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R. Wee, D. P. Han, G. K. Shah; Visual and Anatomical Outcomes Following Vitrectomy for Secondary Epiretinal Membranes Following Therapy for Wet Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6053.
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to evaluate the effect of epiretinal and internal limiting membrane peeling for epiretinal membranes in quiescent exudative macular degeneration following therapy.
The charts of five patients with exudative macular degeneration who underwent surgery for epiretinal membrane were reviewed for pre-op and post-op visions, past AMD treatments, pre-op and post-op OCT central macular thickness and foveal contour, and post-op events. Comparisons were made between pre-op versus post-op visions and OCT findings.
Pre-op and post-op OCT comparisons revealed improvement in foveal contour with surgery. In addition, there was a trend towards improvement in the central 1 mm zone thickness from 316 + 78 microns pre-op to 283 + 117 microns post-op although there was not a statistically significant difference (p=0.625). The pre-op visions were: mean = 0.84 logMAR (Snellen equivalent 20/140), range = 20/50 - 20/200. The post-op visions were: mean = 0.95 logMAR (Snellen equivalent 20/180), range = 20/60 - 20/400. Three of the five patients had initial improvement in vision, but one of those subsequently declined after a rebleed from a choroidal neovascular membrane. The average follow-up time was 6 months.
Anatomical improvement was achieved after epiretinal membrane peeling in patients optimized with anti-VEGF therapy, suggesting that there is a subset of AMD patients who cannot improve with anti-VEGF therapy alone due to tractional changes induced by the epiretinal membrane causing persistent fluid. These patients may require surgery for the tractional component associated with the disease. Vitrectomy may be beneficial in these patients, but the visual outcome may be limited by persistent degeneration secondary to exudative macular degeneration.
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