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Kevin Wells, Lucas Lindsell, Gayatri Reilly; The Evolution of Pre-Existing Epiretinal Membranes Following Cataract Extraction. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4082.
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There is currently little guidance available regarding management of patients with a cataract and pre-existing epiretinal membrane (ERM). We performed a retrospective chart review examining clinical and optical coherence tomography (OCT) data to assess the evolution of a pre-existing ERM following cataract extraction with intraocular lens (CE/IOL) as well as identify characteristics that may predict the need for a future pars plana vitrectomy and membrane peel (PPV/MP).
A retrospective chart review was conducted from records at The Retina Group of Washington between January 1, 2010 and December 31, 2013. The ICD-9 code (362.56) for ERM was used to identify charts for review. Patients were required to have an ERM prior to CE/IOL and have follow-up of at least 6 months. 4,112 charts were reviewed and 190 eyes met inclusion criteria. Clinical data was collected for all patients and OCT data was collected when available (70 eyes).
PPV/MP was performed on 55 eyes; 19/55 had available OCT data. Of the patients who did not undergo PPV/MP, 51/135 had available OCT data. Mean time from CE/IOL to PPV/MP was 5.6 months. Pre- and post-CE/IOL visual acuity (VA) was found to be worse in patients who underwent PPV/MP compared to those who did not (median pre-CE/IOL VA: PPV/MP=20/50, no PPV/MP=20/30, p=0.015; median post-CE/IOL VA: PPV/MP=20/50, no PPV/MP=20/30, p<0.001). Mean pre-CE/IOL central foveal thickness (CFT) and mean change from pre- to post-CE/IOL were both increased in the group who underwent PPV/MP against the group who did not (pre-CE/IOL CFT: PPV/MP=453um, no PPV/MP=342um, p<0.001; change in CFT: PPV/MP=+40.2um, no PPV/MP=+18.5um, p<0.001). Loss of foveal contour on OCT at the pre-CE/IOL visit demonstrated an increased odds ratio for needing a PPV/MP (OR=7.01, p=0.01). Twenty percent of eyes with OCT data did not have CME pre-CE/IOL but developed CME following CE/IOL; this was found to be a predictor of requiring a PPV/MP (p=0.012). Final VA was similar in both groups (median VA: PPV/MP=20/30, no PPV/MP=20/30, p=0.168).
ERMs are a common finding in patients planning to undergo CE/IOL. Patients with poor VA pre- and post-CE/IOL, increased CFT, loss of foveal contour, or the development of CME post-CE/IOL demonstrated the greatest likelihood of needing a PPV/MP. It is important to counsel patients on the possibility of needing a PPV/MP to achieve their full visual potential.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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