vitrectomy

玻璃体切除术
  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    目的:探讨特发性视网膜前膜(iERM)患者术前脉络膜灌注(CCP)作为生物标志物。
    方法:将28例(28只眼)单侧iERM患者纳入回顾性观察性研究。在PPV前后进行光学相干断层扫描(OCT)和血管造影(OCTA)。区域,周边,术前使用OCTA分析双眼浅中央凹无血管区(FAZ)的圆形度。术前CCP也用二值化的正面OCTA图像进行分析。在基线和手术后6个月通过OCT测量最佳矫正视力(BCVA)和中央凹厚度(CFT)。分析术前OCT参数与术后BCVA和CFT降低的相关性。
    结果:与手术前未受影响的双眼相比,iERM患者的CCP明显降低(p<0.001),FAZ缩小(p<0.001)。术后BCVA和CFT显著改善(p=0.001,p<0.001)。多元回归分析显示术前CCP与BCVA改善显著相关(β=0.185,p=0.005),术后BCVA(β=0.108,p=0.023)和术前CFT比值(β=0.106,p=0.044)。
    结论:术前CCP是iERM术后不良功能和解剖学预后的生物标志物。
    OBJECTIVE: To investigate the preoperative choriocapillaris perfusion (CCP) as a biomarker in patients with idiopathic epiretinal membrane (iERM).
    METHODS: 28 patients (28 eyes) with unilateral iERM who received pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling were included for retrospective observational study. Optical coherence tomography (OCT) and angiography (OCTA) was performed before and after PPV. Area, perimeter, and circularity of superficial foveal avascular zone (FAZ) were analyzed preoperatively in both eyes using OCTA. Preoperative CCP was also analyzed with binarized en-face OCTA images. Measurements of best-corrected visual acuity (BCVA) and central foveal thickness (CFT) by OCT were conducted at the baseline and 6 months following the surgery. The correlations of preoperative OCT parameters with postoperative BCVA and CFT reduction were analyzed.
    RESULTS: CCP was significantly lower (p < 0.001) and FAZ had shrunk (p < 0.001) in eyes with iERM compared to unaffected fellow eyes before surgery. BCVA and CFT became significantly improved after surgery (p = 0.001, p < 0.001). Multiple regression analysis revealed that preoperative CCP was significantly related with BCVA improvement (β = 0.185, p = 0.005), postoperative BCVA (β = 0.108, p = 0.023) and ratio of post- to preoperative CFT (β = 0.106, p = 0.044).
    CONCLUSIONS: Preoperative CCP is a biomarker for poor functional and anatomical prognosis after surgery in iERM.
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  • 文章类型: Journal Article
    第一-(单体),二次(预凝胶),和第三代(注射后原位凝胶化)水凝胶先前被引入以替换玻璃体切除术后的玻璃体。在这项研究中,我们评估了手术,光学,在先前应用于眼内植入物的加速老化方案之前和之后,玻璃体替代水凝胶的粘弹性。
    注射力的测量,使用临床建立的玻璃体切除术设置的移除速度,以及在加速老化方案之前和之后进行正向光散射和粘弹性性能的评估。将结果与猪和人玻璃体进行比较,以及目前临床上应用的轻和重于水的硅油。
    所有测试水凝胶的去除速度均大大低于猪玻璃体的去除速度(0.2g/minvs.2.7g/min对于性能最好的水凝胶和猪玻璃体,分别)。在老化过程后,第二代玻璃体替代水凝胶的前向光散射高于平均70岁玻璃体的杂散光(9.4与5.5deg2/sr,分别)。所有水凝胶的粘弹性特性都没有以临床意义的方式改变;然而,老化后刚度和弹性的趋势明显。
    这项研究表明,在临床使用前需要解决水凝胶的手术弱点,特别是低去除速度。与原位凝胶化水凝胶(第三代)相比,预联水凝胶(第二代)在手术性能方面表现较差。
    本研究强调了在临床上应用玻璃体替代水凝胶时可能存在的关于手术和光学性质的缺陷。
    UNASSIGNED: First- (monomers), second- (pre-gelated), and third- (in situ gelating after injection) generation hydrogels were previously introduced to replace the vitreous body after vitrectomy surgery. In this study, we evaluated the surgical, optical, and viscoelastic properties of vitreous body replacement hydrogels before and after an accelerated aging protocol previously applied to intraocular implants.
