Epiretinal Membrane Surgery Using Intraoperative OCT-guided Membrane Removal in the DISCOVER Study versus Conventional Membrane Removal.

Abstract

PURPOSE\nTo provide a comparative assessment of clinical outcomes between subjects undergoing intraoperative optical coherence tomography (OCT) and conventional surgery for pars plana vitrectomy (PPV) with epiretinal membrane (ERM) peel.\n\n\nDESIGN\nCase-control retrospective comparative assessment SUBJECTS: Subjects undergoing PPV with membrane peel for ERMs with eyes pooled from the prospective intraoperative OCT (iOCT) DISCOVER study and eyes undergoing conventional ERM surgery without intraoperative OCT.\n\n\nMETHODS\nVisual acuity and OCT assessment before ERM surgery and at 1-, 3-, 6-, and 12-month follow up after standard small gauge pars plana vitrectomy (PPV) with iOCT feedback (iOCT DISCOVER group) or PPV with compulsory ILM peeling (conventional group). Visual acuity, central subfield thickness (CST), re-operation rate and ERM recurrence were determined by record review and post-hoc assessment of clinical OCTs after ERM peel.\n\n\nMAIN OUTCOME MEASURES\nVisual acuity and ERM recurrence RESULTS: A total of 262 eyes were included. Visual Acuity (VA) improved 12.9 letters in the iOCT group (p < 0.0001) and 11.5 letters in the conventional group (p < 0.0001) at 12 months after ERM surgery. VA improvement did not differ between iOCT and conventional group at 1, 3, 6, or 12 months after surgery (p > 0.05 for each time point). Preoperative mean central subfield thickness (CST) decreased in the iOCT group (p < 0.0001) and conventional group (p < 0.0001) with no difference between groups in CST reduction at 12 months (p = 0.36). There were no re-operations or visually significant recurrent ERMs in both cohorts.\n\n\nCONCLUSIONS\niOCT-guided ERM removal without mandated ILM peeling provided similar visual acuity and anatomic results to conventional ILM peeling for ERM. Future randomized prospective studies are needed to fully assess the possible role for iOCT in ERM surgery and evaluate the potential impact of non-foveal ERM persistence/recurrence in comparison to conventional surgery.