NUR ACAR, Assoc Prof, F.E.B.O. Istanbul, Turkey

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Imogene Wilkinson
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1 Combined cataract surgery and 23g vitrectomy with peeling of epiretinal and internal limiting membranes in one-step after dying with the mixture of trypan blue and brilliant blue-g dyes NUR ACAR, Assoc Prof, F.E.B.O. Istanbul, Turkey Objective: Combined cataract surgery with PPV with peeling of both ERM and ILM in single-step with the use of a mixture of dyes is safe, effective, and precludes the need of a secondary lens surgery. Purpose: To evaluate the efficacy and safety of combined cataract surgery and 23-g vitrectomy with peeling of ERM and ILM in one-step with the single injection of a mixture of trypan blue(tb) and brilliant blue-g (BB-G) dyes in eyes with idiopathic ERM. Methods: Prospective, interventional case series.23-g pars plana vitrectomy (PPV) with ERM and ILM peeling with the use of a mixture of TB and BB-G dyes is performed. Phacoemulsification with IOL implantation is also performed at the same session.patients were examined at postoperative day1,week1,month1,month3,month 6,and thereafter.oct examinations were performed postoperative month1,3,and 6. Changes in VA (logmar), and central macular thickness(cmt) with complication rates are evaluated. Patients older than 16-years-old and a follow-up with 6 months are included Results: 14 eyes were operated between november september 2013 are included. 9 patients were females.mean age of the patients were 68.12±5.84. No intraocular complication was noted. Mean logmar VA increased significantly at 3rd month, and thereafter (p<0.05). Mean CMT decreased significantly at 3rd month, and thereafter (p<0.05). No recurrence of ERM is observed. Conlusion: In this study combined cataract surgery and 23-g PPV with peeling of ERM and ILM in one-step with the single injection of a mixture of TB,and BB-G dyes in eyes with idiopathic ERM is found to be effective and safe preventing recurrence of ERMs. This combined technique precludes sequential peeling of membranes while avoiding injecting dyes more than once during PPV. Combined cataract surgery with PPV helps the eye to get to its full potential of visual gain avoiding a secondary lens surgery which may be more complicated in a vitrectomized eye. Take home message: Single injection of TB and BBG dye mixture is efficient to stain and peel ERM and ILM together at one step. Cataract surgery combined with PPV in selected patients offers patient the advantage of avoiding a secondary lens surgery.

2 Methods Prospective, interventional case series Inclusion criteria: Eyes with primary epiretinal membrane; patients > 16- years-old, and a follow-up with 6 months 23-g pars plana vitrectomy (PPV) with phacoemulsification with IOL implantation performed One step ERM and ILM peeling with the use of a mixture of TB and BB-G dyes Patients were examined at postoperative day 1, week 1, month 1, month 3, month 6, and thereafter. OCT (Heidelberg) examinations at postoperative month 1, 3, and 6. Changes in VA (logmar), and central macular thickness (CMT) with complication rates are evaluated

3 Results: 14 eyes operated between Female/ male: 9/ 5 Mean age: 68.12±5.84 yrs In all eyes single injection mixture of dye effective staining of both ERM and ILM both membranes peeled together Intraocular complication None Mean preop logmar VA increased significantly at 3rd month, and thereafter (p<0.05) 0.4 to 0.17 Mean preop CMT decreased significantly at 3rd month, and thereafter (p<0.05) 502±35 to 327±43 µ No recurrence of ERM is observed.

4 Case 1 Preop VA: 20/63 Postop 1 th mo, VA: 20/40 Postop 9 th mo VA: 20/20

5 Case 2 Preop, VA: 20/32 Postop, 1 st month, VA: 20/20 Postop, 12 th mo VA: 20/20

6 Conlusion: Combined cataract surgery and 23-gPPV with peeling of ERM and ILM in one-step with the single injection of a mixture of TB and BB-G dyes in eyes with idiopathic ERM is found to be effective and safe preventing recurrence of ERMs. This technique precludes sequential peeling of membranes while avoiding injecting dyes more than once during PPV. Combined cataract surgery with PPV helps the eye to get to its full potential of visual gain avoiding a secondary lens surgery which may be more complicated in a vitrectomized eye.

An A to Z guide on Epiretinal Membranes (ERMs) Paris Tranos PhD,ICO,FRCS OPHTHALMICA Vitreoretinal & Uveitis Department

An A to Z guide on Epiretinal Membranes (ERMs) Paris Tranos PhD,ICO,FRCS OPHTHALMICA Vitreoretinal & Uveitis Department Types of ERM Natural history OCT prognostic factors ERM with co-existing pathology