Abstract
Purpose :
Little data are available on the functional outcome of uveitis-induced secondary epiretinal membrane (sERM) removal by vitrectomy and membrane peeling. The benefit of surgery is controversial in the literature. This retrospective single center interventional clinical study evaluates the results in a larger cohort.
Methods :
Retrospective review of 95 consecutive eyes (95 patients) that underwent peeling for uveitic sERM. Surgery was performed between 11/2002 and 04/2023. Data collected included patient demographics, etiology of uveitis, activity status of uveitis, therapeutic regimen, surgical parameters, postoperative complications, spectral domain optical coherence tomography scans and visual outcome. Statistical analysis was performed using paired two-tailed t-test.
Results :
95 eyes of 95 patients (61.1% female, 53.7% right eyes, 50.5% pseudophakic eyes) were included with mean age 63.83±12.85 (range 22-88) years. According to Standardization of Uveitis Nomenclature (SUN) 15.8% had anterior, 49.5% intermediate, 29.5% posterior and 5.3% pan-uveitis. In the immediate preoperative period, 52.6% did not receive steroids, 32.6% received topical and 11.6% systemic steroids, 3.16% both topical and systemic steroids. 28 eyes had history of intravitreal steroids (triamcinolone n=7, dexamethasone n=21).
Postoperative mean follow-up time was 38.57±44.69 months. On average for the entire cohort, no improvement in visual acuity (BCVA) could be achieved (preoperative BCVA was 0.49±0.30 logMAR, postoperative BCVA 0.59±0.70 logMAR; p=0.16). According to SUN classification, only in pan-uveitis (n=5) a slight increase in visual acuity from 0.54±0.30 to 0.46±0.54 logMAR could be achieved. Concerning postoperative steroid therapy compared to preoperative need of steroids, 50.67% required similar therapy, 16.0% needed additional and 33.3% received reduced steroid therapy. Postoperative complications other than cataract development included endophthalmitis (n=1), rhegmatogenous retinal detachment (n=3), vitreous haemorrhage (n=1), new-onset cystoid macular edema (CME; n=4), persistent CME (n=21) and recurrence of ERM (n=5).
Conclusions :
Performing ERM peeling in uveitis should be well reflected as functional improvement may not be achieved and the need for steroids does remain. In addition, complication rates are higher compared to peeling in primary ERM. Results of further follow-up evaluation will be reported.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.