Microincision Vitrectomy Surgery in Vitreomacular Traction Syndrome of Retinitis Pigmentosa Patients

Abstract

Purpose. To investigate long-term retinal changes after microincision pars plana vitrectomy surgery (MIVS) and internal limiting membrane (ILM) peeling outcome in retinitis pigmentosa (RP) patients affected by vitreomacular traction syndrome (VMT) with higher vitreous surface adhesion or coexisting epiretinal membrane (ERM). Methods. Eight RP patients suffering from VMT were evaluated by means of best corrected visual acuity (BCVA), anterior and posterior binocular examination, spectral-domain optical coherence tomography (SD-OCT), MP-1 microperimetry (MP-1), and full-field electroretinogram (ERG), before MIVS and ILM peeling and during the 36-month follow-up. Patients were hospitalized for two days after the surgery. Surgical procedure was performed following this schedule: surgical removal of crystalline lens (MICS), MIVS with 23-gauge sutureless system trocars, core vitreous body removal, and balanced-sterile-salin-solution- (BSS-) air-gas (SF6) exchange. Results. All patients presented visual acuity (VA) increase after MIVS. None of the patients developed ocular hypertension or vitreomacular adhesions during the 3-year follow-up. MP-1 bivariate contour ellipse area (BCEA) was reduced in its dimensions and improved in all patients demonstrating a better fixation. Conclusions. MIVS could be the gold standard therapy in RP patients with VMT and higher vitreous surface adhesion or coexisting ERM if medical therapy is not applicable or not effective.

Association Between Aqueous Flare and Epiretinal Membrane in Retinitis Pigmentosa

“…However, because strong vitreomacular adhesion is frequently observed in RP patients, chronic macular traction may also contribute to the ERM formation in RP. 31 Further studies including histologic investigation are needed to clarify the pathogenesis of ERM secondary to RP.…”

Macular abnormalities in retinitis pigmentosa. Management and treatment

“…The incidence of ERM in RP is 1.4-51.1% [10,33]. Vitreoretinal surgery is a treatment option for the epiretinal membrane, but the available results indicate that the decision on the procedure should be taken carefully in patients with RP due to variable postoperative outcomes [34,35]. After the surgical treatment, a good anatomical result was generally obtained, but this did not improve final visual acuity [35].…”

“…Vitreoretinal surgery is a treatment option for the epiretinal membrane, but the available results indicate that the decision on the procedure should be taken carefully in patients with RP due to variable postoperative outcomes [34,35]. After the surgical treatment, a good anatomical result was generally obtained, but this did not improve final visual acuity [35]. In addition, it has been observed that even after uncomplicated ERM surgery, a patient with RP may develop severe central retinal degeneration [36].…”

Macular hole in retinitis pigmentosa patients: microincision vitrectomy with polydimethylsiloxane as possible treatment

“…suggests that MIVS could be an effective therapy for MH in tapetoretinal dystrophies, and according to Sandeep et al 8,[17][18][19][20] PDMS could be useful compared with air-gas tamponade since RP patients have visual field restriction that can cause movement and posture problems thus facilitating a recurrence of the disease. However, further evidence may be needed to confirm our preliminary findings.…”