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AM Lavina, KA Tawansy, A Agarwal, IU Scott, JD M Gass; Macular Pucker Surgery: Does Pre-existing macular edema make a difference? . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3522.
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Purpose: Whether the presence of cystoid macular edema before macular pucker surgery affects visual prognosis has been the topic of some debate. The purpose of the work is to explore whether visual prognosis varies between 2 groups following macular pucker surgery: 1) Epiretinal membranes (ERM's) that develop after anterior segment surgery and associated cystoid macular edema (CME) 2) Epiretinal membranes that develop idiopathically or due to a retinal break. Methods: A retrospective chart review at Vanderbilt University of all patients who underwent pars plana vitrectomy and membrane peeling for macular pucker was performed. Pre and post-operative visual acuity were recorded and converted to LogMAR. The results of the above 2 groups were analyzed using ANOVA. The patient's age, lens status, presence of a posterior vitreous separation, etiology of the ERM, presence of CME and whether CME resolved following surgery was also recorded. Results: In group 1, there were 6 patients, 4 men and 4 women. The mean age was 74.6 years. All had CME following anterior segment surgery Mean follow-up was 6 months. Mean pre-op vision was 20/80. Mean post-op vision was 20/60. Improvement in visual acuity did not reach statistical significance (pval 0.45). CME resolved in 3/6, and persisted in 3/6.There were 9 patients in group 2, 5 men and 4 women. Mean follow-up was 14 months. Mean age was 69.7 years. Mean pre-operative visual acuity was 20/90. Mean post-op visual acuity was 20/40. There was a statistically significant improvement in vision (pval 0.012). 4/9 had CME pre-operatively, and each had resolution of CME. Conclusion: Patients with pre-existing cystoid macular edema following anterior segment surgery who then develop an ERM may benefit less from pars plana vitrectomy and membrane peeling than those who have an idiopathic ERM. Our data also suggests that patients who have CME secondary to the ERM improve with surgery, and their macular edema tends to resolve with surgery. We postulate that retinal capillary damage may be one reason why the CME group does not improve as much. We have reviewed the charts of similar patients at the Bascom Palmer Eye Institute to increase our number of patients, and that data is being reviewed at the time of the writing of this abstract.
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