Friederike Schaub

Background: There is a paucity of information regarding the results of patients with uveitis and secondary epiretinal membrane (sERM) who undergo pars plana vitrectomy and membrane peeling. This study aims to analyse the functional and anatomical outcomes and possible prognostic factors of a large cohort of eyes with uveitis-associated sERM who underwent vitrectomy with epiretinal membrane peeling. Methods: The results of 76 eyes of 76 consecutive patients with uveitis-associated sERM who underwent pars plana vitrectomy with membrane peeling were analysed. The mean follow-up duration was 42.7 ± 47.9 months. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) before and after intervention were measured. Furthermore, demographic data, type of uveitis according to the Standardization of Uveitis Nomenclature (SUN) classification, benefit of additional peeling of the Membrana limitans interna (ILM), activity status of the uveitis at the time of surgery, lens status and postoperative complications were evaluated. Statistical tests included paired t tests, Wilcoxon signed-rank tests, Mann‒Whitney tests, and Kruskal‒Wallis H tests. Statistical significance was defined as p < 0.05; Holm‒Bonferroni correction was employed to address the cumulative risk of false-positive outcomes (type I error). Results: CRT improved from 421.2 ± 133.2 µm prior to surgery to 331.7±142.5 µm at the final follow-up (p = 0.069), whereas BCVA deteriorated from a mean of 0.49 ± 0.30 logMAR to 0.56 ± 0.60 logMAR in the overall cohort (p > 0.99). The rate of concomitant cystoid macular edema decreased from 42.4% to 34.3%. Conclusions: The indications for membrane peeling in patients with a secondary epiretinal membrane and uveitis should be considered carefully. Anatomical features can be positively influenced by pars plana vitrectomy with ERM peeling, whereas BCVA may only result in beneficial changes in carefully selected patients.

Background: Secondary epiretinal membranes (sERM) are common in uveitis and often associated with cystoid macular edema (CME), which increases the need for anti-inflammatory treatment. While surgical removal can improve anatomical and visual outcomes, its effect on intraocular inflammation and steroid requirement remains unclear. This study evaluates whether vitrectomy with ERM peeling can reduce the need for postoperative steroid therapy in uveitic eyes. Methods: This retrospective single-center study reviewed 67 eyes of 67 patients with history of uveitis who underwent sERM peeling between 11/2002 and 04/2023. Demographic data, uveitis classification (SUN), spectral domain optical coherence tomography (SD-OCT) findings, and pre-/postoperative steroid requirements were analyzed. Statistical significance testing was performed using a paired two-tailed t-test. Results: Of the 67 eyes, 50.7% were right eyes, and 65.7% of patients were female. Mean age at timepoint of surgery was 63.1 ± 13.6 years, with 53.7% phakic eyes. Uveitis was classified as anterior (17.9%), intermediate (44.8%), posterior (31.3%), and panuveitis (6.0%). Steroid therapy was reduced in 28.4% of patients, remained unchanged in 56.7%, and increased in 14.9%. Preoperatively, cystoid macular edema (CME) was present in 41.4% of the 58 available SD-OCT scans. Postoperatively, retinal thickness, macular volume, and total retinal volume decreased significantly (p < 0.001). Postoperative CME was found in 31.3% in first postoperative SD-OCT and was newly observed in 6.0%, while 62.7% showed no CME. Conclusions: ERM peeling in uveitic eyes does not guarantee functional improvement or a consistent reduction in steroid dependency. While approximately one-third of patients benefited from reduced steroid use—particularly those with preoperative CME—the majority showed no change, and a subset required intensified therapy due to postoperative inflammation or CME recurrence. Careful patient selection remains essential.

