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Kieu-Yen Luu, Tynisha Koenigsaecker, Lekha Mukkamala, Amirfarbod Yazdanyar, Lawrence S Morse, Ala Moshiri, Susanna S Park, Glenn Yiu; Long-term outcomes of epiretinal membranes with good visual acuity. Invest. Ophthalmol. Vis. Sci. 2018;59(9):3149.
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© ARVO (1962-2015); The Authors (2016-present)
While most patients diagnosed with idiopathic epiretinal membranes (iERM) and visual acuity of 20/40 or better will never progress to a point of needing surgery, some patients will have the membrane progress to the point of visual significance and is subsequently peeled with a pars plana vitrectomy (PPV). A retrospective cohort study was performed to evaluate the long-term visual and anatomic changes, including rates of progression to surgery, in eyes with iERM and visual acuity of 20/40 or better.
We identified 146 eyes of 121 patients (mean age 70.8 ± 8.2) from patients seen at the UC Davis Eye Center from 2007 to 2017 who had a diagnosis of idiopathic epiretinal membrane and visual acuity of 20/40 or better, with at least 1 year of follow-up. Eyes with other retinal conditions such as retinal detachments, diabetic retinopathy, or uveitis were excluded from the analysis. Clinical and anatomic factors including age, sex, history of diabetes, logMAR visual acuity, presence of visual symptoms or metamorphopsia, central macular thickness (CMT), presence of vitreomacular traction or vitreomacular adhesion, and presence of pseudohole or lamellar hole were recorded at baseline, and at yearly intervals, including dates of surgical intervention when applicable. Multivariate regression analyses using generalized estimating equations were used to determine the factors associated with visual decline and progression to surgery.
At time of diagnosis, the mean logMAR visual acuity was 0.172 ± 0.103 (Snellen 20/30), and mean CMT was 354.4 ± 78.6. Mean follow-up was 3.17 ± 1.802 years (range 1 to 7). Visual acuity declined to mean logMAR 0.214 ± 0.155 at 2 years (Snellen 20/32) and 0.216 ± 0.157 at 3 years (Snellen 20/32). The rates of progression to surgery was 3% at year 1, 8% at year 2, 17% at year 3, and 21% at year 4 and beyond. The mean visual acuity at time of surgery was 0.375 ± 0.165 (Snellen 20/47). The presence of symptoms is associated with worse visual acuity at baseline (P = 0.018).
Patients with idiopathic ERM and visual acuity of 20/40 or better have stable vision, with 21% of eyes requiring surgery at 4 years. The presence of visual symptoms at baseline predicts the speed for visual decline, but not progression to surgical intervention.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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