Association of Epiretinal Membrane With Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma: Prevalence and Functional Impact.

PRCIS: Epiretinal membrane is more frequent in pseudoexfoliation glaucoma than in pseudoexfoliation syndrome or controls, and is independently associated with worse visual field sensitivity, in addition to retinal nerve fiber layer thinning.

PURPOSE: To investigate the prevalence and clinical implications of vitreomacular interface disease, particularly epiretinal membrane (ERM), in eyes with pseudoexfoliation syndrome (PXS) and pseudoexfoliation glaucoma (PXG), and to evaluate the impact of ERM on visual field parameters.

METHODS

This retrospective study included 258 eyes (105 PXS/PXG; 153 matched controls) from 160 participants. All subjects underwent detailed ophthalmologic examination, optical coherence tomography (OCT) imaging, and visual field testing. ERM was graded according to the OCT-based staging system proposed by Govetto et al. The visual field index (VFI) and MD were analyzed concerning ERM presence and retinal nerve fiber layer thickness (RNFLT). Logistic and linear regression analyses were performed using generalized estimating equations to account for intereye correlation.

RESULTS

ERM was significantly more prevalent in PXG eyes (28.8%) compared with PXS (19.6%) and controls (8.5%) ( P <0.001). Complete posterior vitreous detachment was more common in controls, while incomplete posterior vitreous detachment was prevalent in PXS/PXG groups. After age adjustment, PXG was independently associated with ERM, with ∼3.6-fold higher odds compared with controls (OR=3.58; 95% CI: 1.34-9.57; P =0.011). In PXG patients, eyes with ERM showed significantly reduced VFI and MD compared with eyes without ERM ( P =0.011 and 0.034, respectively). Multivariate regression identified both ERM presence and reduced RNFLT as independent predictors of visual field loss.

CONCLUSION

ERM was more prevalent and showed a more pronounced functional impact in PXG eyes. Routine OCT assessment in PXS/PXG patients may facilitate early detection of ERM and improve visual prognosis.