    UNASSIGNED: Measurements of injection force, removal speed using a clinically established vitrectomy setup, as well as evaluation of forward light scattering and viscoelastic properties before and after an accelerated aging protocol were conducted. Results were compared to porcine and human vitreous bodies, as well as currently clinically applied lighter- and heavier-than-water silicone oils.
    UNASSIGNED: Removal speed of all tested hydrogels is substantially lower than the removal speed of porcine vitreous body (0.2 g/min vs. 2.7 g/min for the best performing hydrogel and porcine vitreous body, respectively). Forward light scattering in second-generation vitreous body replacement hydrogels was higher after the aging process than the straylight of the average 70-year-old vitreous body (9.4 vs. 5.5 deg2/sr, respectively). The viscoelastic properties of all hydrogels did not change in a clinically meaningful manner; however, trends toward greater stiffness and greater elasticity after aging were apparent.
    UNASSIGNED: This study demonstrates surgical weaknesses of the hydrogels that need to be addressed before clinical use, especially low removal speed. Pre-linked hydrogels (second-generation) showed inferior performance regarding surgical properties compared to in situ gelating hydrogels (third-generation).
    UNASSIGNED: This study highlights possible pitfalls regarding surgical and optical properties when applying vitreous replacement hydrogels clinically.
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  • 文章类型: Journal Article
    描述在5期家族性渗出性玻璃体视网膜病变(FEVR)伴漏斗状视网膜脱离(RD)的玻璃体切除术期间,氰基丙烯酸酯胶在封闭医源性视网膜破裂(IRB)中的作用。
    从2020年7月至2022年1月,在玻璃体切除术期间,诊断为5期FEVR的9例患者的9只眼睛用氰基丙烯酸酯胶治疗IRB。临床记录,包括病人信息,手术过程,和后续检查,是回顾性收集的。总结了解剖学结果和视觉结果。
    手术平均年龄为19.6个月(范围:3.8-41.1个月)。术后平均随访时间为12.5个月(范围:9.8-18.8个月)。手术前,五只眼睛的RD为开放漏斗,四只眼睛的RD为封闭漏斗。在九只眼睛中尽可能彻底地去除所有视网膜前纤维增生膜。IRB在两只眼睛的后极和七只眼睛的周边视网膜形成。所有的IRB在它们出现时被氰基丙烯酸酯胶成功地密封。在手术后的最后一次访问中,八只眼睛有部分视网膜复位,没有纤维化组织的进展,一只眼睛完全视网膜再脱离。在这项研究中,稳定的解剖学结局率为88.9%(8/9)。可用于七只眼睛的视觉测试显示了五只眼睛的光感知,两只眼睛没有光感知。随访期间未发现严重的围手术期胶水相关并发症。
    氰基丙烯酸酯胶的应用可能是5期FEVR手术中IRB的替代疗法,而长期疗效和安全性仍需进一步研究。
    UNASSIGNED: To describe the role of cyanoacrylate glue in sealing iatrogenic retinal breaks (IRBs) during vitrectomy in stage 5 familial exudative vitreoretinopathy (FEVR) with funneled retinal detachment (RD).
    UNASSIGNED: Nine eyes of nine patients diagnosed as stage 5 FEVR were treated with cyanoacrylate glue for IRBs during vitrectomy from July 2020 to January 2022. The clinical records, including patient information, surgical process, and follow-up examinations, were collected retrospectively. Anatomical outcomes and visual outcomes were summarized.
    UNASSIGNED: The average age at surgery was 19.6 months (range: 3.8-41.1 months). The mean post-operative follow-up period was 12.5 months (range: 9.8-18.8 months). Before surgery, five eyes had an open-funnel RD and four eyes had a closed-funnel RD. All the preretinal fibroplasia membranes were removed as thoroughly as possible in the nine eyes. IRBs formed at the posterior pole in two eyes and peripheral retina in seven eyes. All the IRBs were sealed successfully by the cyanoacrylate glue when they appeared. At the final post-operative visit, eight eyes had partial retinal reattachment without progression of fibroplasia tissues, while one eye had total retinal redetachment. The rate for stable anatomical outcome was 88.9% (8/9) in this study. The visual testing available for seven eyes demonstrated light perception in five eyes and no light perception in two eyes. No severe perioperative glue-related complications were noted during the follow-ups.
