The Role of Vitrectomy in Threatment of Epimacular Fibrosis

Purpose: а comparison of the results of epimacular fibrosis surgical treatment with vitrectomy and without it.

Patients and methods. Two groups of patients with epimacular  fibrosis have been compared. The first group — 20 patients (20  eyes), epiretinal membrane was removed without vitrectomy. The  second group (30 patients — 30 eyes), epiretinal membrane was  removed after subtotal vitrectomy. Control of visual acuity was  monitored, as well as intraocular pressure, the retinal thickness in  the Central zone, and the thickness of the nerve fiber layer of the  retina in different sectors. Sensitivity of the retina macular zone was  determined by using microperimetry Maia, and peripheral zones  were determined with the help of computer perimeter, Humpfrey.  The patients were examined before surgery and at 1, 3, 6 and 12 months after it.

Results. The average duration of surgery was 8 minutes in a group without vitrectomy and 32 minutes in a group of subtotal vitrectomy. 6 patients from 20 in the group of ERM removal without vitrectomy  had a relapse of fibrosis found in terms of 3 to 6 months. The groups showed a comparable improvement in visual acuity and  photosensitivity of the central retina, as well as a decrease of retina  thickness. There was a significant increase in IOP by 1.6 mmHg in  the group of subtotal vitrectomy. Statistically significant changes in  the retinal nerve fiber layer thickness were recorded only in temporal sector, and they were significantly more pronounced in subtotal  vitrectomy group (–15.95 and –22.47 microns respectively). In  absolute terms, the decrease in the sensitivity of the peripheral zone of retina was more pronounced in the group of subtotal vitrectomy,  intergroup differences were reliable.

Conclusion. Direct comparison of the two methods demonstrated their comparable effectiveness in terms of influencing the visual  acuity and light sensitivity of the macula. Remove the ERM without  vitrectomy does not affect the peripheral visual field and intraocular  pressure, in contrast to the removal of the ERM after Subtotal  vitrectomy. ERM removal without vitrectomy entails a high risk of  recurrence, which indicates significant limitations of intervention and the impossibility of widespread use of this method.

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