Purpose: To describe the 2-year functional and anatomical outcomes in patients operated on for combined cataract and idiopathic epiretinal membrane (ERM) and to study the relationship between best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) throughout the follow-up. Methods: This retrospective observational case series included 72 eyes operated on for combined cataract and idiopathic ERM. They were followed with clinical and SD-OCT examinations preoperatively and 1, 6, 12, and 24 months after surgery. Foveolar thickness (FT), photoreceptor status and morphological parameters were assessed. Results: BCVA and FT substantially improved at 24 months. Postoperatively, no significant improvement was observed beyond 6 months for BCVA and 12 months for FT. Outer limiting membrane and inner and outer segment junction disruption scores were well correlated with BCVA both pre- and postoperatively, and significant visual improvement was demonstrated in each subgroup except in those with the highest scores. FT was correlated with BCVA only from 6 to 24 months postoperatively. Conclusion: After combined cataract and idiopathic ERM surgery, BCVA and FT improved rapidly. Most functional and anatomical recovery took place within the first 6 months, but this did not preclude late improvement, in particular in patients with the most disorganized photoreceptor layers. At each time point, the amount of photoreceptor damage seemed closely correlated with visual acuity, but concerning FT, this relationship remains questionable.

Keywords:
Cataract, Combined surgery, Prognostic factors, Epiretinal membrane, Optical coherence tomography
1.
Smiddy WE, Maguire AM, Green WR, et al: Idiopathic epiretinal membranes. Ultrastructural characteristics and clinicopathologic correlation. Ophthalmology 1989;96:811-820.
2.
Michalewski J, Michalewska Z, Cisiecki S, et al: Functional correlations of macular pathology connected with epiretinal membrane formation in spectral optical coherence tomography (SOCT). Graefes Arch Clin Exp Ophthalmol 2007;245:1623-1631.
3.
Watanabe K, Tsunoda K, Mizuno Y, et al: Outer retinal morphology and visual function in patients with idiopathic epiretinal membrane. JAMA Ophthalmol 2013;131:172-177.
4.
Asaria R, Garnham L, Gregor ZJ, et al: A prospective study of binocular visual function before and after successful surgery to remove a unilateral epiretinal membrane. Ophthalmology 2008;115:1930-1937.
5.
Kim J, Rhee KM, Woo SJ, et al: Long-term temporal changes of macular thickness and visual outcome after vitrectomy for idiopathic epiretinal membrane. Am J Ophthalmol 2010;150:701-709.
6.
Machemer R: The surgical removal of epiretinal macular membranes (macular puckers) (author's transl). Klin Monatsbl Augenheilkd 1978;173:36-42.
7.
Massin P, Allouch C, Haouchine B, et al: Optical coherence tomography of idiopathic macular epiretinal membranes before and after surgery. Am J Ophthalmol 2000;130:732-739.
8.
Moisseiev E, Davidovitch Z, Kinori M, et al: Vitrectomy for idiopathic epiretinal membrane in elderly patients: surgical outcomes and visual prognosis. Curr Eye Res 2012;37:50-54.
9.
Thompson JT: Epiretinal membrane removal in eyes with good visual acuities. Retina 2005;25:875-882.
10.
Dugas B, Ouled-Moussa R, Lafontaine PO, et al: Idiopathic epiretinal macular membrane and cataract extraction: combined versus consecutive surgery. Am J Ophthalmol 2010;149:302-306.
11.
Lee JY, Kim KH, Shin KH, et al: Comparison of intraoperative complications of phacoemulsification between sequential and combined procedures of pars plana vitrectomy and cataract surgery. Retina 2012;32:2026-2033.
12.
Savastano A, Savastano MC, Barca F, et al: Combining cataract surgery with 25-gauge high-speed pars plana vitrectomy: results from a retrospective study. Ophthalmology 2014;121:299-304.
13.
Yiu G, Marra KV, Wagley S, et al: Surgical outcomes after epiretinal membrane peeling combined with cataract surgery. Br J Ophthalmol 2013;97:1197-1201.
14.
Bae SH, Kim D, Park TK, et al: Preferential hyperacuity perimeter and prognostic factors for metamorphopsia after idiopathic epiretinal membrane surgery. Am J Ophthalmol 2013;155:109-117.
