Peeling of secondary epiretinal membrane in uveitis-functional improvement to be expected?

There is a paucity of information regarding the results of patients with uveitis and secondary epiretinal membrane (sERM) who undergo pars plana vitrectomy and membrane peeling. This study aims to analyse the functional and anatomical outcomes and possible prognostic factors of a large cohort of eyes with uveitis-associated sERM who underwent vitrectomy with epiretinal membrane peeling.

The results of 76 eyes of 76 consecutive patients with uveitis-associated sERM who underwent pars plana vitrectomy with membrane peeling were analysed. The mean follow-up duration was 42.7 ± 47.9 months. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) before and after intervention were measured. Furthermore, demographic data, type of uveitis according to the Standardization of Uveitis Nomenclature (SUN) classification, benefit of additional peeling of the Membrana limitans interna (ILM), activity status of the uveitis at the time of surgery, lens status and postoperative complications were evaluated. Statistical tests included paired t tests, Wilcoxon signed-rank tests, Mann‒Whitney tests, and Kruskal‒Wallis H tests. Statistical significance was defined as p < 0.05; Holm‒Bonferroni correction was employed to address the cumulative risk of false-positive outcomes (type I error).

CRT improved from 421.2 ± 133.2 µm prior to surgery to 331.7±142.5 µm at the final follow-up (p = 0.069), whereas BCVA deteriorated from a mean of 0.49 ± 0.30 logMAR to 0.56 ± 0.60 logMAR in the overall cohort (p > 0.99). The rate of concomitant cystoid macular edema decreased from 42.4% to 34.3%.

The indications for membrane peeling in patients with a secondary epiretinal membrane and uveitis should be considered carefully. Anatomical features can be positively influenced by pars plana vitrectomy with ERM peeling, whereas BCVA may only result in beneficial changes in carefully selected patients.