This article is more than 5 years old. Information may no longer be current.
Small-gauge vitrectomy for epiretinal membrane beneficial in patients with good preop visual acuity
Best postoperative vision in initially phakic patients was achieved after cataract removal.
Click Here to Manage Email Alerts
Final visual acuity significantly improved after small-gauge vitrectomy in patients with epiretinal membrane and good preoperative visual acuity, according to a study.
Compared with traditional 20-gauge vitrectomy, 25-gauge vitrectomy may be similarly efficacious and have additional benefits, according to a study published in Retina.
“Small-gauge vitrectomy allows for a shorter surgical time, less postoperative inflammation and early postoperative recovery,” lead author Gayatri Reilly, MD, told Ocular Surgery News.
The retrospective chart review evaluated the visual outcomes of 132 eyes that underwent 25-gauge vitrectomy and eight eyes that underwent 23-gauge vitrectomy for symptomatic epiretinal membrane. All patients had 20/50 or better preoperative visual acuity.
Visual outcomes
Overall, mean visual acuity significantly improved from 20/40 preoperatively to 20/35 at the 1-year follow-up. Of 77 pseudophakic eyes, mean visual acuity improved from 20/40 preoperatively to 20/32 at 1 year, whereas 63 phakic eyes only improved from a mean visual acuity of 20/41 preoperatively to 20/40 at the final follow-up.
“There are not that many truly objective measures when it comes to post-surgical outcomes, and visual acuity is one of them,” Reilly said. “Even though these patients were starting off with relatively good vision, 20/50 or better, we still were able to find a statistically significant improvement post-surgery. I would suspect that there were even larger subjective gains in terms of quality of vision and life, but those are much more difficult to quantify.”
Of the phakic eyes, 56 developed a visually significant cataract by the 1-year follow-up.
“Our study suggested that it did not make a difference whether vitrectomy was performed in the setting of phakia or pseudophakia, but it was not until the cataract was removed did those initially phakic eyes obtain their best postoperative vision,” she said.
Follow-up
The mean time for the recommendation of cataract surgery to be performed was 8.4 months after pars plana vitrectomy. In a subgroup analysis, mean postoperative visual acuity in the phakic cohort improved to 20/31 at 1 year after the confounding effect from lens opacity was eliminated.
“When the effect of lens status is not eliminated from the analysis, phakic patients do not achieve significant improvement in final visual acuity at 1 year, suggesting that these eyes should either have combined vitrectomy with lens removal at the time of initial surgery or two separate procedures for maximal benefit,” the study authors said.
Overall, 38 eyes had preoperative cystoid macular edema and 59 eyes underwent internal limiting membrane peeling, but neither significantly affected final visual outcomes.
“Our study did not have enough power to conclude the role of internal limiting membrane peeling with epiretinal membrane recurrence, but four out of the six recurrent epiretinal membranes did not have the internal limiting membrane peeled,” Reilly said. “This was in line with numerous other studies that have found a decreased recurrence rate with internal limiting membrane peeling. Furthermore, internal limiting membrane removal ensures the scaffold for the proliferating cells has been removed.”
Reilly thinks that a study that is able to incorporate quality-of-life surveys would be better able to appreciate the impact of the procedure beyond visual acuity. – by Kristie L. Kahl
- Reference:
- Reilly GT, et al. Retina. 2015;doi:10.1097/IAE.0000000000000558.
- For more information:
- Gayatri Reilly, MD, can be reached at Retina Group of Washington, 7501 Greenway Center Drive, Suite 300, Greenbelt, MD 20770; email: greilly@rgw.com.
Disclosure: Reilly reports no relevant financial disclosures.