christensen U., Cour M. Deferral of surgery for epiretinal membranes: Is it safe? Results of a randomised controlled trial. Br J Ophthalmol. 2016;100(5): 688-692. Available from: http://dx.doi.org/10.1136/bjophthalmol-2015-307301.
21. Rahman R., Stephenson J. Early surgery for epiretinal membrane preserves more vision for patients. Eye. 2014;28(4): 410-414. Available from: http://dx.doi.org/10.1038/eye.2013.305.
22. Bu S. C., Kuijer R., Van der Worp R. J. et al. Immunohistochemical Evaluation of Idiopathic Epiretinal Membranes and In Vitro Studies on the Effect of TGF-β on Müller Cells iERMs, Müller Cells, and TGF-β. Invest. Ophthalmol. Vis. Scie. 2015;56(11): 6506-6514. Available from: http://dx.doi.org/10.1167/iovs.14-15971.
23. Schumann R.G., Eibl K.H., Zhao F. Immunocytochemical and ultrastructural evidence of glial cells and hyalocytes in internal limiting membrane specimens of idiopathic macular holes. Invest. Ophthalmol. Vis. Sci. 2011;52(11): 7822-7834. Available from: http://dx.doi.org/10.1167/iovs.11-7514.
Fyodorov Journal of Ophthalmic Surgery. 2019; : 18-23
Clinical and morphological evaluation of surgical treatment of idiopathic epiretinal membranes in patients with initial signs of pathological process
https://doi.org/10.25276/0235-4160-2019-2-18-23Abstract
Surgical removal of the epiretinal membrane (ERM) remains an effective method in elimination of the traction effect on the retina. But it is not always possible to achieve high functional results in the postoperative period. Therefore, the question on a determination for the period of surgical treatment with the identification of morphological elements of ERM and a confirmation of the progression of the proliferative process in the early stages of its formation remains relevant.
Purpose. To justify and evaluate the efficacy of the tactics in early surgical treatment of idiopathic ERM (iERM) in patients with high visual acuity.
Material and methods. A morphofunctional assessment of early surgical treatment of idiopathic ERM was performed in 30 patients (30 eyes). It was consisted in a dynamic monitoring of the best corrected visual acuity (BCVA), the data of optical coherence tomography. Immunohistochemical examination of epiretinal membrane samples revealed and visualized the following antigens: glial fibrillar protein (GFAP), TGF-β1, α-SM actin, cellular retinaldehyde-binding protein (CRALBP), fibronectin, CD68, CD45, and collagen types II, IV, VI.
Results. A statistically significant difference between preoperative visual acuity and visual acuity at different postoperative follow-up periods was revealed (p<0.05). The immune-histochemical study mainly determined the expression of GFAP, CRALBP and vimentin.
Conclusions. The performed analysis of clinical and functional results in the surgical treatment of iERM in patients with high best-corrected visual acuity confirmed the efficiency in the early surgical treatment of this pathology.
References
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4. Stevenson W., Prospero P., Agarwal D. et al. Epiretinal membrane: optical coherence tomographybased diagnosis and classification. Clin Ophthalmol. 2016;10: 524-537. Available from: doi.org/10.2147/OPTH.S97722.
5. Fraser-Bell S., Guzowski M., Rochtchina E. et al. Five-year cumulative incidence and progression of epiretinal membranes: the Blue Mountains Eye Study. Ophthalmology. 2003;110(1): 34-44.
6. Meyer C., Rodrigues E., Mennel S. et al. Spontaneous separation of epiretinal membrane in young subjects: personal observations and review of the literature. Graefes Arch Clin Exp Ophthalmol. 2004;242(12): 977-985. Available from: doi.org/10.1007/s00417-004-0934-7.
7. Machado L., Furlani B., Navarro R. et al. Preoperative and intraoperative prognostic factors of epiretinal membranes using chromovitrectomy and internal limiting membrane peeling. Ophthalmic Surg Lasers Imaging Retina. 2016;46(4): 457-462. Available from: doi.org/10.3928/23258160-20150422-09.
