Functional and Anatomical Outcomes of Pars Plana Vitrectomy for Epiretinal Membrane in Patients with Uveitis

Abstract

Purpose-To evaluate the anatomical and functional outcomes of vitrectomy and epiretinal membrane (ERM) peeling in patients with uveitis. Secondarily, we evaluated the effect of internal limiting membrane (ILM) peeling on surgical outcomes, and of surgery on uveitis activity and, thus, therapeutic regime. Methods-Bicentre, retrospective, interventional case series of 29 eyes of 29 consecutive patients affected by uveitis and ERM, that had undergone pars plana vitrectomy with ERM peel between 2012 and 2020, with a minimum postoperative follow-up (FU) of six-months. Demographic data, best-corrected visual-acuity (BCVA), clinical findings, intraoperative and postoperative complications, and macular optical-coherence-tomography scans were reviewed. Results-The mean (standard deviation) duration of follow-up was 32 (22) months. At six-month FU, mean central-retinal-thickness (CRT) significantly improved (from 456 (99) to 353 (86) microns; p < 0.001), and mean BCVA improved from 0.73 (0.3) to 0.49 (0.36) logMAR (p < 0.001), with only one (3%) patient experiencing worsening of vision. The rate of concomitant cystoid macular edema decreased from 19 (66%) eyes at presentation to eight (28%) eyes at final-FU (p = 0.003). Comparing eyes in which ILM peeling was performed in addition to ERM peeling only, BCVA or CRT reduction were comparable. Only a minority of six (21%) eyes had a worsening in uveitis activity requiring additional medications, whereas most patients resumed the same treatment (52%) or received less treatment (28%) (p = 0.673). Conclusions-Vitrectomy with ERM peeling led to favourable anatomical and functional outcomes in patients with uveitis regardless of whether the ILM is peeled or not. As in most patients, no activation of the uveitis requiring additional medications was noted, we do not recommend changes in anti-inflammatory/immunosuppressive therapy postoperatively.

Long-Term Safety and Efficacy of Pars Plana Vitrectomy for Uveitis: Experience of a Tertiary Referral Centre in the United Kingdom

“…The rationale for including these patients relies on the attempt to selectively assess the potential effect of PPV itself and avoid confounding factors, in particular, concomitant pathologies. Indeed, the therapeutic role of PPV in uveitis has been variously reported as being beneficial for treating several diseases of the posterior segment affecting uveitic eyes, such as ERM, retinal detachment and persistent CME [6,7]. Our study demonstrated a beneficial effect of PPV in terms of BCVA, uveitis activity and the macular profile.…”

“…First, large amounts of vitreous material can be obtained for microbiological and histopathological analyses to help identify the etiology in cases of atypical clinical presentation or history, inconclusive laboratory or radiologic testing or persistent inflammation or appropriate immunosuppression [5]. Second, PPV has a primary role in the management of posterior segment complications associated with uveitis, including vitreous hemorrhage, epiretinal membrane (ERM), full-thickness macular holes, retinal detachment (RD) and cyclitic membranes causing hypotony [6,7]. In addition, although its exact role as an anti-inflammatory therapy for uveitis remains uncertain, PPV has shown to be effective in improving visual acuity, intraocular inflammation and macular oedema and causing a reduction in immunosuppressive medications [8].…”

Epiretinal membranes in patients with uveitis: an update on the current state of management

“…The frequency of ERM according to SUN classification stood at 28.1% in cases of anterior uveitis, 57.0% in intermediate uveitis, and 43.5% in instances of posterior and panuveitis [ 18 ]. While ERM is a relatively common complication in uveitic eyes, obtaining data regarding demographics, diagnosis, and disease management can be challenging due to the relative paucity of these patients [ 21 ]. Several studies have reported their findings on the evaluation and/or surgical approach of ERMs in uveitic patients [ 6 , 27 – 33 ].…”

“…Cristescu et al [ 21 ] evaluated retrospectively the surgical outcomes of 29 eyes of 29 consecutive uveitic patients with ERM. In particular, this study investigated the anatomical and functional outcome of PPV and ERM peeling and secondarily the effect of ILM peeling on these eyes.…”

“…Similar to idiopathic ERM, the preferred surgical approach is pars plana vitrectomy (PPV) with ERM peeling. Nevertheless, there are ongoing debates surrounding various aspects of the surgical approach for uveitic ERM, such as optimal timing, perioperative therapeutic management, and the potential combination of ILM peeling [ 21 ]. This review aims to summarize the current knowledge on the management of ERM in patients with uveitis.…”