Authors: Jean-Paul Berrod, R. Ouled-Moussa, I. Hubert, P. Genin-Perriguey, Nancy, France

Advantages:

Combined phaco-vitrectomy for epimacular membrane surgery prevents the need of a second operation but may induce macular edema. 25-Gauge vitrectomy minimizing ocular trauma might be the best standard.

Methods:

Retrospective study of 111 eyes operated on between 2001 and 2006 divided into 4 groups with two years follow up.

Group 1 consisted of 41 eyes operated on cataract and ERM with 20-Gauge vitrectomy; Group 2: 31 eyes operated on cataract and ERM with 25-Gauge vitrectomy; Group 3: 18 pseudophakic eyes operated on ERM with 20-Gauge; Group 4: 21 pseudophakic eyes operated on ERM with 25-Gauge. Internal limited membrane was peeled off in all cases without dye; macular thickness was assessed pre- and post-operatively with optical tomography (OCT) using radial lines.

Effectiveness / Safety:

Phaco-vitrectomy had no adverse effect on functional results and gave same good and stable vision at 24 months as vitrectomy alone in pseudophakics. Small Gauge gave better postoperative comfort without rhegmatogenous or infectious complications. Functional results were identical using 20-Gauge or 25-Gauge vitrectomy.

Take home message:

Phaco-vitrectomy for ERM is a safe and effective procedure that can be proposed to every patient over 60 in order to avoid the need for a second operation. Functional results are identical whatever the standard of vitrectomy.