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Mads Kofod; Randomized Clinically Controlled Trial on Early Versus Defered Surgery for Epiretinal Membranes. Visual Acuity and Microperimetri Outcomes. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2311.
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To investigate if early surgery for epiretinal membranes gave superior long term visual acuity outcomes compared to standard treatment, where visual acuity deterioration is observed until visual acuity drops below a set limit allowing for surgery.
Randomized clinical trial on surgery in eyes with epiretinal membranes, visual acuity above 0.5 decimal and metamorphopsia causing binocular daily complaints. Patients were randomized 1:2, one intervention to two controls. Patients in the control group could cross over to the intervention if visual acuity declined significantly or if daily binocular complaints worsened severely. Primary outcome was visual acuity change 12 months after inclusion to the study for the control group, or 12 months after vitrectomy. Phacoemulsification was performed 8 weeks prior to vitrectomy in phakic patients. The study population was divided in three groups. Group 1: intervention with early surgery Group 2: Control group who required surgery due to worsening Group 3: Control group who did not require surgery
54 patients participated in the trial. 20 patients were randomized for early intervention, The control group containing 35 patients was significantly more stable than anticipated and only 7 patients experienced worsening of either visual acuity or daily binocular complaints to allow cross over within the study parameters. The patients did not differ significantly in their baseline data. Visual acuity: Group 1 gained an average of 4.6 ETDRS (CI95:1.8 to 7.4) letters following surgery Group 2 gained an average of 8.3 ETDRS (CI95: -.5 to 17.1) letters following surgery Group 3 gained an average of 1.6 ETRDS (CI95: -1.0 to 3.2) letters during the 12 months observation. There was no statistically significant difference in visual acuity gains. There was no statistical significant difference between visual acuity at the 12 months evaluation between the groups.
This results presented in this poster were unable to identify if early surgery is preferential to deferred surgery where patients have more significant daily complaints before surgery is performed. This study is limited by a ceiling effect of visual acuity as patientes are just below 1.0 decimal visual acuity. This study finds that surgery for epiretinal membranes can be performed at high visual acuity and still gains visual acuity.
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