Comparison of the Prevalence and Clinical Characteristics of Epiretinal Membrane in Pseudoexfoliation and Primary Open-angle Glaucoma

Long-Term Intraocular Pressure Fluctuation and Epiretinal Membrane in Patients with Glaucoma or Glaucoma Suspect

Background: A relationship between glaucoma and epiretinal membrane (ERM) has been suggested previously. We investigated the association between intraocular pressure (IOP) fluctuation and idiopathic ERM in patients with glaucoma or glaucoma suspect. Methods: Among patients with glaucoma or glaucoma suspect, data from 43 patients with ERM and 41 patients without ERM were reviewed and analyzed in this retrospective study. The long-term fluctuation of IOP was defined based on the standard deviation of IOP across all visits. Results: Patients with ERM were older and had a higher SD of IOP and a higher proportion of having a history of cataract surgery and greater macular thickness (p = 0.018, 0.049, 0.013, and <0.001, respectively). In multiple logistic regression analysis, the high-IOP-fluctuation group was associated with the presence of ERM (p = 0.047). Among patients with ERM, eyes with stage-3 or -4 ERM had worse visual field defects based on mean deviation than those with stage-1 or -2 ERM (p = 0.025). Conclusions: Long-term IOP fluctuation was associated with idiopathic ERM in patients with glaucoma or glaucoma suspect. Idiopathic ERM could serve as a biomarker for long-term IOP fluctuation in glaucoma patients, particularly in clinics where measuring long-term IOP fluctuation during the first visit is not feasible due to its time-consuming nature.

Fluctuation of Intraocular Pressure and Vascular Factors Are Associated With the Development of Epiretinal Membrane in Glaucoma

PURPOSE

To identify factors associated with the development of epiretinal membranes (ERM) in glaucoma patients.

DESIGN

Multicenter, propensity-score matched, case-control study.

METHODS

One hundred ninety-two eyes of 192 patients with glaucoma from the Catholic Medical Center Glaucoma Suspect Cohort Study were analyzed. We identified 64 eyes who developed ERM from the cohort, and 128 eyes without ERM were selected by propensity score matching (1:2) according to baseline age and mean deviation (MD) of the visual field (VF). Demographic, systemic, and ocular characteristics were determined at baseline. Intraocular pressure (IOP) was measured, including baseline, mean IOP, and IOP fluctuation. Early-stage ERM, defined as translucent membrane with no underlying retinal distortion, was detected by fundus photography and optical coherence tomography. Central VF progression was considered when new VF defets developed in one either or both hemifields or when there was an increase of 3 or more abnormal points within 12 points of central 10° fixation. Autonomic nervous system status was evaluated by heart rate variability.

RESULTS

Patients who developed ERM were more frequently receiving medication for systemic hypertension and had higher systolic blood pressure, greater IOP fluctuation, more frequent disc hemorrhage (DH), worse VF MD, and a higher rate of central VF progression than patients without ERM. Additionally, patients with early glaucoma who developed ERM had higher rate of autonomic imbalance while patients with moderate-to-advanced glaucoma who developed ERM had greater baseline and peak IOP and worse MD of the last follow-up VF (MD < 6.0 dB). Older age (P = .048), medication for systemic hypertension (P < .001), IOP fluctuation (P < .001), presence of DH (P < .001), and worse last MD of VF (P = .033) were significantly associated with ERM in Cox proportional hazard analysis.

CONCLUSIONS

Early stage of ERMs in glaucomatous eyes are significantly associated with glaucoma progression, medication of systemic hypertension, presence of DH, and IOP fluctuation. These suggest that glaucoma patients who develop early stage of ERMs should be carefully monitored in terms of IOP fluctuation, vascular factors, and glaucoma progression.

Association of Epiretinal Membrane With Pseudoexfoliation Glaucoma and Long-term Factors Affecting Visual Function

PRCIS

Epiretinal membrane (ERM) tended to deteriorate more in pseudoexfoliation eyes with than without glaucoma. Incremental change in central macular thickness (CMT) induced by ERM deterioration affected longitudinal visual function in pseudoexfoliation glaucoma (PXG) eyes.

PURPOSE

The aim was to investigate longitudinal changes in the ERM and their association with glaucoma in patients with pseudoexfoliation syndrome (PXS) and to identify factors associated with the changes in ERM and visual field (VF).

PARTICIPANTS

One hundred two eyes with PXG and 32 eyes with nonglaucomatous pseudoexfoliation (ngPX) (mean 8.1±2.6 years of follow-up).

METHODS

Two observers independently assessed the presence and staging of ERM (stages 1, 2, and ≥3) on serial macular images of spectral-domain optical coherence tomography. Clinical characteristics were compared in eyes with ERM (+) and (-) in both groups. The relationship between putative factors and changes in ERM was determined using logistic regression analysis. Prognostic factors of VF worsening were assessed by Cox proportional hazard analysis.

RESULTS

Of the 102 eyes with PXG, 22 (21.6%) had an ERM at baseline; of the latter, 6 eyes deteriorated (all from stage 1 to 2) and 3 eyes with PXG developed new ERM during follow-up. Of the 32 ngPX eyes, 8 (25%) had an ERM at baseline, with none changing over time. The presence of glaucoma was marginally associated with ERM deterioration (odds ratio: 1.061, P =0.064). Incremental change in CMT was the only factor associated with VF progression (hazard ratio: 1.040, P =0.029) in PXG eyes.

CONCLUSIONS

ERM tended to deteriorate more in PXS eyes with than without glaucoma. Incremental change in CMT induced by ERM deterioration affected longitudinal visual function in PXG eyes.