Epiretinal Membrane Surgery Outcomes in Eyes with Subretinal Drusenoid Deposits

Wilde, Craig; Awad, Mohannad A.; Dua, Harminder S; Gandhewar, Ravi; Chen, Hean-Choon; Amoaku, Winfried

doi:10.1016/j.oret.2018.06.009

Cited by 6 publications

(5 citation statements)

References 45 publications

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“…12 Wilde et al demonstrated less favorable visual outcomes of ERM surgery in eyes with subretinal drusenoid deposits. 13 In another study by Lee et al, significant anatomical and visual improvement after PPV for ERM could be demonstrated, but final visual outcome of eyes with simultaneous non-exudative AMD (BCVA improvement of 0.19 logMAR over 1 year period) was worse than that of eyes with idiopathic ERM without degenerative macular changes (0.28 logMAR BCVA improvement). 14 In our study, the mean BCVA improvement after PPV with macular membrane peel was 0.14 logMAR after a mean follow-up of 9 months.…”

Section: Discussionmentioning

confidence: 95%

<p>To Peel or Not to Peel: Pars Plana Vitrectomy with Macular Membrane Peel in Eyes with Abnormalities of Vitreomacular Interface and Coexisting Dry Age-Related Macular Degeneration</p>

Furashova¹,

Engelmann²

2020

OPTH

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Purpose: To evaluate the outcome of macular surgery with ILM-and epiretinal membrane peel associated with significant dry age-related macular degeneration (AMD) as defined by the Age-Related Eye Disease Study (AREDS). Patients and Methods: Institutional. Retrospective case-control study. A total of 42 pseudophacic eyes of 39 patients (7 with full thickness macular hole and 35 with epiretinal membrane) with coexisting dry AMD underwent pars plana vitrectomy (PPV) with internal limiting membrane (ILM) and epiretinal membrane peel. Preoperative and postoperative data including best corrected visual acuity (BCVA), AMD grade according to AREDS, central retinal thickness (CRT), development of choroidal neovascularization (CNV), and central retinal atrophy have been evaluated. Twenty-eight fellow eyes with dry AMD of the included 39 patients served as a control group. Results: A significant improvement in the visual acuity could be observed after surgery (initial BCVA 0.47±0.31 logarithm of the minimal angle of resolution (logMAR) vs 0.33 ±0.29logMAR 9 months postoperatively; p=0.006). CRT decreased significantly after surgery (p<0.001). In the surgery group, there were 4 eyes (9.5%) with CNV and 1 eye (2.5%) with new central retinal atrophy development after surgery. All these eyes had preoperative AREDS 3 (4 eyes) or AREDS 4 (1 eye) AMD category. In the control group, there was 1 eye (4%) with CNV and 4 eyes (14%) with new central retinal atrophy development during the follow-up of 9 months. These eyes had initially AREDS 2 (1 eye), AREDS 3 (3 eyes) or AREDS 4 (1 eye) AMD category. Conclusion: Eyes with dry AMD of AREDS 3 and AREDS 4 with coexisting VMI abnormalities improve significantly after PPV with membrane peel. While there is a higher risk of CNV development after surgery (9.5%) in these eyes, the vitrectomy does not seem to accelerate central retinal atrophy progression compared to the fellow eyes course.

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Section: Discussionmentioning

confidence: 95%

<p>To Peel or Not to Peel: Pars Plana Vitrectomy with Macular Membrane Peel in Eyes with Abnormalities of Vitreomacular Interface and Coexisting Dry Age-Related Macular Degeneration</p>

Furashova¹,

Engelmann²

2020

OPTH

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“…It is known that SRDD are a risk factor for the development of both MA and CNVM formation in AMD patients [12]. They are associated with outer retinal atrophy [13], visual dissatisfaction [11] and more recently poor visual outcome in eyes undergoing epiretinal membrane surgery [14]. Disruption of ISel is a known feature of SRDD.…”

