SURGICAL OUTCOMES OF EPIRETINAL MEMBRANES ASSOCIATED WITH COMBINED HAMARTOMA OF THE RETINA AND RETINAL PIGMENT EPITHELIUM

Purpose: To determine the surgical outcomes of epiretinal membranes associated with combined hamartoma of the retina and retinal pigment epithelium after pars plana vitrectomy and membrane peeling with or without assistance of autologous plasmin enzyme. Methods: Retrospective review of 11 pediatric eyes that underwent pars plana vitrectomy with membrane peeling with or without autologous plasmin enzyme. Preoperative and postoperative assessments of visual function and retinal architecture were performed by indirect ophthalmoscopy, optical coherence tomography imaging, fundus photography, and measurement of visual acuity. Results: The mean age of the patients was 4.6 years (range, 1-14). Mean follow-up was 15.6 months (range, 6-42 months). The lesions were located solely in the macula in 8 of 11 (73%) patients and in the macula and posterior pole in 3 of 11 (27%) patients. Of the 11 eyes, 6 were preoperatively injected with autologous plasmin enzyme to assist in removal of the posterior hyaloid. All 11 patients (100%) had complete macular reattachment postoperatively. Eight of 11 (73%) showed improved visual acuity postoperatively, and 3 of 11 showed stabilized vision. Eight eyes required only one surgery. Four eyes (36.6%) had recurrences of epiretinal membrane, and three of these eyes required additional surgery. Of the eyes with preoperative plasmin injection, 4 of 6 (66%) showed an improvement in visual acuity whereas 2 of 6 (33%) showed stabilization of visual acuity. Four of five without plasmin showed visual improvement, and one of five had stabilization of vision. Conclusion: In the pediatric population, pars plana vitrectomy with membrane peeling with or without the use of autologous plasmin enzyme for epiretinal membrane associated with combined hamartomas of the retina and retinal pigment epithelium can result in improved retinal architecture and visual acuity. Visual acuity may improve despite recurrence of the epiretinal membrane. RETINA 29:825-830, 2009