Incidence Rate of Epiretinal Membrane Post Cataract Surgery
The incidence rate of epiretinal membrane (ERM) after cataract surgery is approximately 11.2% over a 3-year period, with cellophane macular reflex developing in 6.6% and preretinal fibrosis in 4.2% of eyes that were free of ERM one month after surgery. 1
Prevalence and Detection Considerations
The accurate determination of ERM incidence after cataract surgery is complicated by several factors:
Pre-existing ERM detection issues: There is substantial under-detection of ERM before cataract surgery due to visualization difficulties through the cataract. In one study, ERM was detected in only 3.1% of eyes preoperatively but in 14.8% of the same eyes one month postoperatively, with poor diagnostic agreement (kappa = 0.17) 1
Baseline prevalence: The prevalence of ERM in eyes one month after cataract surgery has been reported as 13.9% 1
Age-related factors: The age-standardized 3-year incidence of ERM in post-cataract surgery eyes (12.1%) is significantly higher than the 5-year incidence in age-matched non-surgical eyes (4.4%) 1
Risk Factors for ERM Development or Progression After Cataract Surgery
Several vitreoretinal interface abnormalities have been identified as independent risk factors for ERM onset or progression following cataract surgery:
- Partial posterior vitreous detachment (PVD) (HR 3.743) 2
- Hyper-reflective foci on the inner retinal surface (HR 2.330) 2
- Discrete margin of different retinal reflectivity on ultra-widefield fundus photography (HR 3.392) 2
Notably, the development or progression of ERM after cataract surgery is not significantly associated with:
- Age
- Axial length
- Presence of ERM at the time of surgery 2
Clinical Implications and Outcomes
When ERM is present during cataract surgery:
- Visual acuity improvement: Eyes with ERM typically gain approximately 3 Snellen lines after cataract surgery (0.27 logMAR improvement) 3
- Comparison to eyes without ERM: This improvement is less than the 4 Snellen lines (0.44 logMAR) gained in eyes without ERM 3
- Preoperative vision impact: Eyes with ERM and preoperative VA of 20/40 or worse show more benefit from cataract surgery than those with better preoperative vision 3
Complications in Eyes with ERM Undergoing Cataract Surgery
- Cystoid macular edema: Significantly higher rate in ERM eyes (8.6%) compared to eyes without ERM (1.38%) 3
- Need for subsequent ERM surgery: Approximately 6.5% of eyes with ERM that undergo cataract surgery eventually require vitrectomy for ERM removal 3
Recommendations for Clinical Practice
Thorough preoperative assessment: Perform meticulous evaluation of the vitreoretinal interface using spectral-domain OCT and wide-field imaging to identify risk factors for ERM development or progression 2
Patient counseling: Inform patients with pre-existing ERM about:
- Expected visual improvement (approximately 3 lines)
- Higher risk of cystoid macular edema (8.6%)
- Possibility of requiring subsequent ERM surgery (6.5%)
Postoperative monitoring: Regular follow-up with OCT imaging to detect early ERM development or progression, particularly in patients with identified risk factors
Prophylactic measures: Consider more aggressive anti-inflammatory therapy post-cataract surgery in eyes with ERM to reduce the risk of cystoid macular edema
By understanding the incidence rate and risk factors for ERM after cataract surgery, ophthalmologists can better counsel patients and implement appropriate monitoring strategies to optimize visual outcomes.