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9. Berrod J., Poirson A. [Which epiretinal membranes should be operated?]. J Fr Ophtalmol. 2008;31(2): 192-199.
10. Hisatomi T., Enaida H., Sakamoto T. et al. A new method for comprehensive bird’s-eye analysis of the surgically excised internal limiting membrane. Am J Ophthalmol. 2005;139(6): 1121-1122. Available from: doi.org/10.1016/j.ajo.2004.11.051.
11. Schechet S., DeVience E., Thompson J. The effect of internal limiting membrane peeling on idiopathic epiretinal membrane surgery, with a review of literature. Retina. 2017;37(5): 873-880. Available from: doi.org/10.1097/IAE.0000000000001263.
12. Rahman R., Stephenson J. Early surgery for epiretinal membrane preserves more vision for patients. Eye. 2014;28(4): 410-414. Available from: doi.org/10.1038/eye.2013.305.
13. Dawson S., Shunmugam M., Williamson T. Visual acuity outcomes following surgery for idiopathic epiretinal membrane: an analysis of data from 2001 to 2011. Eye (Lond). 2014; 28(2): 219-224. Available from: http://dx.doi.org/10.1038/eye.2013.253.
14. Panos D., Gottrau P. Idiopathic macular epiretinal membrane surgery with simultaneous internal limiting membrane peeling. The experience of the Fribourg Eye Clinic. Swiss Med Wkly. 2013;25(143): 13876. Available from: http://dx.doi.org/10.4414/smw.2013.13876.
15. Massin P., Allouch C., Haouchine B. et al. Optical coherence tomography of idiopathic macular epiretinal membranes before and after surgery. Am J Ophthalmol. 2000;130(6): 732-739.
16. Mazit C., Scholtes F., Rabaut C. et al. Assessment of macular profile using optical coherence tomography after epiretinal membrane surgery. J Fr Ophtalmol. 2008;31(7): 667-672.
17. Romano M., Cennamo G., Amoroso F. et al. Intraretinal changes in the presence of epiretinal traction. Graefes Arch Clin Exp Ophthalmol. 2017;255(1): 31-38. Available from: http://dx.doi.org/10.1007/s00417-016-3413-z.
18. Scheerlinck L. , Valk R., Leeuwen R. Predictive factors for postoperative visual acuity in idiopathic epiretinal membrane: a systematic review. Acta Ophthalmol. 2015;93(3): 203-212. Available from: http://dx.doi.org/10.1111/aos.12537.
19. Banker T., Reilly G., Jalaj S., Weichel E. Epiretinal membrane and cystoid macular edema after retinal detachment repair with small-gauge pars plana vitrectomy. Eur J Ophthalmol. 2015;25(6): 565-570. Available from: http://dx.doi.org/10.5301/ejo.5000609.
20. Kofod M., Christensen U., Cour M. Deferral of surgery for epiretinal membranes: Is it safe? Results of a randomised controlled trial. Br J Ophthalmol. 2016;100(5): 688-692. Available from: http://dx.doi.org/10.1136/bjophthalmol-2015-307301.
21. Rahman R., Stephenson J. Early surgery for epiretinal membrane preserves more vision for patients. Eye. 2014;28(4): 410-414. Available from: http://dx.doi.org/10.1038/eye.2013.305.
22. Bu S. C., Kuijer R., Van der Worp R. J. et al. Immunohistochemical Evaluation of Idiopathic Epiretinal Membranes and In Vitro Studies on the Effect of TGF-β on Müller Cells iERMs, Müller Cells, and TGF-β. Invest. Ophthalmol. Vis. Scie. 2015;56(11): 6506-6514. Available from: http://dx.doi.org/10.1167/iovs.14-15971.
23. Schumann R.G., Eibl K.H., Zhao F. Immunocytochemical and ultrastructural evidence of glial cells and hyalocytes in internal limiting membrane specimens of idiopathic macular holes. Invest. Ophthalmol. Vis. Sci. 2011;52(11): 7822-7834. Available from: http://dx.doi.org/10.1167/iovs.11-7514.
