Eyes with Epiretinal Membrane, Glaucoma Linked to Worse Vision Outcomes

Travis Peck, MD

Eyes with epiretinal membrane (ERM) and concurrent glaucoma had worse vision outcomes compared to eyes with ERM alone, particularly those with advanced disc cupping in a set of new findings.

In over half of study eyes with ERM and gluacoma, preoperative inner microcystoid changes on optical coherence tomography (OCT) were present and considered a poor prognostic biomarker.

Led by Travis Peck, MD, The Retina Group of Washington, the team of investigators explored visual acuity outcomes and OCT-based biomarkers of vision outcomes in eyes with glaucoma undergoing pars plana vitrectomy (PPV) for idiopathic ERM.

The retrospective, consecutive case-control series included eyes with glaucoma undergoing PPV for idiopathic ERM. The study used a previously described ERM grading scale for OCT analysis.

Interventions included PPV with membrane peel surgery, while the primary outcome measure was visual acuity at month 6. These outcomes were compared to a contemporary, matched control group of eyes without concurrent glaucoma undergoing PPV for idiopathic ERM.

The study included a total of 103 eyes from 103 patients with ERM and glaucoma were followed for a mean of 656 days after PPV with membrane peel surgery. The findings suggest glaucoma was classified as open angle in 98 (95.1%) eyes and closed angle in 5 (4.9%) eyes.

Data show visual acuity improved from 0.72 ± 0.48 to 0.55 ± 0.51 at 6 months and to 0.50 ± 0.56 at final follow-up (P <.001 for both time points).

Additionally, eyes with preoperative inner microcystoid changes (n = 59; 57.3%) had significantly worse preoperative visual acuity (P = .028), postoperative visual acuity at month 6 (P = .004), and final visual acuity compared to eyes without inner microcystoid changes (P = .007).

Investigators compared eyes to a matched control group of 139 eyes without glaucoma. Eyes were ERM and glaucoma had a higher rate of microcystic changes before surgery (P <.001) and at postoperative month 6 (P <.001). Additionally, these eyes had worse visual acuity at 6 months (P = .03) and final follow-up (P = .04) compared to control eyes without glaucoma.

It was noted that advanced disc cupping was the only factor independently correlated with worse 6-month (P = .01) and final (P = .007) visual acuity in multivariate analysis.

The study, “Epiretinal Membrane Surgery in Eyes with Glaucoma: Visual Outcomes and Clinical Significance of Inner Microcystoid Changes,” was published in Ophthalmology Retina.