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Rohan Shah, Maziar Lalezary, Stephen Kim, Rahul Reddy, Jeffrey Kammer, Rachel Kuchtey, Karen Joos, Franco Recchia, Edward Cherney, Janice Law; One-year results of the Prospective Retinal and Optic nerve Vitrectomy Evaluation (PROVE) Study: A controlled clinical trial. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5779.
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To report 1-year outcomes of the Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE) Study.
This 5-year prospective, controlled, observational study enrolled 80 eyes of 40 patients requiring vitrectomy for epiretinal membrane (ERM), macular hole (MH), or vitreous opacities (VO). All participants underwent baseline evaluation of the study (surgical) and fellow (control) eye that included intraocular pressure (IOP), cup-to-disc ratio (CDR), Humphrey visual field (HVF) testing, and optical coherence tomography (OCT) of the macula and peripapillary retinal nerve fiber layer (pRNFL). Evaluations were repeated at 3 months and 1 year after surgery.
Thirty-seven of 40 patients completed 1-year follow up. Visual acuity (VA) in all study eyes at 1 year was improved from baseline (p=0.003), but remained worse than fellow eyes (p=0.0001). CDR did not change, but unlike baseline or 3 months, the MH group (n=14) had statistically higher mean IOP at 1-year (16.0±3.62 mm Hg) than fellow eyes (14.8±3.40 mmHg, p=0.002). Mean deviation (MD) on HVF improved in ERM study eyes (n=20) at 1-year when compared with baseline (-2.2 vs. -4.0, p=0.02), but remained worse than fellow eyes (-1.2, p=0.002). PSD increased in study eyes when compared with fellow eyes at 1-year (2.85vs.2.05, p=0.009), especially in the MH group (3.41vs.1.90, p=0.01). Postoperatively, the temporal and average pRNFL thickness decreased significantly in study eyes (p<0.05), and study eyes had thinner inferior pRNFL thickness (114±16.8 µm) when compared to fellow eyes (123±14.7 µm, p=0.004). Temporal pRNFL thinning was particularly evident in the ERM group (p=0.005) over time. Central subfoveal thickness (CST) and macular cube volume improved in all study eyes at 1-year, but remained significantly greater compared to fellow eyes (p < 0.05). Greater CST significantly correlated with less VA improvement (r=0.99). No significant OCT changes were present in the VO group (n=5).
One year after vitrectomy, VA, CST, and MD improve in study eyes, but not to the level of fellow eyes. Reduction in CST from baseline correlated with degree of VA improvement. MH eyes demonstrated significantly increased IOP and PSD, and both ERM and MH eyes had decreased inferior pRNFL thickness. Continued follow-up of this cohort will provide further insight into long-term changes after vitrectomy surgery.
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