PARS PLANA VITRECTOMY FOR SYMPTOMATIC EPIRETINAL MEMBRANES IN EYES WITH 20/50 OR BETTER PREOPERATIVE VISUAL ACUITY.

PURPOSE: To evaluate pars plana vitrectomy with membrane peel for symptomatic epiretinal membranes in eyes with preoperative best-corrected visual acuity of 20/50 or better. METHODS: Patients with symptomatic epiretinal membrane and 20/50 or better vision who underwent pars plana vitrectomy with membrane peel by a single surgeon at our institution between January 2007 and January 2014 were identified. The principal outcomes measured were best-corrected visual acuity and central subfield macular thickness at 1, 6, and 12 months of follow-up. Subjective improvement in patient symptoms and complications were also documented. RESULTS: Thirty-three eyes of 33 consecutive patients were included in this retrospective case series. Mean preoperative best-corrected visual acuity was 20/40 and improved to 20/28 (P = 0.00008) at Month 12. Mean central subfield macular thickness improved from 437 µm preoperatively to 391 µm by Month 1 (P = 0.00006) and 388 µm at 12 months (P = 0.00142). Seventy-three percent (24 of 33) of patients (95% confidence interval: 55.6-85.1%) reported improvement of visual symptoms during the follow-up period. Of the 13 patients who were phakic preoperatively, 6 patients (46.1%, 95% confidence interval: 23.2-70.9%) underwent phacoemulsification surgery within 1 year of vitrectomy. CONCLUSION: Patients experienced a gradual gain in acuity and improvement of symptoms after pars plana vitrectomy with membrane peel. Cataract progression necessitating cataract surgery is common in phakic patients.

Epiretinal membranes in uveitic macular edema: effect on vision and response to therapy.

PURPOSE: To evaluate the effects of epiretinal membranes on the response of uveitic macular edema to therapy and on visual acuity outcomes. DESIGN: Retrospective case series. METHODS: One hundred four eyes of 77 patients with uveitic macular edema were identified at a tertiary care center. Epiretinal membranes were diagnosed when identified by 2 investigators' grading of spectral-domain optical coherence tomography and scored for the presence or absence of surface wrinkling. Outcomes included best-corrected visual acuity, central subfield thickness, and rates of macular edema improvement (>20% reduction in central subfield thickness) and resolution (reduction of central subfield thickness to <315 µm) at 3 and 6 months follow-up. RESULTS: Seventy-two eyes of 59 patients had an epiretinal membrane on presentation. Eyes without epiretinal membranes and with epiretinal membranes without surface wrinkling were not significantly different at presentation or at 3 and 6 months follow-up. Conversely, eyes with an epiretinal membrane with retinal surface wrinkling had a greater proportion of eyes with 20/200 or worse visual acuity at presentation, and had worse mean acuities at 3 months (20/94 vs 20/35 for eyes without an epiretinal membrane, P = .002) and at 6 months follow-up (20/110 vs 20/36 for eyes without an epiretinal membrane, P = .02). At 6 months of follow-up the mean central subfield thicknesses were: eyes without an epiretinal membrane, 338 ± 23 µm; and eyes with an epiretinal membrane and surface wrinkling, 405 ± 22 µm (P = .05). CONCLUSIONS: In eyes with epiretinal membranes and retinal surface wrinkling, uveitic macular edema had a poorer visual acuity response to medical therapy and thicker maculae at 6 months.

Subretinal fluid in uveitic macular edema: effect on vision and response to therapy.

PURPOSE: To evaluate the effect of subretinal fluid (SRF), imaged with spectral-domain optical coherence tomography (SD-OCT), on visual acuity outcomes in cases of uveitic macular edema (ME), and to analyze the response of SRF and uveitic ME to therapy. DESIGN: Retrospective case series. METHODS: One hundred and one eyes of 75 patients with uveitic ME, as imaged by SD-OCT, were identified at a single tertiary-care referral center. The main outcome measures were best-corrected visual acuity, central subfield thickness (CSFT), and rates of macular edema improvement (≥20% reduction in CSFT), and resolution (defined as reduction of CSFT to <315 µm) of ME at 3 and 6 months follow-up. RESULTS: Forty eyes of 29 patients had SRF on SD-OCT at presentation, which was associated with greater macular thickness (mean CSFT 488 µm vs 362 µm, P = .0001) and worse visual acuity than ME without SRF (20/115 vs 20/51, P = .015). However, eyes with SRF responded more favorably to treatment, and at 3 and 6 months of follow-up they achieved greater rates of improvement and resolution of ME than eyes without SRF (77% improved and 50% resolved at 6 months, vs 20% and 13%, respectively; P = .003 and P = .017, respectively) and recovered to a similar level of visual acuity (20/62 vs 20/42 at 6 months, P = .54). CONCLUSIONS: SRF in uveitic ME is associated with thicker retinas and worse visual acuity on presentation but responds more favorably to treatment and displays greater rates of edema resolution and visual acuity improvement.