Impact of epiretinal membrane peeling on steroid dependency in uveitic eyes: a retrospective analysis

Abstract

Background: Secondary epiretinal membranes (sERM) are common in uveitis and often associated with cystoid macular edema (CME), which increases the need for anti-inflammatory treatment. While surgical removal can improve anatomical and visual outcomes, its effect on intraocular inflammation and steroid requirement remains unclear. This study evaluates whether vitrectomy with ERM peeling can reduce the need for postoperative steroid therapy in uveitic eyes.

Methods: This retrospective single-center study reviewed 67 eyes of 67 patients with history of uveitis who underwent sERM peeling between 11/2002 and 04/2023. Demographic data, uveitis classification (SUN), spectral domain optical coherence tomography (SD-OCT) findings, and pre-/postoperative steroid requirements were analyzed. Statistical significance testing was performed using a paired two-tailed t-test.

Results: Of the 67 eyes, 50.7% were right eyes, and 65.7% of patients were female. Mean age at timepoint of surgery was 63.1 ± 13.6 years, with 53.7% phakic eyes. Uveitis was classified as anterior (17.9%), intermediate (44.8%), posterior (31.3%), and panuveitis (6.0%). Steroid therapy was reduced in 28.4% of patients, remained unchanged in 56.7%, and increased in 14.9%. Preoperatively, cystoid macular edema (CME) was present in 41.4% of the 58 available SD-OCT scans. Postoperatively, retinal thickness, macular volume, and total retinal volume decreased significantly (p < 0.001). Postoperative CME was found in 31.3% in first postoperative SD-OCT and was newly observed in 6.0%, while 62.7% showed no CME.

Conclusions: ERM peeling in uveitic eyes does not guarantee functional improvement or a consistent reduction in steroid dependency. While approximately one-third of patients benefited from reduced steroid use-particularly those with preoperative CME-the majority showed no change, and a subset required intensified therapy due to postoperative inflammation or CME recurrence. Careful patient selection remains essential.

Keywords: Cystoid macular edema; Epiretinal membrane; Membrane peeling; Steroids; Uveitis.

Fig. 1

Flow chart of the cases included in the evaluation. Abbreviations: PPV - pars plana vitrectomy; SD-OCT - spectral domain optical coherence tomography; sERM – secondary epiretinal membrane

Fig. 2

Spectral Domain Optical Coherence Tomography (SD-OCT) of a left eye. (A) Preoperative SD-OCT of a 46-year-old woman diagnosed with non-infectious posterior uveitis. The SD-OCT reveals focal traction in an epiretinal membrane (ERM), characterized by small, focal adhesions with hyporeflective spaces between the ERM and the internal limiting membrane (ILM), typical for uveitic ERM. Best-corrected visual acuity (BCVA) is 0.3 logMAR. Central retinal thickness (CRT) is 528 μm. (B) Five-year postoperative SD-OCT without ERM recurrence or macular edema and BCVA of -0.1 logMAR

Fig. 3

Spectral Domain Optical Coherence Tomography (SD-OCT) of a left eye of a 68-year-old man diagnosed with intermediate uveitis. (A) Preoperative SD-OCT: Shows an epiretinal membrane (ERM) with hyporeflective spaces between the ERM and the internal limiting membrane (ILM). The patient received two dexamethasone implants preoperatively. Best-corrected visual acuity (BCVA) was 0.8 logMAR. (B) Three months postoperative SD-OCT: No signs of cystoid macular edema (CME) are present, with improved BCVA at 0.3 logMAR. (C) One-year postoperative SD-OCT: Development of CME is observed, accompanied by a decline in visual acuity to 0.4 logMAR. Decision for a dexamethasone implant was made