Vitrectomy for Epiretinal Membrane Enhances Binocular Vision

Pars plana vitrectomy for epiretinal membrane (ERM) treatment can result in better monocular and binocular vision, including binocular fusion, and near and far stereopsis at 3 months after 25-gauge pars plana vitrectomy, according to a study published in Acta Ophthalmologica. Improved distance stereopsis is likely related to perceived quality of vision, along with visual acuity and contrast sensitivity (CS).

The researchers evaluated the fusional amplitude of 23 eyes of 23 participants (mean age, 66.61±7.37 years; 8 women, 15 men) before they underwent vitrectomy for epiretinal membrane. Patients were followed at postoperative months 1 and 3 — revealing significant 3-month improvement in convergence (P <.0001). Randot and TNO stereo tests that measured near stereopsis also showed important gains; (P =.0007) and (P <.0001), respectively. Notably, distance stereopsis assessed with polarized glasses revealed advances from 1661.7±1433 arc seconds to 383.48±840.34 arc seconds (P <.0001).

Further, 3 months after undergoing vitrectomy for epiretinal membrane, participants’ best-corrected visual acuity (BCVA) increased from 66.35±10.95 ETDRS to 77.39±6.58, and CS from 13.51±2.47 dB to 16.57±2.3 dB (both P <.0001). Central macular thickness (CMT)Dormegny L, Foch M, Messerlin A, et al. Binocular visual function improvement after pars plana vitrectomy for epiretinal membrane. Acta Ophthalmologica. Published online April 24, 2023. doi:10.1111/aos.15669 decreased significantly, from 482.96±79.99 µm at baseline to 386.39±61.36 µm at 3 months (P <.0001).

“Far distance stereopsis is rarely assessed although its post-operative recovery might be associated with a certain level of vision quality improvement,” the investigators explain. “Post-operative diplopia seems to be a rare complication when binocular visual function is assessed before surgery.” None of the participants experienced diplopia before or after vitrectomy for epiretinal membrane, though individuals with strabismus were excluded from this sample.

Most previous studies of epiretinal membrane have concentrated on near stereopsis. Reports include a finding that quality of life may rise before near stereopsis increases. Current researchers speculate fusional amplitudes or distance stereopsis could prompt the early quality of life enhancement. Analyses regarding contrast sensitivity have found that despite sustained BCVA, patients may be dissatisfied if CS is inadequate. In the present investigation, high spatial frequencies especially improved.

A limitation is the small sample size. Also, results with the retrospective design may have been affected by 3 patients who presented cataracts, potentially impacting data for binocular vision prior to pars plana vitrectomy for epiretinal membrane surgery.