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

Abstract

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.