Background: Secondary epiretinal membrane (ERM) is a common complication of diabetic retinopathy, but data on surgical outcome is limited. The aim of this study was to evaluate anatomical and functional outcomes after pars plana vitrectomy with ERM peeling in eyes with diabetic retinopathy. Methods: A retrospective analysis was conducted on 87 eyes of 87 consecutive patients with diabetic retinopathy who underwent ERM peeling over a ten-year period (04/2013–11/2022). Collected data included demographics, best-corrected visual acuity (BCVA), stage of diabetic retinopathy, and optical coherence tomography parameters such as central subfield retinal thickness (CSRT), macular volume (MV), and presence of hyperreflective foci, subretinal fluid, and intraretinal fluid. Statistical analyses were performed using a paired t-test and the Wilcoxon test. Results: The majority of patients had type 2 diabetes (96.6%), and 69.0% presented with diabetic macular edema (DME). The mean follow-up was 2.2 ± 2.0 years. Significant postoperative reductions were observed in CSRT (from 377.20 ± 99.28 µm to 337.99 ± 113.834 µm; p = 0.008) and MV (from 10.11 ± 1.46 mm³ to 99.28 ± 1.07 mm³; p < 0.001). No significant changes in BCVA were observed across the entire study cohort. ERM recurrence was rare (2.3%), and no major complications occurred. Conclusions: ERM peeling in diabetic eyes leads to significant anatomical improvement, especially in advanced diabetic retinopathy and DME, but with limited functional gains. The surgical indication should be carefully considered.

Zusammenfassung: Hintergrund: Das durchgreifende Makulaforamen stellt eine seltene Erkrankung dar, bei der nicht alle Defekte mittels primärer chirurgischer Intervention verschlossen werden können. Ziel der Arbeit: Charakterisierung eines umfangreichen Patientenkollektivs dieser seltenen Erkrankung und Detektion möglicher prädiktiver Faktoren für den anatomischen Behandlungserfolg. Material und Methoden: Retrospektive Analyse aller konsekutiven idiopathischen durchgreifenden Makulaforamina im Zeitraum März 2008 bis Juni 2019 an der Universitätsaugenklinik Köln. Untersucht wurden u. a. epidemiologische Daten, präoperative Parameter (Foramengröße) und Operationstechnik in Bezug auf die Verschlussrate nach primärer Operation. Ergebnisse: Die anatomische Verschlussrate bei idiopathischen Makulaforamina nach primärer Operation lag bei 83,6 %. Es konnte kein Einfluss des Alters, des Geschlechts oder des Linsenstatus auf die Verschlussrate aufgezeigt werden. Die identifizierten prognostisch günstigen Faktoren in Bezug auf den anatomischen Operationserfolg waren: eine kleine Foramengröße, eine kurze Symptomdauer, die Durchführung einer transkonjunktivalen 23-Gauge Vitrektomie sowie die Anwendung der invertierten Flap-Technik der Membrana limitans interna (ILM). Schlussfolgerung: Die operative Behandlung des durchgreifenden Makulaforamens stellt aufgrund guter Erfolgsaussichten eine wertvolle Behandlungsoption dar. Eine zeitnahe Intervention nach Diagnosestellung mittels 23-Gauge-Vitrektomie und ILM-Flap mit Gastamponade scheint für das Outcome am günstigsten zu sein.

Background: Aim of the study was to compare success rate and functional outcome following pars plana vitrectomy (PPV) with conventional internal limiting membrane (ILM) peeling versus ILM flap technique for full-thickness idiopathic macular holes (FTMH). Methods: Retrospective analysis of consecutive eyes with FTMH having undergone vitrectomy with sulfur hexafluoride (SF6) endotamponade 25% at the University Medical Center Rostock, Germany (2009–2020). Eyes were divided according to applied surgical technique (ILM peeling [group P] versus ILM flap [group F]). Inclusion criteria were macular hole base diameters (MH-BD) ≥ 400 μm plus axial length ≤ 26.0 mm. Each group was divided into two subgroups based on macular hole minimum linear diameter (MH-MLD): ≤ 400 μm and > 400 μm. Exclusion criteria were FTMH with MH-BD < 400 μm, trauma, myopia with axial length > 26.0 mm or macular schisis. Demographic, functional, and anatomical data were obtained pre- and postoperatively. Preoperative MH-BD and MH-MLD were measured using optical coherence tomography (OCT; Spectralis®, Heidelberg Engineering GmbH, Heidelberg, Germany). Main outcome parameter were: primary closure rate, best-corrected visual acuity (BCVA), and re-surgery rate. Results: Overall 117 eyes of 117 patients with FTMH could be included, thereof 52 eyes underwent conventional ILM peeling (group P) and 65 additional ILM flap (group F) technique. Macular hole closure was achieved in 31 eyes (59.6%) in group P and in 59 eyes (90.8%) in group F (p < 0.001). Secondary PPV was required in 21 eyes (40.4%) in group P and in 6 eyes (9.2%) in group F. Postoperative BCVA at first follow-up in eyes with surgical closure showed no significant difference for both groups (MH-MLD ≤ 400 μm: p = 0.740); MH-MLD > 400 μm: p = 0.241). Conclusion: Anatomical results and surgical closure rate following ILM flap technique seems to be superior to conventional ILM peeling for treatment of FTMH.

