Cataract Surgery Outcomes in Eyes With Primary Epiretinal Membrane

Abstract

IMPORTANCE Primary epiretinal membrane (ERM) is a common retinal disorder with a prevalence of 4% to 18.5%. Although ERM and cataracts commonly occur together, to our knowledge, no studies have investigated the outcome of cataract surgery alone in this setting. OBJECTIVE To analyze the visual outcome and cystoid macular edema risk with cataract surgery in eyes with primary ERM. DESIGN, SETTING, AND PARTICIPANTS In this retrospective clinical database study, data were collected from July 2003 to March 2015 from 8 locations in the United Kingdom. Cataract surgery data of 217 557 eyes were extracted from the electronic medical record of the UK National Health Service. After exclusion of 57 561 eyes with combined surgery, prior vitrectomy, copathology, and complications, 812 eyes with primary ERM and 159 184 reference eyes were analyzed. MAIN OUTCOMES AND MEASURES We report on visual acuity (VA), the incidence of cystoid macular edema, and the need for ERM surgery. RESULTS The mean (SD) age of patients in the ERM group was 73.7 (9.23) years, and 395 of 812 were men (46.8%). The mean (SD) age of patients in the reference group was 74.4 (12.19) years, and 65 265 of 159 184 were men (41%). Epiretinal membrane eyes assessed at 4 to 12 weeks postoperatively gained 0.27 (0.32) logMAR (approximately 3 Snellen lines), with 200 of 448 (44.6%) improving by 0.30 logMAR or more (Ն3 Snellen lines) and 32 of 448 (7.1%) worsening by 0.30 logMAR or more. Reference eyes gained a mean (SD) of 0.44 (0.26) logMAR (approximately 4 Snellen lines), with 48 583 of 77 408 (62.8%) improving by 0.30 logMAR or more and 2125 of 77 408 (2.7%) worsening by 0.30 logMAR or more. Although all eyes with preoperative VA of 20/40 or less improved, only reference eyes with preoperative VA of more than 20/40 showed improvement. Cystoid macular edema developed in 57 of 663 ERM eyes (8.6%) (95% CI, 6.69-10.98) and 1731 of 125 435 reference eyes (1.38%) (95% CI, 1.32-1.45) (P < .001). Epiretinal membrane surgery was performed in 43 of 663 (6.5%) ERM eyes. CONCLUSIONS AND RELEVANCE On average, VA improved 0.27 logMAR (approximately 3 Snellen lines) in eyes with ERM. Eyes with ERM and VA of 20/40 or less showed more benefit after cataract surgery than those with better preoperative vision. However, compared with eyes without ERM, higher rates of cystoid macular edema and a lower postoperative VA gain were noted.

Baseline visual acuity and interdigitation zone as predictors in idiopathic epiretinal membranes: A retrospective cohort study

“…1,2,6,[21][22][23][24] We have found an improvement in visual acuity from 0.5 log-MAR to 0.2 logMAR, which corresponds to an increase of approximately three lines in the Snellen charts, which was similar to the results described by other authors in their analysis. 9,25,26 This increase on BCVA was independent of the phakic status of the patient, because both phakic and pseudophakic eyes were considered in our sample and no significant differences were noted in both pre and post-operative BCVA (Mann-Whitney U; p = 0.93). Concomitant or subsequent cataract surgery was also proved to be the same in terms of refractive error, BCVA, or CMT.…”

Long-term Safety and Efficacy of Sutureless Vitrectomy for Combined Epiretinal and Internal Limiting Membrane Removal

“…In the long term, however, it appears that baseline phakic patients visually outperform pseudophakic patients by a wide margin. Hardin et al 16 have also shown that cataract extraction alone in patients with comorbid primary ERMs can lead to an increase in BCVA of 0.27 logMAR units within 4-12 weeks postoperatively, a significant increase in visual function of roughly 3 Snellen lines.…”

OCT changes of idiopathic epiretinal membrane after cataract surgery

“…Our data shows a statistically significant increase in all these variables. As literature has previously demostrated [7], the presence of an epiretinal membrane is an independent risk factor, which acts sinergically to increase the rate of these inflammatory consequences [13]. Detailed analysis of foveal OCT anatomy was performed demonstrating the changes induced by phacoemulsification in eyes with idiopathic advanced membranes.…”