Chen Xuejing, Klein Kendra A, Shah Chirag P, Heier Jeffery S
Ophthalmic Surg Lasers Imaging Retina. 2018 Oct 15;49(10):S18-S22. doi: 10.3928/23258160-20180814-03.
Patients with idiopathic epiretinal membranes (ERMs) and visual acuity of 20/40 or better are often monitored until vision or associated symptoms worsen to affect everyday living. This study looks at the rate of progression to surgery and the characteristics associated with progression.
This study was a retrospective, consecutive case series of patients with newly diagnosed idiopathic ERMs who were referred to the Retina Service at the Ophthalmic Consultants of Boston between January 2009 and May 2015 with 20/40 or better visual acuity. Surgical membrane peel was typically offered when vision worsened to 20/50 or beyond and/or when patients could not tolerate symptoms attributable to the ERM. All eligible eyes were categorized by baseline optical coherence tomography (OCT) morphology into normal, mild or incomplete, or complete loss of foveal contour. Visual acuities were averaged through conversion to logMAR. Kaplan-Meier survival curves for progression to surgical membrane peel were calculated. The main outcome measure was progression to surgical intervention.
The study included 201 eyes from 170 patients; 29.8% had normal, 18.9% had mild loss, and 51.2% had complete loss of foveal contour on baseline OCT. Overall, 13% of eyes progressed to surgery at 7 years. However, only 5% of eyes with normal foveal contour progressed to surgery by 5.5 years, whereas 17% with incomplete and 16% with complete loss of foveal contour progressed to surgery at 6 and 7 years, respectively. Eyes with worse foveal contours progressed to surgery more rapidly.
A minority of patients with newly diagnosed ERMs who did not need surgical intervention progressed to needing surgery at 7 years with the rate and speed of progression dependent on baseline OCT morphology. These statistics can be useful in counseling patients who are deciding between watchful waiting and surgical intervention. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:S18-S22.].
特发性视网膜前膜（ERM）且视力为20/40或更好的患者通常会接受监测，直至视力或相关症状恶化到影响日常生活。本研究观察了进展至手术的比率以及与进展相关的特征。
本研究是一项回顾性、连续性病例系列研究，纳入了2009年1月至2015年5月间转诊至波士顿眼科顾问公司视网膜科、视力为20/40或更好的新诊断特发性ERM患者。当视力恶化至20/50或更差和/或患者无法耐受ERM所致症状时，通常会进行手术剥膜。所有符合条件的眼睛根据基线光学相干断层扫描（OCT）形态分为正常、轻度或不完全性、或中央凹轮廓完全丧失。通过转换为logMAR来计算平均视力。计算进展至手术剥膜的Kaplan-Meier生存曲线。主要结局指标是进展至手术干预。
该研究纳入了170例患者的201只眼；在基线OCT上，29.8%的患者中央凹轮廓正常，18.9%的患者轻度丧失，51.2%的患者中央凹轮廓完全丧失。总体而言，13%的眼睛在7年时进展至手术。然而，中央凹轮廓正常的眼睛中只有5%在5.5年时进展至手术，而中央凹轮廓不完全丧失和完全丧失的眼睛分别在6年和7年时，有17%和16%进展至手术。中央凹轮廓越差的眼睛进展至手术的速度越快。
少数新诊断的不需要手术干预的ERM患者在7年时进展至需要手术，进展的比率和速度取决于基线OCT形态。这些统计数据有助于为在密切观察等待和手术干预之间做决定的患者提供咨询。[《眼科手术、激光与视网膜成像》。2018；49：S18 - S22。]
