Giant Retinal Tear-Associated Detachment Surgery Has High Epiretinal Membrane Risk

Eyes receiving pars plana vitrectomy (PPV) for giant retinal tear-associated retinal detachment (GRT-RD) may develop epiretinal membrane (ERM) significantly more often than those undergoing routine rhegmatogenous retinal detachment (RRD) surgery, according to a study published in Clinical Ophthalmology. Data shows an approximately 70% incidence in a cohort at the tertiary center, West Virginia University Eye Institute, Morgantown.

Investigators reviewed records of 78 individuals identified by ICD-10 codes for primary giant retinal tear-associated retinal detachment repair with PPV or dual PPV–scleral buckle. Of the sample, 16 patients (17 eyes) met criteria such as no existing ERM or prior membrane peel. Participants underwent surgery between September 2010 and July 2021. Researchers manually evaluated optical coherence tomography (OCT) images.

ERM developed in 13 eyes (70.6%). Variables such as cryopexy, endodiathermy, number or clock-hours of the retinal tear, or medium-term tamponade with perfluorocarbon liquid (PFCL) did not correlate to greater ERM incidence in this study. All individuals experienced structural success. Mean best-corrected visual acuity (BCVA) in logMAR for those with macula-on detachments was 0.19 (range 0 to 0.5) preoperatively, and 0.28 (0 to 0.5) at final visit. Eyes with macula-off giant retinal tear-associated retinal detachment improved from 1.7 (0.5 to 2.3) to 0.7 (0.2 to 1.9).

The study authors suggest that primary internal limiting membrane (ILM) peel is a less feasible approach in the context of giant retinal tear-associated retinal detachment repair — proposing instead an ILM peel when silicon oil or medium-term PFCL is removed, if tamponade was employed. “When the gas tamponade is pursued without primary ILM peel at the time of initial repair, closer monitoring of the ERM progression may be warranted,” the researchers explain.

Limitations of this analysis comprise a small sample size, retrospective design, and no pre-set protocols to standardize surgeries. Follow-up appointment intervals also varied. However, this investigation provides data on post-PPV incidence of ERM unique to giant retinal tear-associated retinal detachment.