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  • Observing epiretinal membranes until visually significant does not worsen surgical outcomes

    Retina/Vitreous

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    Review of: Natural history and surgical timing for idiopathic epiretinal membrane

    Al-Khersan H, Shaheen A, Flynn H, et al. Ophthalmology Retina, November 2022

    This study suggests that only a small proportion of mild epiretinal membranes progress to requiring surgery. Patients who were initially observed for at least six months and subsequently underwent surgery experienced comparable visual improvements to those who underwent surgery upon diagnosis.

    Study design

    This was a retrospective study with a nested case‑control comparison of the outcomes of patients with epiretinal membranes (ERMs) who underwent surgery within 6 months of initial presentation ("immediate surgery") and those who progressed to needing surgery after 6 months of diagnosis ("deferred surgery"). A total of 693 patients from two practices were included from May 1, 2014, to November 11, 2019.

    Outcomes

    Two hundred eighty patients underwent ERM-peeling surgery within 6 months of diagnosis. Among the 413 who did not undergo immediate surgery, 44 (10.7%) pursued surgery after 6 months. Patients in the "immediate surgery" group had better best‑corrected visual acuity (BCVA) outcomes than those in the "deferred surgery" group, but this result was attributed to the progression of cataracts, since the analysis of patients with pseudophakia only found similar improvements in visual acuity between preoperative and postoperative vision in the 2 groups.

    Limitations

    This is a retrospective study with data that could not be fully standardized. There was also a very small sample size for the pseudophakia analysis.

    Clinical significance

    There is unlikely to be a significant decrease in vision improvement after surgery for patients with ERMs who are initially observed until vision was affected enough to require surgery, compared to those who immediately opted for ERM peeling. Waiting may avoid unnecessary immediate surgery, considering only 10.7% of patients who were initially observed to have ERM deteriorated enough to eventually undergo surgery within the study period.

    Financial Disclosures: Dr. Ajay Kuriyan discloses relationships with Adverum (Grant Support); Alimera Sciences (Consultant/Advisor); Allergan (Consultant/Advisor); Annexon (Grant Support); Bausch + Lomb (Consultant/Advisor); EyePoint Pharmaceuticals (Consultant/Advisor); Genentech (Consultant/Advisor, Lecture Fees/Speakers Bureau, Grant Support); Lumata Health (Consultant/Advisor, Equity/Stock Holder - Private Corp); National Eye Institute (Grant Support); Novartis, Alcon Pharmaceuticals (Consultant/Advisor); Optos (Lecture Fees/Speakers Bureau); Recens Medical (Consultant/Advisor, Equity/Stock Holder - Private Corp); Spark Therapeutics (Consultant/Advisor, Lecture Fees/Speakers Bureau).