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J. E. Kim, S. N. Shah, D. J. Browning, R. A. Mittra, S. Dev; Prognostic Factors in Management of Idiopathic Epiretinal Membrane. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3279.
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© ARVO (1962-2015); The Authors (2016-present)
To assess prognostic factors in patients undergoing surgery for epiretinal membrane (ERM) removal.
Records of 169 eyes of 169 patients that have undergone macular ERM peeling using standard three-port pars plana vitrectomy for idiopathic ERMs were reviewed. Patients with at least 6 week follow up were included. Preoperative and postoperative evaluation included visual acuity (VA), clinical examination, and optical coherence tomography (OCT), if performed. A linear regression analysis of the change in VA and change in retinal thickness was performed to identify significant preoperative prognostic factors. Stratification of visual outcome by preoperative VA was also performed.
The overall mean preoperative logMAR VA was 0.56±0.29 (20/70 Snellen). The overall mean final postoperative logMAR VA significantly improved to 0.42±0.33 (20/50-1 Snellen, p<0.0001) at a mean follow up of 9.1±8.4 months. Preoperative CMT was 408±100 µM while postoperative CMT was 311±71 µM (p<0.0001). Foveal thickness also significantly reduced from 407±107 µM to 303±85 µM postoperatively (p<0.0001). Preoperative VA was the only factor that significantly predicted change in VA based on a stepwise linear regression model (R=0.16, p<0.0001). Only 25 of 86 eyes (29%) with better preoperative VA (≥20/60) gained ≥ 2 lines of vision at final follow up. In comparison, 41 of 59 eyes (70%) with poor initial VA (≤20/80) gained ≥ 2 lines of vision at final follow up. Overall, preoperative CMT and center foveal thickness were the strongest predictors of change in retinal thickness after ERM removal (R=0.64, p<0.0001). Patients with increased preoperative retinal thickness were more likely to experience a decrease in retinal thickness at final OCT evaluation. Preoperative CMT or foveal thickness, presence or absence of CME on OCT, type of ERM adherence, and preoperative lens status were not identified as significant prognostic indicators in this study.
Preoperative VA was the only significant predictor of final visual outcome in patients undergoing ERM removal identified in this study. Although patients with better preoperative VA were more likely to have better postoperative VA, patients with poor initial VA were more likely to have improved VA after surgery. Preoperative retinal thickness was moderately correlated to postoperative retinal thickness.
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