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Original Investigation
February 2018

Cataract Surgery Outcomes in Eyes With Primary Epiretinal Membrane

Author Affiliations
  • 1Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock
  • 2Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt
  • 3Department of Ophthalmology, University of Ottawa, Ottawa, Ontario, Canada
  • 4School of Clinical Sciences, University of Bristol and Bristol Eye Hospital, Bristol, United Kingdom
  • 5Wolverhampton Eye Infirmary, Royal Wolverhampton Hospitals National Health Service Trust, New Cross, Wolverhampton, United Kingdom
  • 6Sandwell and West Birmingham National Health Service Trust, Birmingham, United Kingdom
  • 7Ophthalmology Department, Gloucestershire Hospitals National Health Service Trust, Cheltenham, United Kingdom
JAMA Ophthalmol. 2018;136(2):148-154. doi:10.1001/jamaophthalmol.2017.5849
Key Points

Question  In the setting of cataract and primary epiretinal membrane (ERM), what is the magnitude of visual acuity improvement and incidence of cystoid macular edema after cataract surgery?

Findings  A clinical database study involving 812 ERM eyes and 159 184 reference eyes undergoing phacoemulsification cataract surgery showed an increase in visual acuity of 0.27 logMAR (approximately 3 Snellen lines) and an 8.6% incidence of cystoid macular edema in eyes with primary ERM.

Meaning  Cataract surgery in eyes with primary ERM, on average, can lead to an improvement in visual acuity but higher rates of cystoid macular edema and a lower postoperative visual acuity gain compared with cataract surgery in eyes without primary ERM.

Abstract

Importance  Primary epiretinal membrane (ERM) is a common retinal disorder with a prevalence of 4% to 18.5%. Although ERM and cataracts commonly occur together, to our knowledge, no studies have investigated the outcome of cataract surgery alone in this setting.

Objective  To analyze the visual outcome and cystoid macular edema risk with cataract surgery in eyes with primary ERM.

Design, Setting, and Participants  In this retrospective clinical database study, data were collected from July 2003 to March 2015 from 8 locations in the United Kingdom. Cataract surgery data of 217 557 eyes were extracted from the electronic medical record of the UK National Health Service. After exclusion of 57 561 eyes with combined surgery, prior vitrectomy, copathology, and complications, 812 eyes with primary ERM and 159 184 reference eyes were analyzed.

Main Outcomes and Measures  We report on visual acuity (VA), the incidence of cystoid macular edema, and the need for ERM surgery.

Results  The mean (SD) age of patients in the ERM group was 73.7 (9.23) years, and 395 of 812 were men (46.8%). The mean (SD) age of patients in the reference group was 74.4 (12.19) years, and 65 265 of 159 184 were men (41%). Epiretinal membrane eyes assessed at 4 to 12 weeks postoperatively gained 0.27 (0.32) logMAR (approximately 3 Snellen lines), with 200 of 448 (44.6%) improving by 0.30 logMAR or more (≥3 Snellen lines) and 32 of 448 (7.1%) worsening by 0.30 logMAR or more. Reference eyes gained a mean (SD) of 0.44 (0.26) logMAR (approximately 4 Snellen lines), with 48 583 of 77 408 (62.8%) improving by 0.30 logMAR or more and 2125 of 77 408 (2.7%) worsening by 0.30 logMAR or more. Although all eyes with preoperative VA of 20/40 or less improved, only reference eyes with preoperative VA of more than 20/40 showed improvement. Cystoid macular edema developed in 57 of 663 ERM eyes (8.6%) (95% CI, 6.69-10.98) and 1731 of 125 435 reference eyes (1.38%) (95% CI, 1.32-1.45) (P < .001). Epiretinal membrane surgery was performed in 43 of 663 (6.5%) ERM eyes.

Conclusions and Relevance  On average, VA improved 0.27 logMAR (approximately 3 Snellen lines) in eyes with ERM. Eyes with ERM and VA of 20/40 or less showed more benefit after cataract surgery than those with better preoperative vision. However, compared with eyes without ERM, higher rates of cystoid macular edema and a lower postoperative VA gain were noted.

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