Early surgery for epiretinal membrane preserves more vision for patients

Abstract

Purpose To establish whether early vitrectomy for epiretinal membrane (ERM) is preferable to delayed surgery. Methods We carried out a retrospective study of 120 eyes from 120 patients with preoperative visual acuity (VA) of 6/60 or better. Pre-operative logMAR score was considered to act as an appropriate proxy measure for time of surgical procedure, with scores of 0.3 or less considered to represent early surgery, scores of 0.4 or 0.5 considered to represent medium surgery, and scores of 0.6 or more considered to represent late surgery for ERM. Patients were either pseudophakic at the time of vitrectomy or underwent combined phacovitrectomy for symptomatic ERM. Results Evaluation of parameter coefficients indicated that controlling for other factors, a delay of the surgical procedure from a state of early to medium corresponded to an increase (ie, disbenefit) of 0.074 units in postoperative logMAR score (95% confidence interval À 0.001-0.15). A delay of the surgical procedure from a state of early to late corresponded to an increase (ie, disbenefit) of 0.21 units in post-operative logMAR score (95% confidence interval 0.13-0.29). Mean post-operative VA for early surgery was 0.16, out of which 36.2% of patients had a LogMAR score of 0.1 or better. This is in comparison to 17.2% in late ERM (those with a pre-operative logMAR score of 0.6 or more). Conclusion We conclude that early surgery is associated with a lower (ie, better) postoperative logMAR score. Vitrectomy for early symptomatic ERM, in carefully selected patients, is beneficial in preserving excellent vision and allows quicker visual rehabilitation.

Quantifying metamorphopsia in patients with diabetic macular oedema and other macular abnormalities

“…). Distortion and blurring, especially under low contrast conditions, may not be fully reflected with VA testing (Rahman & Stephenson ). Other aspects of the visual function may add valuable information to that obtained by BCVA assessment, as it represents acuity in the central 1° of visual field (Das et al.…”

“…Metamorphopsia significantly correlates with a patient's vision-related quality of life, as was previously demonstrated by the 25-item National Eye Institute Visual Function Questionnaire and a simple 10-question metamorphopsia questionnaire (Fukuda et al 2009;Arimura et al 2011). Distortion and blurring, especially under low contrast conditions, may not be fully reflected with VA testing (Rahman & Stephenson 2014). Other aspects of the visual function may add valuable information to that obtained by BCVA assessment, as it represents acuity in the central 1°of visual field (Das et al 2009).…”

“…The macula, measuring 5-6 mm in diameter, contains the eye's highest density of cone photoreceptors, making it highly adapted for visual acuity (Provis et al 2005). Macular oedema occurs in up to 10% of diabetic patients and represents leakage from microaneurysms and retinal capillaries due to extensive breakdown of the blood-retinal barrier (Rahman & Stephenson 2014). This oedema leads to the accumulation of fluid and debris in the macula and damages the normal retinal architecture, which may result in a profound loss of visual function (Brown et al 2006).…”

Changes in Visual Acuity after Idiopathic Epiretinal Membrane Removal: Good versus Poor Preoperative Visual Acuity

“…Previous studies reported good surgical outcomes and many prognostic factors, such as preoperative visual acuity, retinal thickness, photoreceptor layer status, and the status of other specific layers of the retina, for the outcome following ERM surgery [13,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32]. Among these, preoperative vision is a well-known prognostic factor that influences postoperative vision.…”

Reply to: ‘Four quadrant sclerotomies for uveal effusion syndrome’

“…2 Wang et al suggested in their case report that even in cases of UES with localised subretinal fluid, a surgical intervention with sclerotomies performed in all four quadrants may be necessary to successfully manage the patient.…”