Consider operating early for ERM patients with good visual acuity
FORT LAUDERDALE, Fla. — Ophthalmologists may be delaying surgery for too long to treat epiretinal membranes in patients with good visual acuity, according to a speaker here.
“Even though visual acuity in patients with epiretinal membrane may decrease slowly, surgery usually improves the final visual acuity,” André V. Gomes, MD, PhD, of Brazil, said at the inaugural Retina World Congress. “There is enough evidence that shows waiting too long may favor a worse overall outcome. Therefore, we should think about offering surgery much earlier in the process.”
Surgeons have performed epiretinal membrane (ERM) surgery for decades, but patients rarely return to 20/20 visual acuity. Traditionally, surgeons wait to perform a procedure, and it is apparent they have been waiting too long, Gomes said.
In a recent retrospective study by Chinskey and Shah, 42 patients with visual acuity greater than 20/50 underwent ERM peeling. According to the study, 31 patients had idiopathic ERM. After the procedure, 47.5% gained one line of visual acuity, 25% stayed at their original visual acuity, and 10% lost three lines or more, Gomes said.
Surgery should be considered earlier in patients with visual acuity worse than 20/25, and observation is acceptable for patients with 20/25 visual acuity without metamorphopsia. Additionally, avoiding long periods of preoperative leakage, which can cause anatomic damage, and not leaving tissue behind can improve outcomes, he said.
Minimizing tissue stretching preoperatively and during surgery can also improve visual acuity outcomes, Gomes said. – by Robert Linnehan
Gomes AV. Epiretinal membrane (ERM) with very good vision: Should one operate? Presented at: Retina World Congress; Feb. 23-26, 2017; Fort Lauderdale, Fla.
Disclosure: Gomes reports he has relevant financial disclosures with Novartis, Alcon, Bayer, Volk, Dutch Ophthalmic (DORC), Optovue and Allergan.