Epiretinal Membrane Surgery Outcomes in Eyes with Subretinal Drusenoid Deposits: A Case Control Study

Wilde, Craig; Awad, Mary; Dua, Harminder; Gandhewar, Ravi; Chen, Hean-Choon; Amoaku, Winfried M.

Abstract

© 2018 Purpose: To evaluate outcomes of epiretinal membrane (ERM) surgery in eyes with subretinal drusenoid deposits (SRDDs) and to compare them with those with isolated ERM. Design: Retrospective case-control study of consecutive patients who underwent pars plana vitrectomy (PPV) with ERM peeling. Participants: Twenty-five patients with SRDDs on spectral-domain (SD)-OCT who underwent surgery for ERM were included in the study. From the same cohort, for each case, we selected 2 age-matched control participants (50 eyes with isolated ERM). Preoperative best-corrected visual acuity (BCVA) also was matched as closely as possible. Methods: All participants underwent PPV and ERM peel for primary ERM. Main Outcome Measures: Postoperative BCVA, improvement in BCVA, preoperative and postoperative central macular thickness, surgical complications, and development of age-related macular degeneration (AMD) were recorded. Results: At final examination, mean postoperative BCVA was significantly less for eyes with SRDDs (0.51 logarithm of the minimal angle of resolution [logMAR] vs. 0.21 logMAR; P = 0.0001). Eyes with SRDDs demonstrated less improvement in BCVA after ERM surgery (0.13 logMAR vs. 0.30 logMAR; P = 0.0032). Eyes with SRDDs were significantly less likely to gain 2 or more Snellen lines of BCVA after ERM surgery (28% vs. 56%; P = 0.028). Three of 25 patients (12%) undergoing ERM surgery showed worsening of Snellen BCVA by 2 lines or more. Three of 25 eyes (12%) with SRDDs demonstrated advanced AMD after surgery, compared with 0 participants in the control group (P = 0.034). Conclusions: Epiretinal membrane surgery in eyes with SRDDs is associated with less favorable visual outcomes. Fewer patients demonstrate gain in BCVA, whereas a significant number show a deleterious decline. After surgery, AMD incidence seems high and patients may have an increased risk of raised intraocular pressure. These findings require further study to establish whether this represents a causal relationship. Surgeons should be vigilant for these complications. Appropriate patient counseling during the consenting process must be made.

• Journal Article Type: Article
• Acceptance Date: Jun 19, 2018
• Online Publication Date: Aug 29, 2018
• Publication Date: 2018-12
• Deposit Date: May 9, 2019
• Journal: Ophthalmology Retina
• Print ISSN: 2468-6530
• Electronic ISSN: 2468-6530
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 2
• Issue: 12
• Pages: 1218-1226
• DOI: https://doi.org/10.1016/j.oret.2018.06.009
• Public URL: https://nottingham-repository.worktribe.com/output/1861525
• Publisher URL: https://www.sciencedirect.com/science/article/abs/pii/S2468653018302355
• Additional Information: This article is maintained by: Elsevier; Article Title: Epiretinal Membrane Surgery Outcomes in Eyes with Subretinal Drusenoid Deposits; Journal Title: Ophthalmology Retina; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.oret.2018.06.009; Content Type: article; Copyright: Crown Copyright © 2018 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology