Abstract
Purpose: :
To evaluate postoperative visual outcome of uveitis–related epiretinal membrane.
Methods: :
Retrospective, interventional, noncomparative case series of 19 patients (20 eyes) with epiretinal membrane (ERM) and uveitis, who underwent standard three port pars plana vitrectomy and membrane stripping, with a 22–month follow–up. Surgery was proposed when intraocular inflammation was controlled by specific treatment and corticosteroids (triamcinolone and/or prednisolone). Preoperative and postoperative functional results were assessed with best–corrected visual acuity (BCVA) on logMAR scale. Macular morphology was assessed with stereoscopic biomicroscopy, fluorescein angiography and optical coherence tomography.
Results: :
19 patients (9 men, 10 women) with uveitis, mean age 44.3 years, were evaluated. Uveitis was bilateral in 57.9% of cases, and unilateral in 42.10% of cases. Inflammation was posterior (21 eyes), intermediate (4 eyes) and total (5 eyes). ERM occurred in 66.6% of cases and was bilateral in 13.3% of cases. It was successfully removed in all cases. Two groups were identified:
–First group with poor visual outcome: 11 patients, mean age 41.8 years. Mean BCVA decreased from 0.79 logMAR preoperatively to 0.85 logMAR postoperatively (p<0.05). Preoperative cystoid macular edema (CME) was present in 83.3% of cases with mean duration of 22.7 months (p>0.05). It postoperatively persisted in 83.3% of cases. ERM was at the posterior pole in 50% of cases with vitreomacular traction in 83.3%. Macular traction was present in 50% of cases. Mean complications consisted in ERM recurrence, lamellar hole, retinal detachment, glaucoma, and chronic CME.
–Second group with good visual outcome: 8 patients, mean age 47.8 years. Mean BCVA improved from 0.65 logMAR to 0.18 logMAR postoperatively (p<0.05). Preoperative CME existed in 75% of cases, during 14 months (p>0.05) and persisted postoperatively in 37.5% of cases. In 75% of cases, ERM was at the posterior pole without vitreomacular traction. Uveitis was associated with sarcoidosis, immune recovery uveitis, toxoplasmosis and Behçet disease.
Conclusions: :
Unlike idiopathic type, uveitis–associated ERM occurs at earlier age and preoperative CME seems not to be a significant prognostic factor. Surgery appears to have a beneficial effect on restoring vision when preoperative BCVA is not significantly altered and when ERM is localized at the posterior pole without vitreomacular tractions.
Keywords: inflammation • vitreoretinal surgery • retina