Myopic Shift and Cataract Change after Lens Sparing Vitrectomy in Patients with Idiopathic Epiretinal Membrane in Their 5th and 6th Decade

Jae Jung Lee; Kyung Ho Kim; Min Kyu Shin; Sung Who Park; Ik Soo Byon; Ji Eun Lee; Boo Sup Oum

doi:10.3341/jkos.2015.56.7.1038

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Lee, Kim, Shin, Park, Byon, Lee, and Oum: Myopic Shift and Cataract Change after Lens Sparing Vitrectomy in Patients with Idiopathic Epiretinal Membrane in Their 5th and 6th Decade

Original Article

J Korean Ophthalmol Soc 2015;56(7):1038-1043.

Published online: 27 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.7.1038

Myopic Shift and Cataract Change after Lens Sparing Vitrectomy in Patients with Idiopathic Epiretinal Membrane in Their 5th and 6th Decade

Jae Jung Lee, M.D¹, Kyung Ho Kim, M.D^2,⁴, Min Kyu Shin, M.D^1,³, Sung Who Park, M.D^1,^3,, Ik Soo Byon, M.D^2,⁴, Ji Eun Lee, M.D, PhD^1,³, Boo Sup Oum, M.D, PhD⁵

Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine^¹, Busan, Korea

Department of Ophthalmology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea

Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

Jung Geun Eye Hospital, Busan, Korea

Address reprint requests to Sung Who Park, MD Department of Ophthalmology, Pusan National University Hospital, #179 Gudeok-ro, Seo-gu, Busan 602-739, Korea Tel: 82-51-240-7320, Fax: 82-51-242-7341 E-mail: oph97@naver.com

∗ This work was supported by clinical research grant from Pusan National University Hospital 2015.

Received 5 December 20148 April 2015 Accepted 4 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To determine the myopic shift and cataract change after lens sparing vitrectomy (LSV) in patients with idiopathic epi-retinal membrane (ERM) in their 5th and 6th decade of life.

Methods:

The medical records of patients undergoing LSV for idiopathic ERM from 2008 to 2012 were reviewed. Patients with previous intraocular surgery, preoperative significant cataract, under 40 or over 60 years of age and a follow-up period of less than 6 months were excluded. The change in refractive errors, visual acuity, and cataract grade were evaluated for 6 months af-ter LSV as well as the correlation between myopic shift and cataract change at 6 months after LSV.

Results:

Twenty-eight eyes were included in this study. The cataract status worsened by 1.07 levels, myopia progressed by 3.13 diopters ( p < 0.001), and uncorrected visual acuity (log MAR) decreased from 0.73 to 0.98 ( p = 0.022) at 6 months after LSV. Additional cataract surgery was performed in 22 eyes (78.6%) at 13.6 months on average during the follow-up period (average 16.9 months). In 6 eyes (21.4%) having myopic change below 1.0 diopters, crystalline lens was preserved for 36 months after vitrectomy. Conversely, 22 eyes (78.6%) with myopic change over 1.5 diopters required cataract surgery. Therefore, myopic change over 1.5 diopters could be a major postoperative change predicting the necessity for cataract surgery ( p < 0.001).

Conclusions:

LSV for ERM caused a significant myopic shift and cataract changes in patients in their 5th and 6th decade of life and additional cataract surgery was required in 78.6% of patients within 3 years after vitrectomy. The myopic shift over 1.5 diop-ters at 6 months after vitrectomy could be a major postoperative change predicting the necessity for cataract surgery.

Keywords: Cataract, Epiretinal membrane, Lens sparing vitrectomy, Myopia

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Figure 1.

Kaplan-Meier survival curve of crystal lens after lens sparing vitrectomy. 78.6% of patients needed additional cataract surgery during 3 years after vitrectomy.

Figure 2.

Kaplan-Meier survival curve of crystal lens accord-ing to age (5th and 6th decade) after lens sparing vitrectomy. There was no significant difference of survival rate between two age groups in 3 years after vitrectomy ( p = 0.288 by Fisher exact test).

Table 1.

Comparisons of data between baseline and 6 months after vitrectomy

	Preoperative value	Postoperative 6-months	p-value
LOCS III grading of nucleus	0.9 ± 0.9	1.9 ± 1.2	<0.001^*
Corrected V.A. (log MAR)	0.51 ± 0.30	0.52 ± 0.35	0.471
Uncorrected V.A. (log MAR)	0.73 ± 0.42	0.98 ± 0.50	0.022^*
Spherical equivalent (D)	-0.89 ± 2.76	-4.02 ± 3.47	<0.001^*
CSMT (um)	499.0 ± 99.6	360.6 ± 41.7	<0.001^∗

Values are presented as mean ± SD. LOCS III = Lens Opacities Classification System III; V.A. = visual acuity; D = diopters; CSMT = central subfield macular thickness.

^∗ p < 0.05 by Wilcoxon signed rank test.

Table 2.

Differences according to myopic shift at 6 months after vitrectomy

	Myopic shift less than -1.0 Diopters	Myopic shift more than -1.5 Diop	ters p-value
Number of patients	6 (21.4)	22 (78.6)
Age (years)	53.0 ± 4.4	52.0 ± 2.0	0.259
Corrected V.A. (log MAR)	0.28 ± 0.16	0.5 ± 0.37	0.065
Uncorrected V.A. (log MAR)	0.52 ± 0.32	0.95 ± 0.46	0.007^*
Spherical equivalent (Diopter)	-0.74 ± 1.12	-3.69 ± 3.35	<0.001^*
CSMT (um)	372.5 ± 39.1	351.7 ± 42.6	0.309
Worsened cataract grade	2 (33.3)	20 (90.9)	0.010^*
Cataract operation during 3 years	0 (0)	22 (100)	<0.001^∗

Values are presented as mean ± SD or n (%).

V.A. = visual acuity; CSMT = central subfield macular thickness.

^∗ p < 0.05 by Mann-Whitney U-test or Fisher exact test.

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