Abstract
Purpose :
To explore preoperative features of multimodal retinal imaging that may correlate with postoperative visual outcomes following pars plana vitrectomy with epiretinal membrane peeling (PPV/MP) in pediatric patients with combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) associated with epiretinal membrane (ERM) and decreased visual acuity.
Methods :
A retrospective chart review was performed of pre- and post-operative visual acuity, fundus photographs, fluorescein angiograms, and spectral-domain optical coherence tomography (OCT) images among children with CHRRPE (diagnosed by a pediatric retinal surgeon at the Duke Eye Center between 2010 and 2020) with associated ERM who underwent a single PPV/MP, with at least 3 months of postoperative follow-up.
Results :
Among 8 included patients, mean age at time of surgery was 7.69 years (range, 3 months to 13 years). 5 children were male. 5 lesions were peripapillary with or without macular involvement, 2 were localized to the macula, and one was peripheral with associated macular dragging. After a mean 26.38 months of postoperative follow-up, 3 patients had improved vision, 3 lost up to 2 lines of vision, 1 had stable fix and follow vision, and 1 had no wince to light (and questionable wince to light preoperatively). Among 6 patients with Heidelberg Spectralis OCT scans, mean preoperative central foveal thickness (CFT) was 725 ± 279 µm, with a mean decrease in CFT of 161 ± 151 µm at last follow-up. For 2 patients, OCT scans were available but not retinal thickness measurements. Patients with the greatest improvement in vision postoperatively had preoperative CFT < 700 µm, absence of fovea-involving leakage on fluorescein angiography, and intact outer retinal layers on OCT. Patients with decreased or minimally improved vision postoperatively had fovea-involving leakage on fluorescein angiography and irregular or disrupted subfoveal outer retinal layers.
Conclusions :
A combination of fluorescein angiography and OCT structural features may identify children who will have the greatest visual acuity gains after PPV/MP for CHRRPE associated with ERM.
This is a 2021 ARVO Annual Meeting abstract.