Staged Versus Combined Cataract Surgery For Cataract And Govetto Stage 3 Epiretinal Membranes

To compare the efficacy and safety of staged versus combined surgical approach for patients with concomitant cataract and stage 3 epiretinal membrane (ERM) over 1 year.

Tertiary eye hospital in Singapore.

A randomised, prospective study of 20 patients with cataract and ERM of Govetto staging 3 were enrolled into the study. Other inclusion criteria included best corrected visual acuity of 6/15 or worse. Patients were randomized into the staged or combined surgical approach, with the staged group having cataract surgery only and the combined group having cataract surgery and ERM peel together. Visual outcomes were measured based on visual acuity, M-Chart, and OCT macula changes over 1 year. Chi-square and multiple linear regression models were performed, and results were significant if p<0.05.

There was no statistically significant difference in patients with stage 3 ERMs between the staged group and combined group regarding visual acuity at 1 year (66.9 vs 70.9 ETDRS letters, p = 0.13). There was also no significant difference between M-chart measurements (0.6 vs 0.5, p = 0.2) and microperimetry thresholds (25.7db vs 24.8db, p = 0.1). Macular volume changes were similar in the central 1mm of the Early Treatment Diabetic Retinopathy Study grid.

Our pilot study shows that patients with stage 3 ERMs who undergo staged procedures have similar outcomes as those who undergo combined procedures. This may suggest that a staged approach is appropriate for stage 3 ERMs. However, larger studies are required to determine if there is a significant difference between a staged and combined approach.