Study: Diabetes does not significantly impact outcomes of epiretinal membrane surgery
A Helsinki University Hospital study found diabetes, glycemic control, or insulin therapy did not significantly affect anatomical or functional outcomes after epiretinal membrane surgery.
(Image credit: AdobeStock/wladimir1804)
A recent study conducted at Helsinki University Hospital, Finland, examined whether diabetes influences anatomical and functional outcomes following epiretinal membrane (ERM) surgery. The findings suggest that the presence of diabetes, glycemic control, or insulin therapy does not significantly affect postoperative outcomes.
The study analyzed data from 214 eyes of 214 consecutive patients who underwent ERM surgery between 2017 and 2021. The mean patient age was 71.2 ± 8.2 years, with 45 patients having a diagnosis of diabetes. Outcomes were assessed at 1 month post-surgery.1
Results
Prior to surgery and postoperatively, all patients underwent a complete ophthalmological examination including assessment of best-corrected visual acuity (BCVA), anterior segment and fundus with slit-lamp as well as retinal OCT.
According to researchers, the comparison between patients with and without diabetes revealed no statistically significant differences in anatomical outcomes, such as changes in foveal thickness (−47.8 ± 72.7 μm vs. −38.3 ± 103 μm, p = 0.566) or central subfield macular thickness (−41.6 ± 61.8 μm vs. −41.7 ± 85.7 μm, p = 0.996). Similarly, improvements in best-corrected visual acuity (BCVA) were comparable between the 2 groups (0.06 ± 0.22 vs. 0.12 ± 0.30 LogMAR units, p = 0.214).
A multivariate analysis adjusting for age, sex, presence of preoperative macular cysts, and use of topical nonsteroidal anti-inflammatory drugs (NSAIDs) supported these findings.
Additionally, the researchers noted that preoperative HbA1c levels showed no significant correlation with changes in foveal thickness (r = 0.218, p = 0.264), central subfield macular thickness (r = 0.365, p = 0.056), or BCVA gain (r = −0.177, p = 0.386). Insulin therapy for diabetes also demonstrated no significant impact on anatomical or functional outcomes (p > 0.05 for all comparisons).
“The results show that the degree of improvement was comparable between patients with and without diabetes,” the researchers wrote. “Poor glycemic control or need for insulin treatment were not associated with worse surgical outcomes and should not result in postponing the surgery.”
The researchers acknowledged the study has several limitations. The short follow-up period of one month precluded analysis of long-term outcomes, as patients transitioned to community-based care. Although early postoperative anatomical changes often predict long-term results, improvements in visual acuity and anatomical restoration can continue for up to 12 months. Prognostic OCT biomarkers, such as ellipsoid zone integrity and photoreceptor outer segment length, were not analyzed but are planned for future research.
Diabetic retinopathy was not directly assessed via fundus photography; instead, diagnoses relied on medical records and expert preoperative evaluations. Additionally, only SD-OCT was used for imaging, whereas other advanced modalities and deep learning systems could enhance disease detection and monitoring.
Conclusion
The study concluded that diabetes, glycemic control, and the use of insulin therapy do not appear to influence anatomical or functional outcomes after ERM surgery. These findings suggest that diabetic status should not be a major concern in predicting the success of ERM surgery.
This research provides reassurance for ophthalmologists managing patients with diabetes undergoing ERM surgery and underscores the need for further studies on longer-term outcomes and other factors influencing surgical success.
