BACKGROUND AND AIMS: Currently around 67 million people in Europe are affected by some form of age-related macular degeneration (AMD). As most known types of vitreoretinal (VR) interface disorders can coexist with AMD and as we can favourably affect the former with vitreoretinal surgery, our goal was to evaluate the results of vitreoretinal interface disorder surgery with macular peeling in relation to coincident intermediate stage AMD. METHODOLOGY: This was a retrospective evaluation of eyes operated with 25-gauge pars plana vitrectomy (PPV). The monitored parameters were anatomical and functional findings and, safety of the procedure. The surface of the macula was stained with trypan blue and treated (peeling) with a disposable microforceps. 10% perfluoropropane, or the air tamponade was used. Distance visual acuity was examined on the ETDRS chart, the macular finding was monitored by OCT and photodocumented. The post-operative face-down position was 3-5 days. The follow-up period was 6 months. RESULTS: 17 eyes (14 patients, woman 86%) mean age 74 years. The primary indications for the procedure were: idiopathic macular hole (IMD) 59%, epiretinal membrane 29% and vitreomacular traction syndrome 12%. Ophthalmoscopic and OCT findings of intermediate dry form of AMD (100%), in 24% was drusoid ablation of the pigment leaf. In all cases of IMD, primary closure occurred. Input visual acuity 0.1-0.6 improved to 0.2-0.9 at the end of the follow-up period (P<0.05). No complications during surgery or progression of AMD in the follow-up period were observed. CONCLUSION: PPV for vitreoretinal interface disorders have similar anatomical results, whether the outer part of the retina is disrupted by intermediate AMD or not. Functional results are affected by possible disruption of the RPE or the outer layers of the neuroretina by AMD. The PPV procedure has a standard security profile. It is safe and does not affect the progression of AMD in the short term.

Department of Ophthalmology 3rd Faculty of Medicine Charles University and Hospital Kralovske Vinohrady Prague Czech Republic

Eye Clinic Lexum Prague Czech Republic

Faculty Hospital Nitra Spitalska 6 Nitra Slovak Republic

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Sebag J. Die vitreoretinale Grenzfläche und ihre Rolle in der Pathogenese vitreomakulärer Erkrankungen [The vitreoretinal interface and its role in the pathogenesis of vitreomaculopathies]. Ophthalmologe 2015;112(1):10-9. doi: 10.1007/s00347-014-3048-6 (In German) PubMed DOI

Spirn MJ. Optical coherence tomography of macular holes. American Academy of Ophthalmology 2020. [cited 10 November 21]. Available from: https://eyewiki.aao.org/Optical_Coherence_Tomography

Heissigerová J. a kol. Oftalmologie: pro pregraduální i postgraduální přípravu 2. aktualiz. a dopl. vyd., Praha: Maxdorf Jessenius 2021. p. 202-205. (In Czech)

Kuchynka P. a kol. Oční lékařství 2, přeprac. a dopl. vyd., Praha: GRADA Publishing; 2016. p. 422-431. (In Czech)

Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, Sadda SR, Sebag J, Spaide RF, Stalmans P. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology 2013;120(12):2611-19. doi: 10.1016/j.ophtha.2013.07.042 PubMed DOI

Mitchell P, Liew G, Gopinath B, Wong TY. Age-related macular degeneration. Lancet 2018;392(10153):1147-59. doi: 10.1016/S0140-6736(18)31550-2 PubMed DOI

Li JQ, Welchowski T, Schmid M, Mauschitz MM, Holz FG, Finger RP. Prevalence and incidence of age-related macular degeneration in Europe: a systematic review and meta-analysis. Br J Ophthalmol 2020;104(8):1077-84. doi: 10.1136/bjophthalmol-2019-314422 PubMed DOI

Kasner D. Vitrectomy: a new approach to management of vitreous. Highlights of Ophthalmology 1969;11:304.

Machemer R, Buettner H, Norton EW, Parel JM. Vitrectomy: a pars plana approach. Trans Am Acad Ophthalmol Otolaryngol 1971;75(4):813-20.

Machemer R, Parel JM, Norton EW. Vitrectomy: a pars plana approach. Technical improvements and further results. Trans Am Acad Ophthalmol Otolaryngol 1972;76(2):462-6.

Rozsíval P. a kol. Trendy soudobé oftalmologie 9. Praha: GALÉN; 2013. (In Czech)

Mester V, Kuhn F. Internal limiting membrane removal in the management of full-thickness macular holes. Am J Ophthalmol 2000;129(6):769-77. doi: 10.1016/s0002-9394(00)00358-513 Stefánsson E, Geirsdóttir A, Sigurdsson H. Metabolic physiology in age related macular degeneration. Prog Retin Eye Res 2011;30(1):72-80. doi: 10.1016/j.preteyeres.2010.09.003 DOI

Mojana F, Cheng L, Bartsch DU, Silva GA, Kozak I, Nigam N, Freeman WR. The role of abnormal vitreomacular adhesion in age-related macular degeneration: spectral optical coherence tomography and surgical results. Am J Ophthalmol 2008;146(2):218-27. doi: 10.1016/j.ajo.2008.04.027 PubMed DOI

Gross GJ. ERM Pathogenesis: Three Theories Suggest Defects of Vitreous and ILM. Retina specialist 2018;18-23.

Lee EK, Lee SY, Yu HG. Epiretinal membrane in nonexudative age-related macular degeneration: Anatomical Features, Visual Outcomes and Prognostic Factors. Retina 2016;36(8):1557-65. doi: 10.1097/IAE.0000000000000953 PubMed DOI

Thompson JT. Vitrectomy for epiretinal membranes with good visual acuity. Trans Am Ophthalmol Soc 2004;102:97-103; discussion 103-5.

Elhusseiny AM, Flynn HW Jr, Smiddy WE. Long-Term Outcomes After Idiopathic Epiretinal Membrane Surgery. Clin Ophthalmol 2020;14:995-1002. doi: 10.2147/OPTH.S242681 PubMed DOI

Rao P, Yonekawa Y, Abbey AM, Shah AA, Wolfe JD, Faia LJ. Prevalence and Surgical Outcomes of Macular Hole in Eyes with Age-Related Macular Degeneration. Ophthalmol Retina 2017;1(2):158-64. doi: 10.1016/j.oret.2016.09.014 PubMed DOI

Elhusseiny AM, Schwartz SG, Flynn HW Jr, Smiddy WE. Long-Term Outcomes after Macular Hole Surgery. Ophthalmol Retina 2020;4(4):369-76. doi: 10.1016/j.oret.2019.09.015 PubMed DOI