    UNASSIGNED: The application of cyanoacrylate glue may be an alternative therapy for IRBs in stage 5 FEVR surgeries, while the long-term efficacy and safety still need further investigation.
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  • 文章类型: Case Reports
    波士顿I型人工角膜(KPro-I)已被证明在严重眼烧伤后可成功恢复视力;但是,很少报道其在Phthical眼中的长期结果。一名患有严重碱性化学损伤史的单眼女性,需要在复杂的过程后进行面部移植,左眼具有光线感知,包括失败的KPro-I,治疗性穿透性角膜移植术,眼内炎,矮个子,视网膜完全脱离,和结构变化,包括收缩的18毫米轴向长度和眼壁增厚。患者接受了硅油和KPro-I植入的联合玻璃体切除术,导致她在3年随访时恢复了动态视力(20/250)。
    The Boston Keratoprosthesis type I (KPro-I) has been shown to be successful in restoring vision after severe ocular burns; however, its long-term outcomes in phthisical eyes have rarely been reported. A monocular woman with a history of severe alkali chemical injury necessitating facial transplantation presented with a light perception left eye after a complicated course, including failed KPro-I, therapeutic penetrating keratoplasty, endophthalmitis, hypotony, total retinal detachment, and structural changes, including a shrunken 18 mm axial length and eye wall thickening. The patient underwent a combined vitrectomy with silicone oil and KPro-I implantation, resulting in her regaining ambulatory visual acuity (20/250) at 3 years\' follow-up.
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  • 文章类型: Journal Article
    目的:探讨既往有晶状体性视网膜脱离(RT)病史的患者白内障摘除后视网膜撕裂(RT)和视网膜脱离(RD)的发生率和预后。
    方法:回顾性病例系列。
    方法:用激光光凝或冷冻疗法成功治疗并随后接受白内障手术的法克眼。
    方法:对2012年4月1日至2023年5月31日期间接受RTs治疗的有晶状体眼进行了回顾性回顾。排除包括白内障摘除前的玻璃体视网膜手术和白内障手术后不到6个月的随访。
    方法:白内障手术后RTs和RD的发生率,以及视觉和解剖结果。
    结果:在接受RTs治疗的12,109只眼中,1039只(8.6%)眼接受了白内障手术。排除后,研究了660例患者的713只眼。平均值(标准偏差,SD)白内障手术后的随访期为34.8(24.6)个月,中位随访时间为239天和246天,以达到新的RT或RD发展。白内障术后RT和RD的总诊断发生率为7.3%(52/713)(2.9%和4.3%,分别),一年发病率为5.6%(2.2%和3.4%,分别)。多变量回归分析确定年轻个体中RT/RD的风险较高(比值比[OR]1.034;95%置信区间[CI]1.004-1.065,P=0.028),男性(OR2.058;95%CI1.110-3.816,P=0.022),激光治疗和白内障手术间隔较短的患者(OR1.001;95%CI1.001-1.001,P=0.011)。在3个月时,25只眼(80.6%)实现了RD修复的单次手术解剖成功,最终重新附着率为100%。RT的中位最终logMAR视力为0.10(20/25),显示白内障手术后没有明显变化,RD为0.18(20/30),白内障手术后的严重恶化。
    结论:白内障手术后一年,先前治疗过的RT患者的RT和RD诊断率相对较高,发生在18只眼睛中的近1只。在年轻人中发现了更高的风险,男性,以及初始RT治疗和白内障手术之间间隔较短的患者。RD修复取得了良好的解剖效果,但是视力下降了。
    OBJECTIVE: To investigate the incidence and outcomes of retinal tear (RT) and retinal detachment (RD) after cataract extraction in patients with a history of previous phakic RT.
    METHODS: Retrospective case series.
    METHODS: Phakic eyes with RT that were successfully treated with laser photocoagulation or cryotherapy and subsequently underwent cataract surgery.
