Small-gauge vitrectomy for epiretinal membrane beneficial in patients with good preop visual acuity

Issue: January 10, 2016

Eyes with epiretinal membrane and good preoperative visual acuity may have better final visual acuity outcomes after small-gauge pars plana vitrectomy, according to a study.
The retrospective chart review evaluated visual outcomes of 132 eyes that underwent 25-gauge vitrectomy and eight eyes that underwent 23-gauge vitrectomy, all with 20/50 or better preoperative visual acuity, because of symptomatic epiretinal membrane.

Overall, mean visual acuity significantly improved from 20/40 preoperatively to 20/35 at the 1-year follow-up. Of the 77 pseudophakic eyes, mean visual acuity improved from 20/40 preoperatively to 20/32 at 1 year, whereas the 63 phakic eyes only improved from a mean visual acuity of 20/41 preoperatively to 20/40 at the final follow-up.

Of the phakic eyes, 56 developed a visually significant cataract by the 1-year follow-up.

The mean time for the recommendation of cataract surgery to occur was 8.4 months after pars plana vitrectomy was performed. In a subgroup analysis, mean postoperative visual acuity in the phakic cohort improved to 20/31 at 1 year after the cofounding 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. – by Kristie L. Kahl

Disclosure: The authors report no relevant financial disclosures.

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Source:

Reilly GT, et al. Retina. 2015;doi:10.1097/IAE.0000000000000558.