15.
Shiono A, Kogo J, Klose G, et al: Photoreceptor outer segment length: a prognostic factor for idiopathic epiretinal membrane surgery. Ophthalmology 2013;120:788-794.
16.
Suh MH, Seo JM, Park KH, et al: Associations between macular findings by optical coherence tomography and visual outcomes after epiretinal membrane removal. Am J Ophthalmol 2009;147:473-480.
17.
Oster SF, Mojana F, Brar M, et al: Disruption of the photoreceptor inner segment/outer segment layer on spectral domain-optical coherence tomography is a predictor of poor visual acuity in patients with epiretinal membranes. Retina 2010;30:713-718.
18.
Wolf-Schnurrbusch UE, Ceklic L, Brinkmann CK, et al: Macular thickness measurements in healthy eyes using six different optical coherence tomography instruments. Invest Ophthalmol Vis Sci 2009;50:3432-3437.
19.
Alkabes M, Salinas C, Vitale L, et al: En face optical coherence tomography of inner retinal defects after internal limiting membrane peeling for idiopathic macular hole. Invest Ophthalmol Vis Sci 2011;52:8349-8355.
20.
Sayegh RG, Georgopoulos M, Geitzenauer W, et al: High-resolution optical coherence tomography after surgery for vitreomacular traction: a 2-year follow-up. Ophthalmology 2010;117:2010-2017.
21.
Arndt C, Rebollo O, Seguinet S, et al: Quantification of metamorphopsia in patients with epiretinal membranes before and after surgery. Graefes Arch Clin Exp Ophthalmol 2007;245:1123-1129.
22.
Pilli S, Lim P, Zawadzki RJ, et al: Fourier-domain optical coherence tomography of eyes with idiopathic epiretinal membrane: correlation between macular morphology and visual function. Eye (Lond) 2011;25:775-783.
23.
Hwang JU, Sohn J, Moon BG, et al: Assessment of macular function for idiopathic epiretinal membranes classified by spectral-domain optical coherence tomography. Invest Ophthalmol Vis Sci 2012;53:3562-3569.
24.
Inoue M, Morita S, Watanabe Y, et al: Inner segment/outer segment junction assessed by spectral-domain optical coherence tomography in patients with idiopathic epiretinal membrane. Am J Ophthalmol 2010;150:834-839.
25.
Mitamura Y, Hirano K, Baba T, et al: Correlation of visual recovery with presence of photoreceptor inner/outer segment junction in optical coherence images after epiretinal membrane surgery. Br J Ophthalmol 2009;93:171-175.
26.
Inoue M, Arakawa A, Yamane S, et al: Long-term outcome of preoperative disrupted inner/outer segment junctions assessed using spectral-domain optical coherence tomography in patients with idiopathic epiretinal membrane. Ophthalmologica 2012;228:222-228.
27.
Kim HJ, Kang JW, Chung H, et al: Correlation of foveal photoreceptor integrity with visual outcome in idiopathic epiretinal membrane. Curr Eye Res 2014;39:626-633.
28.
Mitamura Y, Ohtsuka K: Relationship of dissociated optic nerve fiber layer appearance to internal limiting membrane peeling. Ophthalmology 2005;112:1766-1770.
29.
Kauffmann Y, Ramel JC, Lefebvre A, et al: Preoperative prognostic factors and predictive score in patients operated on for combined cataract and idiopathic epiretinal membrane. Am J Ophthalmol 2015;160:185-192.
30.
Treumer F, Bunse A, Rudolf M, et al: Pars plana vitrectomy, phacoemulsification and intraocular lens implantation. Comparison of clinical complications in a combined versus two-step surgical approach. Graefes Arch Clin Exp Ophthalmol 2006;244:808-815.
31.
Demetriades AM, Gottsch JD, Thomsen R, et al: Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology. Am J Ophthalmol 2003;135:291-296.
32.
Mochizuki Y, Kubota T, Hata Y, et al: Surgical results of combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation. Eur J Ophthalmol 2006;16:279-286.
© 2016 S. Karger AG, Basel
2016
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