De Clerck Ivo, Zeyen Alexander, Sierens Lennart, Cornelis Stijn, Van Calster Joachim, Jansen Joyce, Stalmans Peter
Military Hospital Queen Astrid, Belgium; and.
University Hospitals Leuven, Belgium.
Retina. 2025 Oct 1;45(10):1878-1885. doi: 10.1097/IAE.0000000000004559.
To report surgical outcomes of (combined) pars plana vitrectomy with epiretinal membrane (ERM) and inner limiting membrane peeling, validate the Govetto OCT-based staging system for idiopathic ERM, and assess the prevalence of postsurgical macular edema (PSME) relative to Govetto stages.
Retrospective study of 996 consecutive eyes undergoing (combined) pars plana vitrectomy with ERM and inner limiting membrane peeling for idiopathic ERM (2015-2023) at University Hospitals Leuven. Eyes with secondary ERM or significant ocular comorbidities were excluded. Visual outcomes were analyzed using Govetto optical coherence tomography stages. Clinically relevant PSME was defined as intraretinal cysts on optical coherence tomography requiring treatment.
The median best-corrected visual acuity improved from 20/40 preoperatively to 20/25 at final follow-up (median 15 months). Vision worsened (>0.1 LogMAR) in 6.49% of eyes. Preoperative best-corrected visual acuity strongly predicted postoperative vision (estimate = 0.22, P < 0.001). Significant interstage differences in best-corrected visual acuity existed preoperatively and at 2 months postoperatively; however, only stage 4 remained significantly worse at long-term follow-up. Epiretinal membrane foveoschisis (4.17%) outcomes resembled stage 2 ERM. Clinically relevant PSME occurred in 23.19% of eyes, strongly correlated with higher Govetto stages, especially stage 4 (44.12%). Combined phacovitrectomy significantly increased PSME prevalence (23.19% vs. 15.93%, P = 0.01) without affecting visual outcomes.
(Combined) pars plana vitrectomy with ERM and inner limiting membrane peeling effectively improves visual acuity in idiopathic ERM. Govetto staging reliably predicts early postoperative outcomes, while PSME incidence correlates strongly with higher Govetto stages. Epiretinal membrane foveoschisis resembles stage 2 ERM, highlighting the importance of distinguishing it from lamellar macular holes.
报告玻璃体视网膜联合手术治疗特发性视网膜前膜（ERM）及内界膜剥除术的手术效果，验证基于Govetto OCT的特发性ERM分期系统，并评估相对于Govetto分期的术后黄斑水肿（PSME）患病率。
对鲁汶大学医院2015 - 2023年间996例连续行玻璃体视网膜联合手术治疗特发性ERM及内界膜剥除术的患眼进行回顾性研究。排除继发性ERM或有严重眼部合并症的患眼。使用Govetto光学相干断层扫描分期分析视力结果。临床相关的PSME定义为光学相干断层扫描显示需要治疗的视网膜内囊肿。
最佳矫正视力中位数从术前的20/40提高到最后随访时的20/25（中位随访时间15个月）。6.49%的患眼视力下降（>0.1 LogMAR）。术前最佳矫正视力强烈预测术后视力（估计值 = 0.22，P < 0.001）。术前及术后2个月时，最佳矫正视力在各分期之间存在显著差异；然而，长期随访时仅4期仍显著较差。视网膜前膜性黄斑劈裂（4.17%）的结果类似于2期ERM。临床相关的PSME发生在23.19%的患眼中，与较高的Govetto分期密切相关，尤其是4期（44.12%）。联合晶状体玻璃体切除术显著增加了PSME患病率（23.19%对15.93%，P = 0.01），但不影响视力结果。
玻璃体视网膜联合手术治疗特发性ERM及内界膜剥除术可有效提高视力。Govetto分期能可靠地预测术后早期结果，而PSME发生率与较高的Govetto分期密切相关。视网膜前膜性黄斑劈裂类似于2期ERM，凸显了将其与板层黄斑裂孔区分开来的重要性。