A common severe neurotoxic side effect of breast cancer (BC) therapy is chemotherapy-induced peripheral neuropathy (CIPN) and intervention is highly needed for the detection, prevention, and treatment of CIPN at an early stage. As the eye is susceptible to neurotoxic stimuli, the present study aims to determine whether CIPN signs in paclitaxel-treated BC patients correlate with ocular changes by applying advanced non-invasive biophotonic in vivo imaging. Patients (n = 14, 10 controls) underwent monitoring sessions after diagnosis, during, and after therapy (T0-T3). Monitoring sessions included general anamnesis, assessment of their quality of life, neurological scores, ophthalmological status, macular optical coherence tomography (OCT), and imaging of their subbasal nerve plexus (SNP) by large-area confocal laser-scanning microscopy (CLSM). At T0, no significant differences were detected between patients and controls. During treatment, patients’ scores significantly changed while the greatest differences were found between T0 and T3. None of the patients developed severe CIPN but retinal thickenings could be detected. CLSM revealed large SNP mosaics with identical areas while corneal nerves remained stable. The study represents the first longitudinal study combining oncological examinations with advanced biophotonic imaging techniques, demonstrating a powerful tool for the objective assessment of the severity of neurotoxic events with ocular structures acting as potential biomarkers.

Purpose: Objective tyndallometry using laser flare photometry can be utilized e.g., in management of uveitis. Previous studies showed a significant difference in flare values between pseudophakic and phakic eyes. We investigate a potential association between the degree of lens opacification and flare value in a large cohort phakic eyes. Methods: Retrospective, non-interventional single center study. Laser flare values of 460 healthy fellow eyes from two large cohorts (primary rhegmatogenous retinal detachment (RRD), macular holes (MH)) were correlated with lens status, degree of lens opacity, and age. Results: Out of 460 patients (mean age 64.6 ± 11.2, 57% male) 30.4% were pseudophakic (70.2 ± 10.9) and 69.6% phakic, of which 47.8% showed a clear lens (57.3 ± 9.1), 43.2% an mild cataract (65.2 ± 9.0) and 9.0% a moderate cataract (73.5 ± 9.0). In pseudophakia, flare (8.14 ± 4.6 pc/ms) was significantly higher compared to phakia (6.4 ± 3.9 pc/ms; p < 0.001). In phakic eyes, flare values increased significantly with increasing lens opacity (clear lens 5.3 ± 2.8 pc/ms; mild cataract 7.0 ± 4.0 pc/ms; moderate cataract 9.5 ± 6.1 pc/ms; p < 0.001). In clear lenses and mild cataract, age correlated significantly with flare (two-sided, p < 0.001, clear lenses R = 0.3; mild cataract R = 0.4). In clear lenses, flare values increased with age by 0.09 per year, in mild cataract by 0.17 (regression coefficients). No significant correlation was found between age and flare value in moderate cataract and pseudophakic eyes. Conclusion: The level of objective tyndallometry seems to be dependent on lens status, degree of lens opacity and age. These factors should therefore be taken into account when interpreting laser flare values in the future.