Secondary epiretinal membrane after Ex-Press glaucoma filtration device implant
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GLAUCOMA
Secondary epiretinal membrane after Ex-Press glaucoma filtration device implant Pasquale Loiudice 1
&
Francesco Sartini 1 & Michele Figus 1 & Marco Nardi 1 & Chiara Posarelli 1 & Giamberto Casini 1
Received: 19 July 2020 / Revised: 10 November 2020 / Accepted: 20 November 2020 # The Author(s) 2020
Abstract Purpose To estimate the frequency of epiretinal membrane (ERM) in eyes with primary open-angle glaucoma (POAG) treated with Ex-Press shunt implant. Secondarily, we aimed to assess the role of concomitant cataract surgery and the impact of the ERM on central foveal thickness and macular volume. Methods In this prospective, consecutive, case-control study, we enrolled 54 patients affected by PAOG and scheduled for ExPress device implant with or without contemporary phacoemulsification. Contralateral eyes affected by POAG and receiving anti-glaucomatous eyedrops constituted the control group. Complete ophthalmologic evaluation and spectral-domain optical coherence tomography (OCT) were performed before and 1, 3 and 6 months after surgery. Results Twenty-six eyes received the Ex-Press implant alone, and 28 eyes underwent the combined procedure. Six months postoperatively, we observed 18 (33%) cases of ERM: 15 (28%) of cellophane macular reflex (CMR) and 3 (6%) of pre-macular fibrosis (PMF). In the control group, 9 (17%) eyes developed an ERM: 8 (15%) were CMR, and 1 (2%) was PMF. The frequency of ERM statistically differs between treated and contralateral eyes (P = 0.032, χ2 test). The ERM frequency did not statically differ between eyes subjected to simple or combined surgery (P = 0.846, χ2 test). Mean central foveal thickness and mean macular volume did not significantly differ between groups. Conclusion The Ex-Press glaucoma shunt may increase the risk of ERM onset regardless of the concomitant cataract surgery; however, most cases were cellophane macular reflex with limited functional and anatomical impact. Keywords Cellophane macular reflex . Epiretinal membrane . Ex-press glaucoma filtration device . Glaucoma surgery . Macular pucker . Pre-macular fibrosis . Primary open-angle glaucoma
Key messages Ex-Press shunt implant is a widespread procedure for surgical treatment of glaucoma The frequency of epiretinal membrane was higher in eyes subjected to Ex-Press shunt implant than in naïve contralateral eyes Concomitant cataract surgery did not influence the onset of secondary epiretinal membrane
Introduction * Pasquale Loiudice [email protected] 1
Ophthalmology Unit, Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, Via Savi, 10, 56126 Pisa, Italy
Epiretinal membrane (ERM) is a fibrocellular proliferation at the vitreomacular interface, associated with symptomatology ranging from entirely asymptomatic to severe visual impairment with metamorphopsia, photopsia, micropsia, or macropsia and decline of central vision [1]. The pathogenesis
Graefes Arch Clin Exp Ophthalmol
of ERM has not yet been fully elucidated although it is currently regarded as re
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