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Brian Toussaint, Gayatri Reilly, Alex Melamud; Visual Outcomes in Patients with Macular Pucker and Good Pre-Operative Visual Acuity After Vitrectomy with Membrane Peeling. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2612.
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To evaluate whether patients with macular pucker (ERM) and good pre-operative visual acuity (20/50 or better) benefit from vitrectomy (PPV) with membrane peeling.
Retrospective chart review of eyes undergoing PPV for idiopathic ERM. Inclusion criteria was impaired visual acuity (20/50 or better) due to ERM. Exclusion criteria included any ERM that was non-idiopathic (eg. post surgical or post-inflammatory) and the presence of any other macular or corneal disease. Main outcome measures were final visual acuity after one year and any postoperative complications. Secondary outcome measures included visual acuity with and without intraoperative internal limiting membrane (ILM) peeling, length of time to recommendation of cataract surgery and recurrence of epiretinal membrane.
79 eyes met inclusion criteria of which 85% underwent 25-gauge vitrectomy (remainder had 23-gauge). There was a statistically significant improvement in visual acuity at one year with the average Log Mar preoperative vision being 0.299 (20/40) and average post operative vision 0.188 (20/31) (p=0.000027). 45 eyes (57%) were phakic preoperatively of which 39 (87%) underwent cataract surgery by final examination at one year. Average timeline to recommendation of cataract surgery was approximately 7 months. 39 (49%) eyes underwent peeling of the ILM. Final visual acuity at one year of those that had the ILM peeled was 0.198 (20/31); final vision of those that did not have ILM peeling was 0.187 (20/31) (p=.841). Four (5%) eyes had recurrent ERM.
Pars plana vitrecomy is a safe option for patients with epiretinal membranes and good preoperative vision. We found that patients experienced a statistically significant improvement in visual acuity at one year. On average phakic patients tend to experience progression of their cataract within 7 months. Internal limiting membrane peeling did not have a statistically significant effect on visual outcomes.
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