Long-term natural history of idiopathic epiretinal membranes with good visual acuity

Abstract

Background/objectives To evaluate the long-term progression of idiopathic epiretinal membranes (iERMs) with good baseline visual acuity, and to identify predictors of visual decline. Design Retrospective case series Subjects methods We reviewed records of 145 eyes with iERM and best-corrected visual acuity (BCVA) of 20/40 or greater at presentation, including BCVA, lens status, and central macular thickness (CMT) at yearly visits; as well as anatomic biomarkers including vitreomacular adhesion, pseudohole, lamellar hole, intraretinal cysts, disorganization of the inner retinal layers (DRIL), and disruption of outer retinal layers. Linear mixed effects and mixed-effects Cox proportional hazards models were used to identify clinical and anatomic predictors of vision change and time to surgery. Results At presentation, mean BCVA was 0.17 ± 0.10 logMAR units (Snellen 20/30) and mean CMT was 353.3 ± 75.4 μm. After a median follow-up of 3.7 years (range 1-7 years), BCVA declined slowly at 0.012 ± 0.003 logMAR units/year, with phakic eyes declining more rapidly than pseudophakic eyes (0.019 ± 0.003 vs. 0.010 ± 0.004 logMAR units/year). Metamorphopsia, phakic lens status, lamellar hole, and inner nuclear layer cysts were associated with faster visual decline. Cumulative rates of progression to surgery were 2.9, 5.6, 12.2, and 21.1% at years 1-4. Visual symptoms, metamorphopsia, greater CMT, and disruption of outer retinal layers were associated with greater hazard for surgery. Conclusion Eyes with iERM and visual acuity ≥ 20/40 experience slow visual decline, with 21% of eyes requiring surgery after 4 years. Clinical and anatomic predictors of vision loss may be distinct from factors associated with earlier surgical intervention.

Long-Term Follow-Up of Outer Retinal Layers in Patients with Epiretinal Membranes

“…The results of this study are in agreement with another long-term follow-up of patients with ERMs by Luu et al [8] with a minimum of 1-year follow-up and a shorter mean follow-up than our study (3.7 years). In that study, patients experienced a slow decline of visual acuity (0.012 ± 0.003 LogMAR per year) with 21% of the patients undergoing vitrectomy and membrane peeling [8]. The incidence of patients demonstrating ellipsoid zone loss was also similar to our study, as 41% of patients developed ellipsoid zone loss, compared with 37% in our study [8].…”

“…Pars plana vitrectomy and ERM peeling, first described by Machemer in 1978 [6], has become the established surgical treatment for visually significant ERM [4, 7]. However, ERMs may be safely observed if the visual acuity is good or the patient has minimal symptoms [8].…”

Spectral-Domain OCT Predictors of Visual Outcomes after Ranibizumab Treatment for Macular Edema Resulting from Retinal Vein Occlusion

“…33,34 The size of the largest intraretinal cyst for each eye was also measured based on the horizontal diameter as described in previous studies of OCT biomarkers. 35,36 Eyes with SRF were quantified for SRF thickness based on the linear distance perpendicular to the RPE. SRF thickness was considered ungradable if signal attenuation, or "shadowing," from overlying intraretinal fluid prevented accurate measurement of SRF thickness.…”

A novel quantitative analysis method for idiopathic epiretinal membrane

“…Patients symptoms range from being completely asymptomatic to complaining of metamorphopsia and loss of vision depending on macular involvement [ 4 ]. Disease progression leads to gradual but mild vision loss, a retrospective study reported that 21% of patients required surgery at 4 years if baseline visual acuity was ≥ 20/40 [ 8 ]. Treatment options consist of mainly in watchful waiting or vitrectomy surgery with peeling of the membrane [ 9 ].…”