Clinical course and surgical treatment of macular epiretinal membranes in young subjects

Objective: To examine the surgical and nonsurgical visual outcomes of young subjects with idiopathic macular epiretinal membranes (ERMs). Design: Retrospective observational and noncomparative interventional case series. Participants: Nineteen consecutive subjects (20 eyes) aged 40 years or less with an idiopathic macular ERM. Methods: Group 1: 10 consecutive eyes were initially seen with visual acuity of 20/50 or better; 7 eyes were observed, and 3 eyes with progressive visual loss to <20/50 underwent vitrectomy and membrane peeling. Group 2: 10 consecutive eyes with presenting visual acuity of 20/60 or worse underwent vitrectomy and membrane peeling. Main Outcome Measures: Visual acuity, cataract formation, ERM recurrence, operative complications. Results: Group 1: With no surgery, visual acuity remained stable or improved in 5 of 10 eyes (50%), with a mean follow-up of 3.7 years. Three of 10 eyes (30%) had visual loss 20/60 develop and underwent vitrectomy. Postoperative visual acuity improved an average of 6 lines with a mean follow-up of 17.6 months. Group 2: After vitrectomy, visual acuity improved 2 or more lines in 7 of 10 eyes (70%), with a mean improvement of 4.4 lines and mean follow-up of 29.2 months, Groups 1 and 2: Three of 13 eyes (23%) that underwent vitrectomy had recurrent ERM formation. Conclusions: Young subjects with idiopathic macular ERMs and a presenting visual acuity of 20/50 or better had a favorable visual outcome with observation. Subjects with an initial vision of 20/60 or worse, or those who had a visual decrease to less than or equal to 20/60 had significantly improved visual acuity after vitrectomy. ERM recurrence is relatively high after surgery. Ophthalmology 2001;108:23-26 (C) 2001 by the American Academy of Ophthalmology.