Epiretinal Membrane Formation After Macula-On Rhegmatogenous Retinal Detachment Repair
Purpose
Epiretinal membrane (ERM) formation after repair of a macula-on rhegmatogenous retinal detachment is a frequent cause of visual impairment after successful surgical repair. This study’s purpose is to examine the incidence of ERM formation after different retinal detachment repair procedures and compare visual outcomes of ERM eyes and non-ERM eyes.
Methods
A retrospective case series of 282 patients who underwent primary rhegmatogenous retinal detachment repair was performed. Patients who had primary macula-on RD repair (pneumatic retinopexy (PR), scleral buckle (SB), pars plana victrectomy (PPV) and vitrectomy/scleral buckle (PPV/SB)) were included. Patient charts were selected based on database coding searches from January 1, 2007 to December 31, 2012 in a large retina referral practice. To isolate the effects of procedure type and ERM status, phakic patients who underwent PPV were excluded. Patients with a history of retinal surgery, silicone oil tamponade, or other visually significant ocular conditions were also excluded. Main outcomes included visual acuity and ERM incidence.
Results
Of the 282 charts examined, 62 met inclusion criteria and 219 were excluded. 27 (44%) were PR, 35 (56%) were other surgeries (SB, PPV, or PPV/SB). The overall ERM incidence across all procedures was 29%. Across all procedure types, in the ERM group, the percentage of patients with visual acuity 20/40 or worse pre-operatively was 33% compared to 61% at last follow-up of one year or greater. In the non-ERM group, the percentage was 38% pre-operatively and 45% at the same time point, with a p value of 0.25. The incidence of ERM formation was 40% in the PR patients and 20% in the other surgery group with a p value of 0.08 using a t test of proportions.
Conclusion
There is a trend towards better vision in the non-ERM patients compared to the ERM patients. There also exists a strong trend towards a higher incidence of ERM formation in those treated with pneumatic retinopexy compared to those treated with other modalities with a p value of 0.08. Understanding the incidence and visual outcomes gives a sense of the value of potential treatment that stops the ERM from forming in the first place.