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Abstract #99168 Published in IGR 22-4
Epiretinal Membrane Surgery in Eyes with Glaucoma: Visual Outcomes and Clinical Significance of Inner Microcystoid Changes
Peck T; Salabati M; Mahmoudzadeh R; Soares R; Xu D; Myers JS; Hsu J; Garg SJ; Khan MAOphthalmology. Retina 2022; 6: 693-701
OBJECTIVE: To investigate visual acuity (VA) outcomes and optical coherence tomography (OCT)-based biomarkers of vision outcomes in eyes with glaucoma undergoing pars plana vitrectomy (PPV) for idiopathic epiretinal membrane (ERM). PURPOSE: To assess surgical outcomes of PPV with membrane peel (MP) surgery in eyes with idiopathic ERM and concurrent glaucoma, and to identify potential imaging-based biomarkers of vision outcomes. METHODS: Retrospective, consecutive case-control series. A previously described ERM grading scale was utilized for OCT analysis. The primary outcome was VA at post-operative month 6. Outcomes were compared to a contemporary, matched control group of eyes without concurrent glaucoma undergoing PPV for idiopathic ERM. RESULTS: A total of 103 eyes of 103 patients with ERM and glaucoma were followed for a mean (± SD) of 656 (± 421) days after PPV with MP surgery. Glaucoma was classified as open angle in 98 (95.1%) eyes and closed angle in 5 (4.9%) eyes. VA improved from 0.72±0.48 (20/105) to 0.55±0.51 (20/71) at 6 months and to 0.50±0.56 (20/63) at final follow-up (p<0.001 for both timepoints). Eyes with pre-operative inner microcystoid changes (n=59, 57.3%) had significantly worse pre-operative, post-operative month 6, and final VA compared to eyes without inner microcystoid changes (p=0.028, 0.004 and 0.007, respectively). Eyes were then compared to a matched control group of 139 eyes without glaucoma. Eyes with ERM and glaucoma had a higher rate of microcystic changes both pre-operatively (p<0.001) and at post-operative month 6 (p<0.001), and had a worse VA at 6 months (p=0.03) and final follow-up (p=0.04) compared to control eyes without glaucoma. Advanced disc cupping was the only factor independently correlated with worse 6-month (p=0.01) and final (p=0.007) VA in multivariate analysis. CONCLUSIONS: Pre-operative inner microcystoid changes on OCT were present in over half of eyes with ERM and concurrent glaucoma, and may be a poor prognostic OCT biomarker. Eyes with ERM and concurrent glaucoma experienced worse vision outcomes compared to eyes with ERM alone, particularly those with advanced disc cupping.
Wills Eye Hospital, Retina Service, Thomas Jefferson University, Philadelphia, PA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
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