    METHODS: A retrospective review of phakic eyes treated for RTs between April 1, 2012 and May 31, 2023 was performed. Exclusions included prior vitreoretinal surgery before cataract removal and follow-up of less than 6 months post-cataract surgery.
    METHODS: The incidence of RTs and RDs after cataract surgery, along with visual and anatomic outcomes.
    RESULTS: Of 12,109 phakic eyes treated for RTs, 1039 (8.6%) eyes underwent cataract surgery. After exclusions, 713 eyes of 660 patients were studied. The mean (standard deviation, SD) follow-up period post-cataract surgery was 34.8 (24.6) months with a median of 239 and 246 days to a new RT or RD development. The overall incidence for diagnosis of post-cataract surgery RT and RD was 7.3% (52/713) (2.9% and 4.3%, respectively), with a one-year incidence of 5.6% (2.2% and 3.4%, respectively). Multivariable regression analysis identified a higher risk of RT/RD among younger individuals (odds ratio [OR] 1.034; 95% confidence interval [CI] 1.004-1.065, P=0.028), males (OR 2.058; 95% CI 1.110-3.816, P=0.022), and those with shorter interval between laser treatment and cataract surgery (OR 1.001; 95% CI 1.001-1.001, P=0.011). Single surgery anatomic success for the RD repair was achieved in 25 eyes (80.6%) at 3 months, with a 100% final reattachment rate. The median final logMAR visual acuity was 0.10 (20/25) for RT, showing no significant change from post-cataract surgery, and 0.18 (20/30) for RD, a significant worsening from after cataract surgery.
    CONCLUSIONS: One year post-cataract surgery, the rate of diagnosed RT and RD in patients with previously treated RTs was relatively high, occurring in nearly 1 in 18 eyes. Higher risk was noted among younger individuals, males, and patients with a shorter interval between initial treatment for RT and cataract surgery. RD repair achieved good anatomical results, but vision declined.
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  • 文章类型: Journal Article
    目的:本研究旨在调查人口统计学,临床特征,急性感染性眼内炎(AIE)患者的治疗结果。
    方法:对2017年至2022年临床诊断为感染性眼内炎的所有患者进行回顾性分析。人口统计数据,患者的临床特征,急性感染性眼内炎的类型(术后,创伤后,气泡相关,和内源性眼内炎),手术后病例的外科手术类型,玻璃体样品的微生物分析结果,治疗措施,并记录患者的视觉结果。
    结果:在这项研究中,182名与会者包括122名男性(67%)和60名女性(33%),参与其中。患者平均年龄为54.56±21岁,年龄在1-88岁之间。最常见的AIE类型是术后(59.9%),其次是内源性(19.2%),创伤后(17%),和泡相关(3.8%)。AIE患者术后亚组中最常见的眼内手术类型是超声乳化术(57.8%)。患者的主要和最终BCVA的中位数(四分位距)为1.5(1.35,1.85)和0.65(0.35,1.35),分别。玻璃体混浊等级(OR,2.89;95%CI,1.11-5.74;p=0.009)和主要VA(OR,60.34;95%CI,2.87-126.8;p=0.008)显示最终视力丧失的统计学意义。
    结论:AIE是一种破坏性疾病,视力不良,无论其类型如何,都具有急性炎症体征和症状。然而,及时和适当的治疗导致许多患者的视力恢复到功能水平。
    OBJECTIVE: This study aimed to investigate the demographics, clinical characteristics, and management outcomes of patients with acute infectious endophthalmitis (AIE).
    METHODS: This retrospective chart review was conducted on all patients admitted with the clinical diagnosis of infectious endophthalmitis from 2017 to 2022. Demographic data, patients\' clinical characteristics, the type of acute infectious endophthalmitis (post-operative, post-traumatic, bleb-associated, and endogenous endophthalmitis), the type of surgical procedure in the post-operative cases, the microbiologic analysis results of vitreous samples, therapeutic measures, and visual outcomes of patients were recorded.
