Abstract
Purpose To report the results of the epiretinal membrane (ERM) management guidelines followed in our center. Methods Patients with ERM seen between 2014 and 2015, with ≥2 years follow-up or who had undergone ERM surgery, were included. Corrected visual acuity (VA), lens status, and ERM configuration were recorded at each visit. Our guidelines for ERM are if VA is ≥20/30, observation is recommended unless there is moderate/intense metamorphopsia. Vitrectomy is recommended during follow-up if there is a drop >one line in VA with changes in ERM configuration. If VA at diagnosis is <20/30, vitrectomy is recommended. If visual loss is thought to be due to cataract, phacoemulsification is performed first and visual status reevaluated. Results Ninety-nine eyes of 94 patients were included; 52 eyes underwent vitrectomy, and 47 eyes were monitored. From eyes with VA at diagnosis <20/30 (41 eyes), 8 eyes underwent isolated phacoemulsification: VA improved to ≥20/30. Vitrectomy was recommended but refused by 4 patients. The other 29 eyes underwent vitrectomy. Of the 58 eyes with VA at diagnosis ≥20/30, 5 underwent surgery due to metamorphopsia. Eighteen eyes underwent vitrectomy during follow-up. VA improved a mean of 0.13 logMAR (SD 0.30) after vitrectomy. There were no differences in mean VA improvement between eyes that underwent vitrectomy within six months of diagnosis (0.24, SD 0.32) and those that underwent surgery more than six months after diagnosis (mean 0.17, SD 0.17), p=0.106. Three eyes developed postsurgical complications with visual loss: persistent macular edema in one eye, two consecutive retinal detachments in one eye, and a central visual defect in another eye. At the end of follow-up, VA was similar in the observation group (0.14, SD 0.14) and in the vitrectomy group (0.16, SD 0.28), p=0.528. Conclusions Our proposed guidelines lead to visual preservation in most patients while limiting surgery and its possible complications.
Highlights
Epiretinal membranes (ERMs) are sheet-like fibrous structures that develop on the surface of the retina. ey produce few symptoms, but in some patients, epiretinal membrane (ERM) contraction leads to a distortion of the foveal structure, causing visual loss and/ or metamorphopsia
Five eyes were excluded because they had advanced pigmentary retinosis and 25 because they had undergone ERM surgery elsewhere and no data were available on preoperative visual acuity. us, 99 eyes of 94 patients were included in the study: 52 eyes underwent vitrectomy (Group 1) and 47 eyes were followed-up for at least two years (Group 2)
Together with the fact that in almost all reports, preoperative visual acuity is the main prognostic factor of postoperative visual acuity [2, 11, 12], this is leading to surgery being proposed to patients with very good visual acuities
Summary
Epiretinal Membrane Surgery in Daily Clinical Practice: Results of a Proposed Management Scheme. To report the results of the epiretinal membrane (ERM) management guidelines followed in our center. Vitrectomy is recommended during follow-up if there is a drop >one line in VA with changes in ERM configuration. From eyes with VA at diagnosis
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