In the JournalsPerspective

ERM significantly under-detected prior to cataract surgery

Epiretinal membrane was severely under-detected before cataract surgery, resulting in inflated reporting of the condition postoperatively, according to a large study.

The Australian Prospective Cataract Surgery and Age-Related Macular Degeneration Study included 1,394 patients aged 64 years or older who underwent mydriatic retinal photography and phacoemulsification; 1,040 patients had retinal photographs taken preoperatively and 1 month postoperatively.

Investigators compared the cumulative incidence of epiretinal membrane (ERM) from 1 month to 3 years postoperatively to the 5-year incidence of idiopathic ERM in an age-matched subset of 781 participants culled from the Blue Mountains Eye Study (BMES) who had no baseline retinal pathologies conducive to ERM formation, significant cataract or cataract surgery.

Overall prevalence of ERM was 13.8% in the 1,394 eyes included in the analysis. Among the 1,040 eyes with preoperative and postoperative images, ERM prevalence was 3.1% preoperatively and 14.8% postoperatively.

The 3-year incidence of ERM was 12.1% in the study cohort and 4.4% in the BMES comparator subset.

Disclosure: Calvin Sze-Un Fong, MD, received a travel grant from the Association for Research in Vision and Ophthalmology. Paul Mitchell, MD, serves on advisory boards for Novartis and Bayer, and has received fees and payments from those companies. Jie Jin Wang, MD, received funding from a National Health and Medical Research Council Senior Research Fellowship. The remaining authors have no relevant financial disclosures.

Epiretinal membrane was severely under-detected before cataract surgery, resulting in inflated reporting of the condition postoperatively, according to a large study.

The Australian Prospective Cataract Surgery and Age-Related Macular Degeneration Study included 1,394 patients aged 64 years or older who underwent mydriatic retinal photography and phacoemulsification; 1,040 patients had retinal photographs taken preoperatively and 1 month postoperatively.

Investigators compared the cumulative incidence of epiretinal membrane (ERM) from 1 month to 3 years postoperatively to the 5-year incidence of idiopathic ERM in an age-matched subset of 781 participants culled from the Blue Mountains Eye Study (BMES) who had no baseline retinal pathologies conducive to ERM formation, significant cataract or cataract surgery.

Overall prevalence of ERM was 13.8% in the 1,394 eyes included in the analysis. Among the 1,040 eyes with preoperative and postoperative images, ERM prevalence was 3.1% preoperatively and 14.8% postoperatively.

The 3-year incidence of ERM was 12.1% in the study cohort and 4.4% in the BMES comparator subset.

Disclosure: Calvin Sze-Un Fong, MD, received a travel grant from the Association for Research in Vision and Ophthalmology. Paul Mitchell, MD, serves on advisory boards for Novartis and Bayer, and has received fees and payments from those companies. Jie Jin Wang, MD, received funding from a National Health and Medical Research Council Senior Research Fellowship. The remaining authors have no relevant financial disclosures.

    Perspective

    This is a large prospective study on the incidence and progression of epiretinal membrane (ERM) following cataract surgery using retinal photographs to detect and grade ERM. The authors point out that there was a substantial under-detection of ERM before cataract surgery. This is most likely due to presence of lens opacity affecting the photographic images. It would have been interesting to know how photographic detection correlated with ERM detection by clinical examination and with optical coherence tomography, which may provide some insight into the best way to detect presence and prevalence of ERM before cataract surgery and whether routine preoperative OCT should be considered.
    The corollary is that it is important for cataract surgeons to suspect that some of the vision loss in some patients with cataract may be due to retinal conditions, such as ERM. While the 3-year cumulative incidence of ERM was found to be 11.2%, it appears that the majority of ERM was not visually significant, because there was no difference in the proportion with more than 2 logMAR lines of vision loss over 3 years between the eyes that developed ERM and those that did not. However, because the incidence of ERM was greater after cataract surgery compared to age-matched controls and nearly half of ERM progressed over 3 years, discussion of potential development and progression of ERM should be considered preoperatively with patients.

    • Judy E. Kim, MD
    • OSN Retina/Vitreous Board Member

    Disclosures: Kim has no relevant financial disclosures.