Abstract
‘En bloc’ dissection is a technique in which epiretinal membranes (ERM) are separated from the retina as a single lamina with a 20-gauge blunt flute needle. We used this technique to remove epimacular membranes of various aetiologies in a consecutive series of 25 eyes, with a minimum follow-up of 5 months (mean 10.4 months). Small residual epicentres of ERM away from the fovea remained in 7 (29.1%) eyes only; 3 were inside and 4 outside the temporal vascular arcades. Postoperatively 64% (16/25) of patients achieved a final visual acuity of 6/12 or better and 76% (19/25) achieved a final visual acuity of 6/18 or better. Progressive lens opacities were the most important postoperative complication in phakic eyes that significantly affected the visual results. This technique successfully removed epimacular membranes over a wide area, without the need to find a starting edge or the use of sharp instruments near the retina. Diaphanous ERMs with ill-defined borders and tenaciously adherent membranes could be removed with minimal trauma to the underlying retina. Histopathological and immunohistochemical examination of 10 ERMs demonstrated the absence of internal limiting lamina in 6 (60%).
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Smiddy WE, Michels RG, Glaser BM, de Bustros S . Vitrectomy for impending idiopathic macular holes. Am J Ophthalmol 1988; 105: 371–6.
Mein CE, Flynn HW . Recognition and removal of the posterior cortical vitreous during vitreoretinal surgery for impending macular hole. Am J Ophthalmol 1991; 111: 611–3.
Margherio RR, Cox MS, Trese MT, et al. Removal of epimacular membranes. Ophthalmology 1985; 92: 1075–83.
Michels RG . Vitreous surgery for macular pucker. Am J Ophthalmol 1981; 92: 628–39.
Michels RG, Rice TA, Ober RR . Vitreoretinal dissection instruments. Am J Ophthalmol 1979; 87: 836.
Michels RG . Vitreous surgery. St Louis: CV Mosby, 1981: 357–62.
Charles S . Vitreous microsurgery. Baltimore: Williams & Wilkins, 1987: 153–7.
Smiddy WE, Michels RG, Green WR . Morphology, pathology, and surgery of idiopathic vitreoretinal macular disorders: a review. Retina 1990; 10: 288–96.
Maguire AM, Smiddy WE, Nanda SK, et al Clinico-pathologic correlation of recurrent epiretinal membranes after previous surgical removal. Retina 1990; 10: 213–22.
Uhr G, Giebel J, Schwenk M . Combined lectin binding and PAS/alcian blue staining in glycol methacrylate sections. Biotech Histochem 1993; 68: 240–5.
Margherio RR . Discussion. Ophthalmology 1984; 91: 1387–8.
Machemer R . Die chirurgische Entfernung von epiretinalen Makulamembranen (macular puckers). Klin Monatsbl Augenheilkd 1978; 173: 36–42.
Mittleman D, Green WR, Michels RG, de La Cruz Z . Clinicopathologic correlation of an eye after surgical removal of an epiretinal membrane. Retina 1989; 9: 143–7.
Michels RG . Vitrectomy for macular pucker. Ophthalmology 1984; 91: 1384–8.
Morino I, Hiscott P, McKechnie N, Grierson I . Variation in epiretinal membrane components with clinical duration of proliferative tissue. Br J Ophthalmol 1990; 74: 393–9.
de Bustros S, Rice TA, Michels RG, et al. Vitrectomy for macular pucker: use after treatment of retinal tears or retinal detachment. Arch Ophthalmol 1988; 106: 758–60.
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Kanawati, C., Wong, D., Hiscott, P. et al. ‘En bloc’ dissection of epimacular membranes using aspiration delamination. Eye 10, 47–52 (1996). https://doi.org/10.1038/eye.1996.7
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DOI: https://doi.org/10.1038/eye.1996.7