Use of systemic steroid after successful macular surgery in eyes with epiretinal membrane: a randomized, controlled clinical study

Abstract

Purpose: To evaluate the functional and morphological outcomes of postoperative systemic steroid therapy after successful macular surgery in eyes with macular edema due to idiopathic macular epiretinal membranes (ERMs).

Design: Prospective, randomized, investigator-masked, controlled clinical study.

Methods: Twenty-eight patients scheduled for 23-gauge vitrectomy combined with ERM and inner limiting membrane (ILM) peeling for macular edema due to ERM were included in this single center trial. Patients were randomized to receive oral steroid therapy (Prednisolone, 100 mg per day for 5 days) or no oral steroid (control group) after surgery. Main outcome measures included best corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study), central retinal thickness (CRT), retinal volume (RV), and macular morphology as determined by spectral domain optical coherence tomography (SD-OCT, Cirrus). Examinations were carried out preoperatively and at week 1, at months 1 and 3, postoperatively.

Results: At month 3, mean BCVA improved to a eight-letter gain in each study group (P<0.01 compared with baseline for both groups), showing no statistically significant difference between both the groups (P=0.19). Morphologically, retinal surface folds resolved within 1 month after surgery in both treatment groups, followed by a progressive recovery of retinal layer integrity and a statistical significant (P<0.01) decrease in CRT and RV without significant differences between both groups (P=0.62, P=0.13, respectively, ANOVA between the groups).

Conclusion: The early postoperative use of systemic steroid treatment after successful vitrectomy combined with ERM and ILM peeling does not seem to improve significantly the anatomic and functional outcomes in eyes with ERM.

Figure 1

Course of BCVA at 12 weeks follow-up comparing steroid treatment with no steroid treatment after macular surgery for macular edema due to idiopathic ERM. Data are presented as means. P>0.05 between the groups. ETDRS, early treatment of diabetic retinopathy study protocol vision chart.

Figure 2

Course of CRT at 12 weeks follow-up comparing steroid treatment with no steroid treatment after macular surgery for macular edema due to idiopathic ERM. Data are presented as means. P>0.05 between the groups.

Figure 3

Macular morphology. Cirrus SD-OCT B-scans (left column) and retinal thickness maps (right column) of a representative case from each treatment group during follow-up. Panels (a–c) show scans of a patient from the steroid group: 3a=baseline, 3b=month 1, and 3c=month 3. Panels (d–f) show scans of a patient from the control group: 3d=baseline, 3e=month 1, and 3f=month 3. In both the cases, the mild preoperative retinal wrinkling similarly resolved, the retinal thickness decreased, and the retinal layer integrity was restored.