Section: Discussionmentioning

confidence: 99%

Natural course of adult-onset vitelliform lesions in eyes with and without comorbid subretinal drusenoid deposits

et al. 2020

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Purpose Adult vitelliform lesions (AVL) are associated with age related macular degeneration (AMD) and subretinal drusenoid deposits (SRDD). We evaluated the natural course of AVL, assessing the influence of SRDD on disease progression, visual function and incidence of macular atrophy (MA) and choroidal neovascular membranes (CNVM). Methods A retrospective cohort study was conducted between January 2011 and March 2016. Demographic, clinical and imaging data from 26 consecutive AVL patients were analysed following case note review. Optical coherence tomography images were graded for SRDD and patients divided into those with/without SRDD. Outcomes included presenting/changes in best corrected visual acuity (BCVA) and incidence of MA/CNVM. Results Mean age was 78.6 ± 7.6 years. Mean follow-up was 51.5 ± 25.6 months. Twelve patients (46.2%) had SRDD at presentation with 3 more (11.5%) developing them. Subjects with SRDD were older (mean 81.7 ± 6.1 years vs 74.3 ± 7.6 years, p = 0.010). Mean presenting BCVA was worse in SRDD eyes (0.39 ± 0.31 logMAR vs 0.19 ± 0.18 logMAR, p = 0.017). Eight of 15 patients with SRDD (53.3%) developed incident MA or CNVM; higher than those with no SRDD (1/11, 9.1%; p = 0.036). Two patients (7.7%) developed full thickness macular holes.Conclusions Patients with AVL and SRDD likely represent an advanced pathological stage or phenotype with worse visual outcome and higher risk of MA/ CNVM. Possible overlap with AMD exists. Follow-up, counselling and provisions for early detection/treatment of complications should be made. Better classification including improved understanding of phenotypic and genetic variations with reference to comorbid diseases including AMD is required. Presence of SRDD in AVL offers a dichotomous classification, indicating risk of future MA/CNVM formation.

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“…A recent case-control study demonstrates surgery in eyes with SRDDs is associated with less favorable visual outcomes. Fewer patients demonstrate gain in BCVA, whereas a significant number show a deleterious decline [5].…”

Section: Introductionmentioning

confidence: 95%

Pitfalls and Complications of Epiretinal Membrane Peeling in Eyes with Comorbid Subretinal Drusenoid Deposits: A Report of Five Cases

Ross¹,

Wilde²,

Chen³

et al. 2020

SCR

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Background: Idiopathic epiretinal membranes (ERM) are common with potential for severe visual loss. Surgical outcomes are excellent but predominantly reported from healthy eye studies rather than those with co-morbidities. We report a series of patients with subretinal drusenoid deposits (SRDD) and comorbid ERM with post-operative complications or poor outcomes, describing potential pitfalls to avoid. Case Presentation: This is a case series illustrating the poor functional and morphological outcomes following ERM surgery in five eyes with SRDD. These eyes appear at risk of geographic atrophy (GA), choroidal neovascular membrane (CNVM) formation (pre-and post-operatively) and outer retinal atrophy (ORA), all of which can limit outcomes. Conclusion: ERM surgery in eyes with SRDD presents specific challenges. Assessment of outer retinal changes can be challenging pre-operatively, particularly with significant oedema. Identification of patients with SRDD in ERM eyes often relies on examination of the contralateral eye. Appropriate listing is paramount, with care taken to rule out pre-existing GA or CNVM through use of fundus fluorescein angiography. Patients should be given a guarded prognosis during the consenting process if the outer retina is poorly visualized.

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Epiretinal Membrane Surgery Outcomes in Eyes with Subretinal Drusenoid Deposits

Cited by 6 publications

References 45 publications

<p>To Peel or Not to Peel: Pars Plana Vitrectomy with Macular Membrane Peel in Eyes with Abnormalities of Vitreomacular Interface and Coexisting Dry Age-Related Macular Degeneration</p>

<p>To Peel or Not to Peel: Pars Plana Vitrectomy with Macular Membrane Peel in Eyes with Abnormalities of Vitreomacular Interface and Coexisting Dry Age-Related Macular Degeneration</p>

Natural course of adult-onset vitelliform lesions in eyes with and without comorbid subretinal drusenoid deposits

Pitfalls and Complications of Epiretinal Membrane Peeling in Eyes with Comorbid Subretinal Drusenoid Deposits: A Report of Five Cases

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