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Fuad Makkouk, Ahmed Elkeeb; Relationship of Retinal Tear Location and Incidence of Epiretinal Membrane Formation. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3702. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Macular epiretinal membrane formation is a known complication of laser treated retinal breaks. Studies have found growth factors and Cytokines in the vitreous of epiretinal membrane patients. These growth factors may be released from a retinal tear, and settle on the macula, initiating epiretinal membrane formation. We performed a retrospective, observational clinical study to determine if patients with superior retinal tears were more likely to develop macular epiretinal membranes.
The records of patients with retinal tears treated with laser retinopexy at the University of Texas Medical Branch between 2009 and 2015 were reviewed for development of epiretinal membrane, as diagnosed on Ocular Coherence Tomography, within five years of diagnosis of the retinal tear. The Institutional Review Board at the University of Texas Medical Branch approved the conduct of this study. Patients were classified with an inferior tear if the tear was between 4 and 8 clock hours, and were classified with a superior tear if it occurred between the 9 and 3 clock hours. The main outcome was development of an epiretinal membrane within 5 years of diagnosis of a retinal tear. Statistical analysis used a Chi-squared test and logistic regression to evaluate for a statistically significant relationship with P<0.05 being significant.
151 patients were reviewed and 105 had superior retinal tears and 46 had inferior retinal tears. 21 patients developed an epiretinal membrane within the 5 year follow up period after being diagnosed with a retinal tear. A chi-squared test comparing the location of a retinal tear, superior or inferior, and the formation of an epiretinal membrane revealed a P value of 0.0246, meaning that there was a statistically significant relationship.
A statistically significant relationship exists between the superior location of a retinal tear, and the development of a macular epiretinal membrane within 5 years. The proposed mechanism supporting this is RPE cells and inflammatory mediators settle more readily on the macula when released from superior tears. This relationship has bearing on patient management after treatment for retinal tear. For example, patient’s with superior tears may be advised to adopt a head up position in an attempt to allow the inflammatory mediators to settle below the macula.
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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