    RESULTS: In this study, 182 participants, including 122 male (67%) and 60 (33%) female, were involved. The mean age of patients was 54.56 ± 21 years, with a range of 1-88 years old. The most prevalent type of AIE was post-operative (59.9%), followed by endogenous (19.2%), post-traumatic (17%), and bleb-associated (3.8%). The most common type of intraocular surgery in the post-operative subgroups of AIE patients was phacoemulsification (57.8%). The median (interquartile range) of the primary and final BCVA of patients was 1.5 (1.35, 1.85) and 0.65 (0.35, 1.35), respectively. Vitreous haziness grade (OR, 2.89; 95% CI, 1.11-5.74; p = 0.009) and the primary VA (OR, 60.34; 95% CI, 2.87-126.8; p = 0.008) revealed statistical significance for final vision loss.
    CONCLUSIONS: AIE is a devastating condition with poor visual outcomes, which presents with acute inflammatory signs and symptoms regardless of its type. However, prompt and appropriate treatment leads to visual recovery to a functional level in many patients.
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  • 文章类型: Letter
    目的:报告在其他替代方法不适用的情况下,使用自体Tenon补片移植治疗巨大的全厚度黄斑裂孔(FTMHs)的结果。
    方法:对3例病例均采用相同的手术方法。简而言之,收集了Tenon组织的小碎片。通过23G套管针引入移植物,并在PFCL气泡下在黄斑孔上释放。将补片巧妙地推向孔的边缘,以在下面滑动。然后在视盘旁边主动抽吸PFCL气泡。随后注入气体或硅油填充剂,注意在手术过程中尽量减少流体湍流。
    结果:报告了三种巨大FTMHs中自体Tenon贴片移植的结果。在第一种情况下,硅油填塞被注射,在第二个,注入C2F6气体。在第三种情况下,患有晚期青光眼的女性,眼睛里没有留下填塞.在手术期间或之后没有观察到不良反应。在所有三例病例的随访期间,记录了黄斑裂孔的闭合和功能改善。
    结论:经过长达6个月的随访,Tenon补片移植似乎是处理复杂FTMH病例的一种有前途的技术。需要进行其他研究以调查长期结果并确定最合适的适应症。
    OBJECTIVE: To report the results of using autologous Tenon patch grafts for managing giant full-thickness macular holes (FTMHs) when other alternatives are not applicable.
    METHODS: The same surgical technique was performed in all three cases. Briefly, a small fragment of Tenon\'s tissue was collected. The graft was introduced through a 23G trocar and released over the macular hole under a bubble of PFCL. The patch is delicately pushed towards the edges of the hole to slide underneath. The PFCL bubble is then actively aspirated next to the optic disc. Tamponade with gas or silicone oil is subsequently injected, with care taken to minimize fluid turbulence during the procedure.
    RESULTS: The outcomes of autologous Tenon patch grafts in three giant FTMHs are reported. In the first case, silicone oil tamponade was injected, in the second, C2F6 gas was injected. And in the third case, that of a woman with advanced glaucoma, no tamponade was left in the eye. No adverse effects were observed during or after the procedures. Closure of the macular hole and functional improvement were documented during the follow-up period in all three cases.
    CONCLUSIONS: With a follow-up of up to 6 months, the Tenon patch graft appeared to be a promising technique for managing complex cases of FTMH. Additional studies to investigate long-term outcomes and determine the most appropriate indications are warranted.
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  • 文章类型: Journal Article
    背景:磁性眼内异物可以用磁化一次性镊子去除。这项研究的目的是比较不同尺寸的镊子的磁化能力,形式和制造商。
    方法:使用既定程序磁化镊子。在镊子的尖端测量可诱导的磁通量密度。然后在BSS溶液中使用钢球测试可以用磁化镊子提起的质量。测量镊子的金属部分的重量。
    结果:可以感应的磁通量密度,可以提升的钢球的重量和镊子中使用的不锈钢的质量如下:Alcon末端抓取23G:7.12mT,87.43毫克,1191毫克;Alcon端抓25G:6.43mT,87.43毫克,1189毫克;Alcon锯齿状:4.39mT,63.78毫克,1284毫克;Alcon锯齿状23G:3.62mT,13.74毫克,1200毫克;Alcon锯齿状25G:2.4mT,13.74毫克,1195毫克;DORC端抓23G:5.52mT,32.54毫克,153毫克;协同作用端抓23G:4.35mT,16.37毫克,193毫克;VitreqBV末端抓取23G:2.65mT,无,88mg。
    结论:一次性微镊子的可磁化性似乎取决于镊子尖端的钢质量。铁晶格的结构可能具有更大的影响。并非每个一次性镊子都可以被充分磁化以用于该技术。
    BACKGROUND: Magnetic intraocular foreign bodies can be removed with magnetized disposable forceps. Aim of this study is to compare the forceps magnetizability of different size, form and manufacturer.
