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Noor Haffar, Pauline T. Merrill, Michael Davis, James Maletich; Techniques and Outcomes in Surgical Management of Epiretinal Membranes. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4501.
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To review intraoperative variables of epiretinal membrane surgery and determine which, if any, have an impact on the visual acuity or optical coherence tomography outcomes in these patients.
A retrospective chart review was conducted of patients who underwent pars plana vitrectomy with ERM peeling from January 2007 to December 2008 in a multi-office retina practice. Patients with a pre-operative and post-operative OCT at 6 to 12 months were included. Patients with less than 6 months of follow-up or any other ocular condition that would limit VA were excluded. Data collected included: age, sex, and VA and OCT measurements preoperatively and at 3, 6, and/or 12 months. Intraoperative variables examined were the use of indocyanine green (ICG) dye, internal limiting membrane (ILM) peeling, and the use of intravitreal triamcinolone (IVTA).
54 eyes were included with a mean age of 68.1 years with 61.1% males. Mean follow up was 11.6 months. The mean preoperative VA was 20/83. The mean postoperative VA was 20/79, 20/68, and 20/54 at 3, 6, and 12 months, respectively. The mean preoperative central macular thickness (CMT) on OCT was 447 microns. The mean postoperative CMT on OCT at was 313, 319, and 306 microns at 3, 6, and 12 months, respectively. 72.2% of eyes had ICG used, 64.8% ILM peeling, and 38.9% IVTA; 11.1% had none of these used. No statistically significant difference was observed between the four groups with regard to CMT change at 3, 6, or 12 months. Eyes treated with IVTA showed almost a 3 line greater VA improvement at 3 months than eyes not receiving IVTA (p < 0.01). At 12 months, eyes with ILM peeling had a 2 line greater VA improvement than eyes that did not undergo ILM peeling (p < 0.01). There was no significant difference in VA change at any time point in eyes that had ICG used and those that did not.
ILM peeling and/or IVTA were shown to be beneficial in improving VA after ERM surgery. This benefit was statistically significant for the IVTA group at 3 months and for the ILM group at 12 months. This suggests that IVTA may be beneficial in improving VA early in the postoperative course; whereas, ILM peeling may have a more long-lasting benefit. There was no statistically significant difference between the groups on OCT. Future research should evaluate these results prospectively.
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