Abstract
Purpose :
Epiretinal membrane (ERM) peeling is a common technique with good results in most cases of conventional primary ERM both functional and morphologically. However, decision making, surgery and clinical outcomes are more challenging in the presence of co-morbidities such as diabetic retinopathy or maculopathy. This retrospective single center interventional clinical study evaluates outcomes in a large cohort of patients with diabetes.
Methods :
Retrospective analysis of consecutive eyes with peeling of diabetic secondary ERM in a ten-year period (04/2013–04/2023). Data collected included patient demographics, severity of diabetic retinopathy or maculopathy and vitreo-macular interface changes detected by funduscopy and optical coherence tomography (OCT) including non-proliferative (nPDRP), proliferative diabetic retinopathy (pDRP), tractional retinal detachment, diabetic macular edema (DME), lamellar macular hole, full-thickness macular hole. Furthermore, need for anti-vascular endothelial growth factor (VEGF) or steroid treatment intravitreally, anatomical features including central retinal thickness (CRT) and macular volume (MV), postoperative complications, and visual outcome were evaluated. Statistical analyses were performed using paired t-test.
Results :
299 consecutive eyes of 299 patients (61.2% male, 51.8% right eyes, mean age 65.67±14.19 (range 23-95)) were included. Only 10.4% of patients had neither diabetic retinopathy, nor maculopathy. DME was present in 38.1%, nPDRP in 36.8%, pDRP in 50.8%. Prior to surgery 35.8% were treated with either anti-VEGF or steroids intravitreally for DME. During surgery, 55.9% of eyes were endotamponaded with air, 25.1% with silicone oil, 14.0% with sulfur-hexafluoride gas, and 5.0% with balanced salt solution. Visual acuity improved slightly from 0.82±0.57 logMAR at baseline to 0.79±0.61 logMAR at last follow-up visit (p=0.29), whereas anatomical features changed significantly as follows: Mean CRT in OCT decreased from 401.10±163.0 µm to 366.10±170.15 µm (p=0.048) and MV from 9.82±2.33 mm3 to 8.86±2.10 mm3 (p<0.01). Epiretinal membranes recurred in 9.0% of cases.
Conclusions :
Epiretinal membrane peeling in diabetic retinopathy seems to be a safe procedure and leads to an improvement of macular anatomy in the majority of cases, although there is marginal benefit in functional outcome.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.