Epiretinal membrane vitrectomy: outcomes with or without cataract surgery and a novel prognostic factor for cystoid macular edema

Diagnostic Reliability of Optical Coherence Tomography Biomarkers for Postsurgical Success in Visual Acuity in Patients with Idiopathic Epiretinal Membranes

INTRODUCTION

Several optical coherence tomography (OCT) biomarkers for postsurgical success in patients with idiopathic epiretinal membranes (iERMs) have been described in single predictor analyses. The aim of this study was to assess the reliability of diagnosis of OCT biomarkers and to calculate their impact on postsurgical visual acuity by applying multiple regression analysis.

METHODS

This retrospective study included patients scheduled for pars plana vitrectomy with membrane peeling for iERMs. Presurgical OCT scans were analyzed for the presence of OCT biomarkers by two reviewers. Intra- and interobserver reliability was calculated with the Kuder-Richardson 20 test.

RESULTS

Among the 136 patients included, intra-/interobserver reliability of the OCT biomarkers was 0.89/0.70 for ectopic inner foveal layer (EIFL), 0.82/0.53 for disorganization of retinal inner layer (DRIL), 0.93/0.89 for intraretinal cystoid changes, 0.84/0.78 for alterations of the ellipsoid zone, 0.84/0.72 for cotton ball sign, 0.68/0.58 for hyperreflective foci, 0.55/0.47 for epimacular membrane rips (EMM-rips), and 0.87/0.60 for retinal contraction. Only DRIL and central subfield macular thickness (CMT) were significant predictors for BCVA 3 months after surgery in a multiple regression analysis.

CONCLUSION

Intraobserver reliability of OCT biomarkers was higher than interobserver reliability, reflecting both clinical and grading experience with respect to OCT biomarker evaluation. DRIL and CMT were shown to be significant predictors in a multiple regression analysis, with potential for negative influence on final BCVA after vitrectomy with membrane peeling for iERMs.

Combined versus Sequential Pars Plana Vitrectomy and Phacoemulsification for Macular Hole and Epiretinal Membrane - A Systematic Review and Meta-Analysis

TOPIC

To compare the efficacy and safety between combined and sequential pars plana vitrectomy and phacoemulsification for macular hole (MH) and epiretinal membrane (ERM).

CLINICAL RELEVANCE

The standard of care for MH and ERM is vitrectomy, which increases risk of developing cataract. Combined phacovitrectomy eliminates the need for a second surgery.

METHODS

Ovid MEDLINE, EMBASE, and Cochrane CENTRAL were searched in May 2022 for all articles comparing combined versus sequential phacovitrectomy for MH and/or ERM. The primary outcome was mean best-corrected visual acuity (BCVA) at 12-months follow-up. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane RoB 2 tool for randomized controlled trials (RCTs) and ROBINS-I tool for observational studies. (PROSPERO, registration number, CRD42021257452) RESULTS: Of the 6470 studies found, 2 RCTs and 8 non-randomized retrospective comparative studies were identified. Total eyes for combined and sequential groups were 435 and 420, respectively. Meta-analysis suggested no significant difference between combined and sequential surgery for 12-month BCVA (combined = 0.38 logMAR, sequential = 0.36 logMAR; mean difference (MD) = +0.02 logMAR; 95% CI = -0.04 to 0.08; p = 0.51, I² = 0%, n = 4 studies, 398 participants), as well as absolute refractive error (p = 0.76, I² = 97%, n = 4 studies, 289 participants), risk of myopia (p = 0.15, I² = 66%, n = 2 studies, 148 participants), MH non-closure (p = 0.57, I² = 48%, n = 4 studies, 321 participants), cystoid macular edema (p = 0.15, I² = 0%, n = 6 studies, 526 participants), high intraocular pressure (p = 0.09, I² = 0%, n = 2 studies, 161 participants), posterior capsule opacification (p = 0.46, I² = 0%, n = 2 studies, 161 participants), posterior capsule rupture (p = 0.41, I² = 0%, n = 5 studies, 455 participants) and retinal detachment (p = 0.67, I² = 0%, n = 6 studies, 545 participants).

