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Ivy Zhu, William F Mieler; Clinical and anatomic outcomes of concurrent phacovitrectomy surgery for epiretinal membrane (ERM), vitreomacular adhesion (VMA), and macular hole (MH). Invest. Ophthalmol. Vis. Sci. 2017;58(8):2828.
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© ARVO (1962-2015); The Authors (2016-present)
To report the clinical and anatomic outcomes of concurrent phacovitrectomy surgery for ERM, VMA, and MH at post-operative months 1, 3, and 6.
Twenty eyes were included in a retrospective analysis of concurrent phacovitrectomy surgery performed for either ERM, VMA, or MH by the same surgeons (Mieler, Tu). Cases of VMA secondary to proliferative diabetic retinopathy were excluded. The following data was collected: pre-operative indication for surgery and best-corrected visual acuity (BCVA); intraoperative and short-term complications; status of post-operative retinal anatomy and BCVA at months 1, 3, and 6. A two-sample paired t-test and chi-squared test were used to determine the statistical significance of any improvements in BCVA and retinal anatomy, respectively.
Average age was 66.6 +/- 9.3 years with 65.0% (13/20) females; 60.0% (12/20) of cases were performed for ERM, 25.0% for MH, and 15.0% for VMA. Pre-operative BCVA as measured by logMAR was 0.96 +/- 0.80. There were no intraoperative complications, though one patient required a second operation for MH reopening. Post-operative BCVA was 0.90 +/- 0.89, 0.55 +/- 0.52, and 0.69 +/- 0.66 for post-operative months 1, 3, and 6, respectively. At month 6, 3 patients (15%) had been lost to follow up. Of the remaining patients, the improvement in BCVA was 0.38 (p = 0.03), analogous to a two-line improvement in vision. Vision was limited by abnormalities in retinal anatomy (cystoid macular edema (CME), failure of hole closure, or macular pigment mottling) with a prevalence of 40.0%, 50.0%, and 52.9% at post-operative months 1, 3, and 6, respectively. Improvements in retinal anatomy between months 1 and 6 were not statistically significant (p = 0.43).
In our study of concurrent phacovitrectomy surgery used to treat ERM, VMA, and MH, the BCVA improved by an average of two lines of Snellen acuity, with 47% (8/17) 20/40 or better by post-operative month 6. There were no intraoperative or short-term complications, though one patient required a second operation for a reopened MH. Final visual function improved in the majority of cases, though was limited in a few cases by mild persistent CME, macular pigment mottling, or recurrent opening of the MH. Study limitations include the relatively small number of cases and lack of follow-up in a minority of patients.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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