Abstract
PurposeTo evaluate the necessity and safety of primary posterior capsulotomy during phaco-vitrectomy for idiopathic epiretinal membrane (ERM).SettingSeoul National University Bundang Hospital, Seongnam, Korea.DesignRetrospective consecutive cohort analysis.MethodsThis study enrolled 219 patients (228 eyes) who underwent combined 25-gauge phaco-vitrectomy for idiopathic ERM and cataract, divided into capsulotomy (−) group (152 eyes, 144 patients) and capsulotomy (+) group (76 eyes, 75 patients). The main outcomes were rate of posterior capsular opacity (PCO) occurrence and postoperative complications. Ophthalmic examinations were performed at baseline, 1, 3, 6, and 12 months postoperatively.ResultsPCO only occurred in capsulotomy (−) group (20 eyes, 13.2%), with mean onset of 10.59 months. Visually-significant PCO that needed Nd:YAG posterior capsulotomy was present in 9 eyes (45.0% of PCO eyes). The rate of cystoid macular edema (CME) was higher in capsulotomy (+) group (6.6% vs. 15.8%, p = 0.026) with longer duration (1.50 vs. 3.36 months, p = 0.019). Female sex and posterior capsulotomy were significant risk factors for CME occurrence (p < 0.05).ConclusionPrimary posterior capsulotomy during phaco-vitrectomy for idiopathic ERM obviated the need for Nd:YAG posterior capsulotomy, but visually-significant PCO that needed Nd:YAG laser was not common. Considering the low rate of visually-significant PCO and high rate of postoperative CME, routine posterior capsulotomy during phaco-vitrectomy may not be necessary for preventing PCO in ERM.
Highlights
Epiretinal membrane (ERM) is a common retinal disorder in older individuals characterized by fibroglial cellular proliferation on the inner surface of macula [1]
Visuallysignificant posterior capsular opacity (PCO) that needed Neodymium:yttrium aluminum garnet (Nd):YAG posterior capsulotomy was present in 9 eyes (45.0% of PCO eyes)
Primary posterior capsulotomy during phaco-vitrectomy for idiopathic epiretinal membrane (ERM) obviated the need for Nd:YAG posterior capsulotomy, but visually-significant PCO that needed Nd:YAG laser was not common
Summary
Epiretinal membrane (ERM) is a common retinal disorder in older individuals characterized by fibroglial cellular proliferation on the inner surface of macula [1]. The formation of ERM formation is regulated by extracellular matrix, cytokines, growth factors, and miRNAs [2, 3]. The contractile membrane can cause distortion of fovea, leads to decreased and distorted vision [4]. Surgical treatment of membrane peeling shows improved visual acuity and metamorphopsia [5,6,7]. The combined surgery of pars plana vitrectomy (PPV) with phacoemulsification and intraocular lens (IOL) implantation is widely used for various vitreoretinal diseases, including ERM, co-existing with cataract [8, 9]. The phaco-vitrectomy procedure allows cost-effectivity and faster recovery, [10] with low complication rate [11].
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