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Calvin S. Fong, Paul Mitchell, Elena Rochtchina, Thomas Hong, Tania de Loryn, Jie J. Wang, Australian Prospective Cataract Surgery and Age-Related Macular Degeneration Study; Prevalence And Incidence Of Epiretinal Membranes In Post-Cataract Surgical Eyes. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5916.
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The clinical impression of a high frequency of epiretinal membranes (ERM) in eyes after cataract surgery may result from the presence of cataract making the detection of ERM difficult. We aimed to assess 1) the prevalence of ERM, and 2) incidence and progression of ERM in eyes after cataract surgery in a large cataract surgical cohort.
Between 2004-2007, 1685 cataract surgical patients aged ≥64 years were recruited at Westmead Hospital into the Australian Prospective Cataract Surgery and Age-Related Macular Degeneration Study (CSAMD). Mydriatic retinal photographs were used to assess ERM (either cellophane macular reflex, CMR, or preretinal macular fibrosis, PMF) at pre-operative or one-month post-operative visits (baseline) and then annual follow-up visits for up to three years post-operation. Inter-visit agreement on ERM detection was calculated using Cohen’s (or simple) kappa coefficient. Incidence of ERM was determined if either CMR or PMF was newly found in any of the annual follow-up visits in operated eyes that had no signs of ERM at baseline. Three-year incidence of ERM was estimated using Kaplan-Meier method.
Of 1448 patients with one-month post-operative photographs gradable, the prevalence of CMR and PMF was 9.3% (n=135) and 6.5% (n=94) respectively at baseline. Of 1109 patients who had both pre-operative and one-month post-operative retinal photographs, ERM was found in 8.8% of the study eyes (to be operated on) pre-operatively but 14.6% of the same eyes one-month post-operatively (p<0.0001, kappa coefficient 0.22). Of the 1219 eyes at risk of ERM at baseline, three-year cumulative incidence of ERM was 12.9% (CMR: 7.4%; PMF: 5.7%). Progression from CMR to PMF occurred in 16.3% of 135 eyes with CMR at baseline that had been followed-up for up to three post-operative years.
Our findings indicate that significantly more ERM cases were detected immediately after cataract removal from the same eyes, compared to the detection pre-operatively. In addition, incidence of ERM was also higher in post-cataract surgical eyes compared to that reported from the Blue Mountains Eye Study population, in which ERM was assessed by the same photographic grader as the CSAMD.
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