Impact of surgical case order on epiretinal membrane peeling surgery

Abstract

Objective: To determine whether surgical warm-up affects epiretinal membrane (ERM) peeling complication rates and surgical case times.

Setting: Jewish General Hospital, Montreal, QC, Canada.

Design: Retrospective case-control study.

Methods: We assessed consecutive patients who underwent pars plana vitrectomy for ERM peel (macular pucker) by one surgeon at the Jewish General Hospital from January 2006 until March 2016. Cases evaluated were sequential ERM peels performed as the first 2 surgeries of the day. The first case of the day was considered the "warm-up" and the second case was the "post-warm-up." Baseline demographics, pre-operative characteristics, perioperative and postoperative best-corrected visual acuity (BCVA) at 2 months and 6 months, as well as postoperative complications are described. Results were analyzed using the χ² test, t test, and Fischer's exact test. Regression models were used to identify any predictors of postoperative BCVA.

Results: The study reviewed 108 patients. The warm-up group was compared with the post-warm-up group, and there was no significant difference between the mean pre-operative BCVA and the post-operative BCVA at 2 and 6 months. ERM peeling surgery complication rates were not statistically different between the warm-up cases and the post-warm-up cases. There was a tendency for performing complex surgeries that needed phaco procedures in post-warm-up cases (13% vs 2%, p = 0.03). Analysis of simple ERM peeling procedures (with no concomitant phaco procedures) showed no statistically significant tendencies for any of the groups to go beyond the 60 minutes allocated for the surgery (25.4% vs 20.0%, p = 0.27).

Conclusion: Warming-up does not influence the rate of postoperative complications or the postoperative BCVA in patients undergoing ERM peels. The strongest predictor of post-operative BCVA was pre-operative BCVA.