We assessed the value of preoperative optical coherence tomography (OCT) for predicting the visual outcome for patients undergoing macular surgery for epiretinal membranes (ERMs). In a retrospective trial, we analyzed the medical charts of patients who had received surgery for ERMs between January and August 2011. The best-corrected pre- and postoperative logMAR visual acuity was assessed. We pre- and postoperatively measured the central foveal thickness with high-resolution spectral-domain OCT and analyzed the structure of the outer retinal layers (retinal pigment epithelium, photoreceptors, and external limiting membrane) before and after surgery. The study included 49 patients (23 male, 27 female) with an average age of 69 years (SD 6.7) who had received macular surgery during the above-mentioned period. For phakic eyes (n = 34), treatment had also included phacoemulsification and intraocular lens implantation. Postoperative follow-up examinations and OCT controls had been conducted after an average of 9 weeks (SD 5). The mean improvement in visual acuity was 2.4 lines (SD 2.3; p < 0.001). For patients with phakic eyes, the combination of vitrectomy and cataract surgery resulted in a slightly better, but insignificant increase in visual acuity than for patients with primary pseudophakia (Δ = 0.05, p = 0.46). On average, central foveal thickness regressed by 94 μm (SD 129 μm). Linear regression showed a significant linear relationship between the reduction of central foveal thickness and improvement of visual acuity (R (2) = 0.16, B = 0.71, p = 0.004). A decrease in foveal thickness by 100 μm resulted in an increase in visual acuity by 0.71 lines. Visual improvement did not significantly differ between the group of patients with intact outer retinal layers before surgery and the group of patients with preoperative defects of the retina (p = 0.085). We found a significant linear relationship between the reduction of central foveal thickness and improvement of visual acuity for patients undergoing surgery for ERM. However, the preoperative OCT status (intact vs. broken) of the outer retinal layers did not correlate with the change in visual acuity.
Ausgehend vom subjektiven Eindruck vieler vitreoretinaler Chirurgen und der Beobachtung stark steigender Zahlen von Patienten mit Netzhautablösungen an einzelnen Zentren in den letzten Jahren, wurde die jüngere Literatur zu Veränderungen der Inzidenz der Netzhautablösungen weltweit gesichtet. Dabei zeigten sich ganz erhebliche methodische Unterschiede der Studien, die einen Vergleich und klare Schlussfolgerungen zur Entwicklung der Häufigkeit von Netzhautablösungen erschweren. Trotz dieser Einschränkungen sprechen alle Daten aus aktuellen Untersuchungen für eine Zunahme der Zahl der Netzhautablösungen. Die Ablatio-Inzidenz in der westlichen Welt scheint derzeit bei über 20 Fällen pro 100.000 Personenjahren zu liegen, somit deutlich höher als in früheren Jahrzehnten beschrieben. Ursächlich kann vermutet werden, dass ein Anstieg der Prävalenz der Myopie, eine demographische Zunahme der Patienten im typischen Ablatio-Alter und eine steigende Zahl an Katarakt-Operationen, insbesondere bei jüngeren Patienten, für die steigende Inzidenz der Ablatio verantwortlich sind.
Based on the subjective impression of many vitreoretinal surgeons and the observation of
strongly increasing numbers of patients with retinal detachments at individual centres in
recent years, the literature on changes in the incidence of retinal detachments worldwide
was reviewed. This revealed quite significant methodological differences among the studies,
making comparison and clear conclusions on the development of the incidence of retinal
detachments difficult. Despite these limitations, all data from recent studies suggest an
increase in the number of retinal detachments. The incidence of retinal detachment in the
western world currently seems to be above 20 cases per 100,000 person-years, which is
significantly higher than described in earlier decades. It can be assumed that an increase in
the number of individuals with myopia, a demographic increase in patients of typical retinal
detachment age and an increasing number of cataract surgeries, especially in younger
patients, are responsible for the rising incidence of retinal detachment.
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