Epiretinal Membranes in Uveitic Macular Edema: Effect on Vision and Response to Therapy

Abstract

Purpose To evaluate the effects of epiretinal membranes on the response of uveitic macular edema to therapy and on visual acuity outcomes. Design Retrospective case series. Methods 104 eyes of 77 patients with uveitic macular edema were identified at a tertiary care center. Epiretinal membranes were diagnosed when identified by two investigators’ grading of spectral-domain optical coherence tomography and scored for the presence or absence of surface wrinkling. Outcomes included best corrected visual acuity, central subfield thickness, and rates of macular edema improvement (>20% reduction in central subfield thickness) and resolution (reduction of central subfield thickness to <315 μm) at 3 and 6 months follow-up. Results 72 eyes of 59 patients had an epiretinal membrane on presentation. Eyes without epiretinal membranes and with epiretinal membranes without surface wrinkling were not significantly different at presentation or at 3 and 6 months follow-up. Conversely, eyes with an epiretinal membrane with retinal surface wrinkling had a greater proportion of eyes with 20/200 or worse visual acuity at presentation, and had worse mean acuities at 3 months (20/94 vs. 20/35 for eyes without an epiretinal membrane, P=0.002) and at 6 months follow-up (20/110 vs. 20/36 for eyes without an epiretinal membrane, P=0.02). At 6 months of follow-up the mean central subfield thicknesses were: eyes without an epiretinal membrane, 338 ± 23 μm; and eyes with an epiretinal membrane and surface wrinkling, 405 ± 22 μm (P=0.05). Conclusions In eyes with epiretinal membranes and retinal surface wrinkling, uveitic macular edema had a poorer visual acuity response to medical therapy and thicker maculae at 6 months.

Spectral-domain optical coherence tomography findings of the macula in 500 consecutive patients with uveitis

“…13 In the present study, we found ERM formation to be comparably significantly associated with BSCVA, regardless of the presence of retinal wrinkling (Po0.001 for ERM+ and ERM − ). It is conceivable, that in the previous study 13 the association of lower BSCV to presence of wrinkling might actually represent an association to CRT, similar to our study. In addition, both types of ERM formation were significantly associated with higher age at onset, insidious onset of uveitis, persistent duration of an attack, and a chronic course of uveitis.…”

“…13 Furthermore, the presence of ERM formation in uveitic ME was reported to be associated with a poorer visual acuity improvement following treatment if retinal wrinkling was present (ERM+). 13 In the present study, we found ERM formation to be comparably significantly associated with BSCVA, regardless of the presence of retinal wrinkling (Po0.001 for ERM+ and ERM − ). It is conceivable, that in the previous study 13 the association of lower BSCV to presence of wrinkling might actually represent an association to CRT, similar to our study.…”

“…26 ERM consists of an additional secondary layer on the inner surface of the retina that can lead to tractional wrinkling of the retinal surface (ERM+) or can be present without retinal surface wrinkling (ERM − ). 13 Exemplar images of the SD-OCT findings are shown in Supplementary Figure 3.…”

“…Besides detection of various macular pathologies, measurement of general anatomical indices such as central retinal thickness (CRT) and macular volume (MV) has been correlated in previous studies with visual acuity and response to therapy. 2,3 While previous studies using SD-OCT focused on uveitis patients with manifest secondary changes of the retina, primarily CME, [2][3][4][5][6][7][8][9][10][11][12][13][14] we were interested to analyze the macular morphology in a large series of consecutive patients with different types of uveitis, using SD-OCT. We assessed the CRT, MV, and presence of cystoid macular edema (CME), diffuse macular edema (DME), serous retinal detachment (SRD), ERM with (ERM+) and ERM without (ERM − ) retinal surface wrinkling.…”

Uveitis

“…For example, macular scarring and macular edema are much more common in intermediate uveitis, posterior uveitis, and panuveitis. 48 Other poor prognostic features include development of glaucoma, 22 presence of macular edema, 49 epiretinal membrane, 50 and failure to initiate immunosuppressive therapy. 51 One of the most important and underappreciated risk factors for visual loss is delay in presentation to a uveitis subspecialist.…”