Long-Term Anatomical and Functional Outcomes after Combined Cataract and Idiopathic Epiretinal Membrane Surgery.

PURPOSE: To describe the 2-year functional and anatomical outcomes in patients operated on for combined cataract and idiopathic epiretinal membrane (ERM) and to study the relationship between best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) throughout the follow-up. METHODS: This retrospective observational case series included 72 eyes operated on for combined cataract and idiopathic ERM. They were followed with clinical and SD-OCT examinations preoperatively and 1, 6, 12, and 24 months after surgery. Foveolar thickness (FT), photoreceptor status and morphological parameters were assessed. RESULTS: BCVA and FT substantially improved at 24 months. Postoperatively, no significant improvement was observed beyond 6 months for BCVA and 12 months for FT. Outer limiting membrane and inner and outer segment junction disruption scores were well correlated with BCVA both pre- and postoperatively, and significant visual improvement was demonstrated in each subgroup except in those with the highest scores. FT was correlated with BCVA only from 6 to 24 months postoperatively. CONCLUSION: After combined cataract and idiopathic ERM surgery, BCVA and FT improved rapidly. Most functional and anatomical recovery took place within the first 6 months, but this did not preclude late improvement, in particular in patients with the most disorganized photoreceptor layers. At each time point, the amount of photoreceptor damage seemed closely correlated with visual acuity, but concerning FT, this relationship remains questionable.

Preoperative Prognostic Factors and Predictive Score in Patients Operated On for Combined Cataract and Idiopathic Epiretinal Membrane.

PURPOSE: To report preoperative prognostic factors associated with visual acuity recovery 1 year after combined cataract and idiopathic epiretinal membrane (ERM) surgery and to introduce a predictive score. DESIGN: Interventional case series and estimation of a predictive score. METHODS: One hundred forty-two patients (1 eye per patient) operated on for combined cataract and idiopathic ERM in the University Hospital of Dijon were followed for 12 months. Preoperative clinical features and spectral-domain optical coherence tomography (OCT) parameters were compared between eyes that recovered ≥20/20 final best-corrected visual acuity (BCVA) and those with <20/20 final BCVA. Multivariate analysis and predictive score were provided. RESULTS: At 12 months, 60 eyes (42%) recovered ≥20/20 BCVA and 82 (58%) had lower visual results. Logistic regression analysis showed that final BCVA was associated with age (P = .040), duration of symptoms (P = .025), initial BCVA (P = .002), and inner and outer segment (IS/OS) junction disruption on spectral-domain OCT (P = .010). The preoperative 10-point predictive score including these parameters reached 82% sensitivity and 66% specificity. With a score >5, patients had a ≥56% chance of recovering 20/20 final BCVA instead of ≤27% when the score was ≤5. CONCLUSIONS: Age, duration of symptoms, and initial BCVA appear to be reliable prognostic factors in patients undergoing combined cataract and idiopathic ERM surgery. Combining these factors with analysis of the IS/OS junction provides a predictive score to estimate individual chances of good visual outcome.