Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE) study: findings at 3 months

Abstract

Background: The purpose of this paper is to report the 3-month findings of the Prospective Retinal and Optic Nerve Vitrectomy Evaluation (PROVE) study.

Methods: Eighty eyes of 40 participants undergoing vitrectomy were enrolled. Participants underwent baseline evaluation of the study (surgical) and fellow (control) eye that included: intraocular pressure, central corneal thickness, gonioscopy, cup-to-disc ratio measurement, color fundus and optic disc photography, automated perimetry, and optical coherence tomography of the macula and optic nerve. Evaluation was repeated at 3 months. Main outcome measures were changes in macula and retinal nerve fiber layer (RNFL) thickness and intraocular pressure.

Results: All participants completed follow-up. Mean cup-to-disc ratio of study and fellow eyes at baseline was 0.43 ± 0.2 and 0.46 ± 0.2, respectively, and 13% of participants had undiagnosed narrow angles. There was no significant change in intraocular pressure, cup-to-disc ratio, or pattern standard deviation in study eyes compared with baseline or fellow eyes at 3 months. Vision improved in all study eyes at 3 months compared with baseline (P = 0.013), but remained significantly worse than fellow eyes (P < 0.001). Central subfield and temporal peripapillary RNFL thickness were significantly greater in eyes with epiretinal membrane (P < 0.05), and resolution after surgery correlated with visual improvement (P < 0.05).

Conclusion: The 3-month results do not indicate any increased risk for open-angle glaucoma but suggest that a relatively high percentage of eyes may be at risk of angle closure glaucoma. Temporal RNFL thickness and central subfield were increased in eyes with epiretinal membrane, and resolution correlated with degree of visual recovery.

Keywords: epiretinal membrane; intraocular pressure; macular hole; open-angle glaucoma; vitrectomy.

Figure 1

Representative images and test results for a patient with macular hole in the right eye and normal left eye are shown. (A) Optic nerve photographs, automated visual field test results, and SD-OCT of the optic nerve. (B) Fundus photographs, fundus autofluorescence, and SD-OCT of the macula Abbreviations: SD-OCT, spectral domain-optical coherence tomography; OD, right eye; OS, left eye.

Figure 2

Mean central subfield thickness (CSF) in eyes with epiretinal membrane at baseline and 3 months after surgery Notes: Black diamonds and gray squares represent study and fellow eyes, respectively. *P < 0.001 compared to baseline and to fellow eyes.

Figure 3

Scatter plot showing the change in central subfield thickness in eyes with epiretinal membrane from baseline on the y-axis versus change in vision in logarithm of the minimum angle of resolution (logMAR) units from baseline on the x-axis (r = 0.69; P < 0.001). The diagonal line represents the best-fitted linear regression. Negative values for central subfield thickness and logMAR vision indicate reduction in thickness and improvement in vision from baseline, respectively Abbreviations: CSF, central subfield thickness; BCVA, best-corrected visual acuity; logMAR, logarithm of the minimal angle of resolution.

Figure 4

Scatter plot showing the change in T-RNFL thickness in eyes with epiretinal membrane from baseline on the y-axis versus change in vision in logMAR units from baseline on the x-axis (r = 0.56; P = 0.007). The diagonal line represents the best-fitted linear regression Abbreviations: T-RNFL, temporal peripapillary retinal nerve fiber layer; BCVA, best-corrected visual acuity; logMAR, logarithm of the minimal angle of resolution.

Figure 5

Fundus photograph (A), SD-OCT image of the macula (B) and SD-OCT optic nerve analysis (C) illustrating thickened T-RNFL in a patient with epiretinal membrane of the macula in the right eye compared with the fellow control eye. Note that the T-RNFL measures 130 μm in the eye with epiretinal membrane compared with 63 μm in the normal left eye Abbreviations: SD-OCT, spectral-domain optical coherence tomography; RNFL, retinal nerve fiber layer; OD, right eye; OS, left eye; TEMP, temporal; SUP, superior; NAS, nasal; INF, inferior; S, superior; T, temporal; I, inferior; N, nasal.