Elsevier

Ophthalmology

Volume 106, Issue 8, 1 August 1999, Pages 1541-1545
Ophthalmology

Nonvitrectomizing vitreous surgery: A strategy to prevent postoperative nuclear sclerosis

Presented in part at the Association for Research in Vision and Ophthalmology annual meeting, Fort Lauderdale, Florida, May 1998.
https://doi.org/10.1016/S0161-6420(99)90451-7Get rights and content

Abstract

Objective:

The development or progression of postoperative nuclear sclerosis is the most common complication of successful vitrectomy in elderly patients. The authors treated idiopathic epimacular proliferation (EMP) with nonvitrectomizing vitreous surgery in an attempt to prevent postoperative nuclear sclerosis.

Design:

Prospective, nonrandomized, comparative case series.

Participants:

The authors surgically removed membranes from the sensory retina in 21 eyes of 21 patients with EMP.

Intervention:

Neither intravitreal infusion nor vitrectomy of any kind was performed during the procedure. The peeled membrane was left floating in the vitreous cavity in 11 (group 1) eyes and removed in 10 eyes (group 2). Nonoperated fellow eyes served as controls.

Main outcome measures:

Visual acuity, slit-lamp and/or Scheimpflug photography, and refractometry were performed pre- and postoperatively to evaluate changes in the degree of lenticular opacity.

Results:

There was no difference in the rate of development or progression of nuclear sclerosis or the degree of myopic shift between operated and control eyes during the postoperative follow-up period (mean, 9.7 months). No serious complications were noted. There was no difference in postoperative course between patients in the two operative groups.

Conclusions:

Although interpretation of the results of this study is limited due to its small size and short follow-up, nonvitrectomizing vitreous surgery seems to decrease the postoperative development or progression of nuclear sclerosis in patients with idiopathic EMP.

Section snippets

Materials and methods

From December 1995 through June 1997, 21 patients with idiopathic EMP underwent unilateral nonvitrectomizing vitreous surgery at our institution. Eyes chosen for surgery had epiretinal membranes within the temporal arcades and symptoms of visual loss or metamorphopsia. Patients who had undergone previous intraocular surgery or had a history of other ocular disorders in the EMP eye and patients with asymmetric lens opacities in the two eyes were excluded from the study. Eyes that had more than a

Results

We performed nonvitrectomizing vitreous surgery in 21 eyes of 21 patients with EMP. There were 5 men and 16 women, ranging in age from 51 to 77 years (mean, 62.0 years). We randomly assigned 11 eyes to group 1 (membrane left floating in the vitreous cavity), and 10 eyes to group 2 (membrane removed from the eye). The follow-up period ranged from 6 to 24 months (mean, 9.7 months). Nineteen of the 21 eyes had final visual acuity equal to or better than preoperative levels (Fig 1).

There were no

Discussion

Nonvitrectomizing vitreous surgery under ordinary set-up was first described by Charles15 in 1987. He described membrane peeling and excision without removal of the vitreous in patients with EMP and small membranes but recommended core vitrectomy when membranes were larger and denser. Charles later abandoned nonvitrectomizing surgery because of initial postoperative floaters and vitreous opacities (personal communication, 1997).

Some hypotheses have been proposed regarding the possible causes of

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Supported by the Grants-in-Aid for Scientific Research (#07557263) from the Ministry of Education, Science and Culture, and Health Science Research Grants, Japan.

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