EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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73 EW MEETING REPORTER May 2015 hypothesized that "when tangential retinal traction becomes intense, the inward peak of the outer retinal lay- er is exaggerated, resulting in attach- ment of adjacent parafoveal inner retinal layers," she said. "Once the attachment occurs, the cells in these layers lose their normal alignment, failing normal neural transduction." Dr. Yoon then wondered wheth- er this "blockage" in normal neural transduction can be "reopened" by surgically releasing the traction through ERM removal. In 57 consecutive patients with idiopathic ERM and decreased vision due to abnormally thick CIRLT, best corrected visual acuity (BCVA) and metamorphopsia improved 12 months after surgery. In a multivariate analysis of these cases, CIRLT was the only fac- tor significantly associated with v - sual acuity apart from initial BCVA. Postoperative visual outcomes, she said, correlated well with postoperative restoration of inner retinal layer configuration after ERM peeling. "Eyes having a thicker inner retinal thickness at the central fovea and a longer duration of disease at baseline tended to restore poorly after surgery," she added. These findings were recently published in Retina. EW day) for 2–4 days and a nonsteroidal anti-inflammato y drug (NSAID) for 3–4 days, as well as topical admin- istration of steroid (3–5x/day) for 3 months, NSAID (3x/day) for 3 months, and mydriatics (1–2x/day) for 1 month. After surgery, 117 eyes (72.6%) had better than 0.5 visual acuity. Compared to preoperative visual acuity, 120 eyes (74.0%) had a 2-fold increase, 33 eyes (20.4%) had no change, and 9 eyes (5.6%) had a 2-fold decrease in vision. These eyes, Dr. Usui said, are prone to recurrent inflammation. Dr. Usui said that surgeons should carry out the appropriate operation using proper surgical pro- cedures and provide the necessary postoperative care and treatment to control complications including recurrence, cystoid macular edema, ocular hypertension, and posterior synechiae. Arthur Lim Award Lecture posits determinant for visual acuity in idiopathic ERM The APAO presents the Arthur Lim Award in recognition of ophthal- mologists who have exhibited exem- plary leadership in ophthalmology, leading to substantial improvements in ophthalmic teaching and training in their region and beyond. It hon- ors the late Prof. Arthur Lim, former president and secretary-general of the Academy. This year, the honor of deliver- ing this prestigious lecture went to Young Hee Yoon, MD, Seoul, South Korea. For her Arthur Lim Award Lecture, Dr. Yoon discussed "Micro- structural Change in Foveal Inner Retina as a Visual Predictor of Idio- pathic ERM," in which she proposed a hypothesis for the main determi- nant of visual acuity in idiopathic epiretinal membranes (ERM). In addition, she proposed an approach to manage the condition based on her hypothesis. "In clinical practice, we often witness a discrepancy between the morphologic change and visual acuity in persons with epiretinal membrane," she said. "Several factors have been associated with visual acuity in ERM patients." These include central retinal thick- ness, inner retinal layer thickness, presence of cystoid macular edema, and photoreceptor inner segment/ outer segment (IS/OS) junction layer disruption. "Among these factors, IS/OS disruption has been suspected as the most significant determinant in most retinal diseases," she said. However, isolating idiopathic ERM from other retinal conditions, IS/OS disruption, she said, is rarely observed. Dr. Yoon presented OCT images from a case with advanced ERM with poor visual acuity. The OCT image showed the IS/OS junction layer to be intact. The partner eye had IS/OS dis- ruption secondary to branch retinal vein occlusion. Numerous diseases, she said, may cause secondary ERM. Among them are those that require flu - rescence angiography for accurate diagnosis, including macular branch retinal vein occlusion. What, then, determines visual acuity in idiopathic ERM? Dr. Yoon reviewed eyes with ERM and carefully selected those with idiopathic causes on the basis of fluorescence angiograph . In this review, Dr. Yoon and her colleagues reported that central in- ner retinal layer thickness (CIRLT) of the fovea was the major determinant of visual acuity—they found that eyes with thick foveal centers could still have very good visual acuity if the inner retinal layer at the foveal center was not thickened. In fact, she said, only 2 eyes out of 134 with idiopathic ERM were ob- served to have IS/OS junction layer disruption. How inner retinal layer thick- ening in idiopathic ERM affects visual acuity remains the subject of speculation. Dr. Yoon herself View videos from Friday at APAO 2015: EWrePlay.org Elizabeth Yeu, MD, Norfolk, Va., discusses how to approach the unhappy postoperative patient and identify factors preoperatively that can lead to dissatisfaction. View all the daily news and photos at daily.eyeworld.org