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  • Increased ERM formation follows rhegmatogenous retinal detachment repair with a retinotomy

    Retina/Vitreous

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    Review of: Drainage retinotomy confers risk of epiretinal membrane formation after vitrectomy for rhegmatogenous retinal detachment repair

    Ishikawa K, Akiyama M, Mori K, et al. American Journal of Ophthalmology, February 2022

    Investigators in Japan conducted a retrospective cohort analysis to identify risk factors for epiretinal membrane (ERM) formation following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) repair.

    Study design

    Data were assessed from 2239 patients with RRD treated with PPV who were registered in the Japan-Retinal Detachment Registry between 2016 and 2017. Using univariate analysis and propensity score-matched analysis, the authors evaluated associations between baseline characteristics and surgical techniques with postsurgical ERM formation 6 months after PPV.

    Outcomes

    Six months following PPV, the incidence of ERM formation was 4.6%. Within the study population, 30% had undergone a drainage retinotomy; at the 6-month timepoint, ERM developed in 3.5% of eyes without drainage retinotomy and 7.4% of eyes with drainage retinotomy. A propensity score-matched model of 492 pairs of cases with and without drainage retinotomy showed that a drainage retinotomy was significantly associated with ERM formation (odds ratio 3.35; P<0.001).

    Limitations

    The choice of retinotomy is often based on surgeon preference, so there may be unexplored confounders associated with differences among surgeons. Additionally, it is unclear what accountability measures were used by the registry to ensure that the entered data were accurate. The presence of only postoperative ERM was reviewed, so the ultimate visual significance of the postoperative ERMs is unclear.

    Clinical significance

    During a PPV, subretinal fluid in an RRD can be drained through either a retinotomy or an existing retinal break, or left undrained. The choice is often driven by surgeon training and preference. This study suggests a postoperative complication of PPV that might help surgeons decide between surgical techniques.