| 본문 : We devised a new technique called “Island-off” technique, in which an island of internal limiting membrane(ILM) around the fovea is preserved and only the peripheral ILM is removed. The results of clinical long-term follow-up over 24 months post-surgery indicate that this new technique may be a safe alternative to achieve adequate ILM peeling in severe epiretinal membrane(ERM) with macular distortion while simultaneously protecting the foveal area.
Case summaries:
Case 1. The patient was a 59-year-old woman who visited our clinic presenting with decreased visual acuity of her right eye. She had undergone a vitrectomy of the right eye three months previously due to vitreous hemorrhage because of proliferative diabetic retinopathy. ILM peeling was not performed then. In the intervening three months between the vitrectomy and her presentation to our clinic, ERM had relapsed and contracted, resulting in macular distortion. Examination also revealed that the macula was deviated to the right and slightly upward due to severe ERM, and the decision was made to perform a second vitrectomy. The foveal structure was successfully restored and maintained for 24 months after surgery without recurrence of ERM.
Case 2. The patient was a 75-year-old woman who visited our clinic presenting with ERM in her right eye. Initial visual acuity was 20/100. “Island-off” technique was performed with vitrectomy. Visual acuity in the right eye improved to 20/40 and was maintained for 30months after surgery without recurrence of ERM.
Case 3. The patient was a 63-year-old woman who visited our clinic presenting with ERM in her right eye. Initial visual acuity was 20/200. “Island-off” technique was performed with vitrectomy. Visual acuity in the right eye improved to 20/30 and was maintained for 28 months after surgery without recurrence of ERM.
Our case studies suggest that the “island-off” technique may offer a safe alternative to complete ILM peeling in severe ERM with macular distortion. Mechanical damage to the foveal area is minimized by leaving an island of central ILM undisturbed. This technique may also prevent aggravation of macular edema by avoiding tangential traction.
|