    METHODS: The forceps were magnetized using an established procedure. The inducible magnetic flux density was measured at the tip of the forceps. The mass that can be lifted with the magnetized forceps was then tested using steel balls in BSS solution. The weight of the metal parts of the forceps was measured.
    RESULTS: The magnetic flux density that could be induced, the weight of the steel balls that could be lifted and the mass of stainless steel used in the forceps were as follows: Alcon end-grasping 23G: 7.12 mT, 87.43 mg, 1191 mg; Alcon end-grasping 25G: 6.43 mT, 87.43 mg, 1189 mg; Alcon serrated: 4.39 mT, 63.78 mg, 1284 mg; Alcon serrated 23G: 3.62 mT, 13.74 mg, 1200 mg; Alcon serrated 25G: 2.4 mT, 13.74 mg, 1195 mg; DORC end-grasping 23G: 5.52 mT, 32.54 mg, 153 mg; Synergetics end-grasping 23G: 4.35 mT, 16.37 mg, 193 mg; Vitreq BV end-grasping 23G: 2.65 mT, none, 88 mg.
    CONCLUSIONS: The magnetizability of a disposable microforceps seems to depend on the mass of steel at the tip of the forceps. The structure of the iron lattice could have an even greater influence. Not every disposable forceps can be sufficiently magnetized for this technique.
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  • 文章类型: Journal Article
    目的:这篇综述旨在总结当前有关临床特征的知识,诊断工作,葡萄膜视网膜前膜(ERM)的治疗方法。
    方法:使用PubMed数据库对文献进行了全面调查。此外,在GoogleScholar上进行了补充搜索,以确保在集合中包含所有相关项目。
    结果:ERM是玻璃体视网膜界面的异常层,由于肌纤维母细胞沿着中央视网膜的内表面增殖,导致视力障碍。以各种名字闻名,ERM有不同的原因,包括特发性或继发性因素,与眼科成像技术,如OCT改善检测。在葡萄膜炎中,ERM的发生很常见,手术干预涉及带ERM剥离的平坦部玻璃体切除术,尽管关于最佳方法的争论仍然存在。
    结论:组织病理学研究和OCT进展改善了ERM的理解,在没有统一模型的情况下揭示一组不同的疾病。共识支持渐进性病例中葡萄膜ERM的手术,但是变异性需要仔细考虑和有效的炎症管理。OCT生物标志物,深度学习,手术的进展可能会提高结果,医疗干预和机器人技术显示出早期ERM干预的希望。
    OBJECTIVE: This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up, and therapeutic approach of uveitic epiretinal membranes (ERM).
    METHODS: A thorough investigation of the literature was conducted using the PubMed database. Additionally, a complementary search was carried out on Google Scholar to ensure the inclusion of all relevant items in the collection.
    RESULTS: ERM is an abnormal layer at the vitreoretinal interface, resulting from myofibroblastic cell proliferation along the inner surface of the central retina, causing visual impairment. Known by various names, ERM has diverse causes, including idiopathic or secondary factors, with ophthalmic imaging techniques like OCT improving detection. In uveitis, ERM occurrence is common, and surgical intervention involves pars plana vitrectomy with ERM peeling, although debates persist on optimal approaches.
    CONCLUSIONS: Histopathological studies and OCT advancements improved ERM understanding, revealing a diverse group of diseases without a unified model. Consensus supports surgery for uveitic ERM in progressive cases, but variability requires careful consideration and effective inflammation management. OCT biomarkers, deep learning, and surgical advances may enhance outcomes, and medical interventions and robotics show promise for early ERM intervention.
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