Surgery Deferral in Eyes with iERM Shows No Disadvantage Compared with Immediate Surgery

William E. Smiddy, MD

New findings from a retrospective study suggest the vast majority of eyes with idiopathic epiretinal membrane (IERM) remained stable after initial presentation.

Investigators, led by William E. Smiddy, MD, M. Brenn Green Chair in Ophthalmology, University of Miami, additionally reported the deferral of surgery in the minority of patients who progress to surgery did not have a disadvantageous final outcome compared with immediate surgery.

The retrospective study with nested case-control comparison assessed the prevalence of progression to surgery on iERM and compared the results with those of immediate surgery. It included patients with mild iERM at initial presentation.

Investigators conducted the trial to compare the outcomes of individuals who later progressed to surgery (deferred surgery) with those of a control group that underwent surgery within 6 months of initial presentation (immediate surgery).

The main outcomes of the trial included the prevalence of performing vitrectomy with membrane peeling after initial deferral, features associated with deferred surgery, and the visual acuity (VA) outcomes of surgery compared with those with immediate surgery, according to investigators.

A total of 413 patients were included in the base study cohort, including 369 who did not undergo iERM peeling. Meanwhile, 44 (10.7%) underwent deferred surgery at a mean duration of 18.1 months after initial presentation.

Investigators indicated the factor most associated with later progression to surgery, determined using a multivariate analysis, was symptoms at initial presentation (odds ratio [OR], 8.75; 95% CI, 3.80 - 20.15; P <.0001).

They additionally reported the immediate surgical group (controls) had a poorer logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) at presentation compared with the deferred surgery group. However, this decreased in the latter group to nearly the same preoperative level immediately before the deferred surgery. This was typically why they underwent surgery, according to investigators.

Moreover, the final logMAR BCVA was similar in the deferred and immediate surgical groups when only pseudophakic cases were analyzed.

An analysis of the change from preoperative BCVA to final BCVA showed no difference in the magnitude of change between the pseudophakic subgroups of the deferred and immediate surgery groups (median preoperative VA, 0.52; 95% CI, 0.40 - 0.60 in the deferred surgery group and 0.44; 95% CI, 0.39 - 0.60 in the immediate surgery group (P = .7256).

Further, within the deferred and immediate surgery groups, data show the median change from preoperative BCVA to final BCVA in the pseudophakic subgroups was 0.22 (P = .0082) in the former and 0.21 (P = .0001) in the latter.

The abstract, “Natural History and Surgical Timing for Idiopathic Epiretinal Membrane,” was published in Ophthalmology Retina.