CONCLUSION

No significant difference was detected between combined and sequential surgeries for visual outcomes, refractive outcomes, or complications. Given that most studies were retrospective and contained a high risk-of-bias, future high-quality RCTs are warranted.

Efficacy and safety of primary posterior capsulotomy during phaco-vitrectomy for epiretinal membrane

Purpose

To evaluate the necessity and safety of primary posterior capsulotomy during phaco-vitrectomy for idiopathic epiretinal membrane (ERM).

Setting

Seoul National University Bundang Hospital, Seongnam, Korea.

Design

Retrospective consecutive cohort analysis.

Methods

This study enrolled 219 patients (228 eyes) who underwent combined 25-gauge phaco-vitrectomy for idiopathic ERM and cataract, divided into capsulotomy (−) group (152 eyes, 144 patients) and capsulotomy (+) group (76 eyes, 75 patients). The main outcomes were rate of posterior capsular opacity (PCO) occurrence and postoperative complications. Ophthalmic examinations were performed at baseline, 1, 3, 6, and 12 months postoperatively.

Results

PCO only occurred in capsulotomy (−) group (20 eyes, 13.2%), with mean onset of 10.59 months. Visually-significant PCO that needed Nd:YAG posterior capsulotomy was present in 9 eyes (45.0% of PCO eyes). The rate of cystoid macular edema (CME) was higher in capsulotomy (+) group (6.6% vs. 15.8%, p = 0.026) with longer duration (1.50 vs. 3.36 months, p = 0.019). Female sex and posterior capsulotomy were significant risk factors for CME occurrence (p < 0.05).

Conclusion

Primary posterior capsulotomy during phaco-vitrectomy for idiopathic ERM obviated the need for Nd:YAG posterior capsulotomy, but visually-significant PCO that needed Nd:YAG laser was not common. Considering the low rate of visually-significant PCO and high rate of postoperative CME, routine posterior capsulotomy during phaco-vitrectomy may not be necessary for preventing PCO in ERM.

The impact of COVID-19 pandemic on surgical primary retinal detachments

PURPOSE

To describe the impact of COVID-19 pandemic on the presentation characteristics, timings and surgical decisions for primary rhegmatogenous retinal detachment (RRD).

METHODS

Historical cohort including all patients who presented to the Surgical Retina Section at Centro Hospitalar Universitário do Porto (CHUPorto), over a 2-year period were recruited and divided in 2 groups: pre-COVID and COVID groups. The onset of the COVID-19 pandemic was recorded as starting on March 18, 2020, the same day the first pandemic-related lockdown came to effect in Portugal.

RESULTS

This study enrolled four hundred and forty-nine eyes of 443 patients: 272 in the pre-COVID group and 177 in the COVID one. Of the patients, 63.6% were male and the mean±SD age was 63.0±13.2y (range 13 to 92y). Of the eyes, 55.5% (n = 151) presented with macular detachment in the pre-COVID group compared with 66.9% (n = 119) in the COVID group (odds ratio [OR] 1.62; 95% confidence interval [CI], 1.09-3.86; p=0.016). The time from symptoms onset to hospital admission (p=0.021) and from admission to surgery (p<0.001) was longer in the COVID era. In the COVID period, silicone oil (OR 2.03, 95%CI 1.09-3.79, p=0.025) and C3F8 gas (OR 2.42, 95%CI 1.57-3.71, p<0.001) were used more often. No differences in anatomical success or final visual acuity were found.

CONCLUSIONS

The lockdown due to COVID pandemic affected the epidemiology of RRD. The services must adapt to the novel reality and produce backup plans for similar events. Despite the contingencies, the final results were not different between groups.