Progression of Optic Nerve Head and Macular Parameters from Optical Coherence Tomography in Glaucomatous Eyes with Concomitant Epiretinal Membrane

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Introduction/Purpose: Epiretinal membrane (ERM) can distort macular and peripapillary architecture, altering optical coherence tomography (OCT)–derived measurements and potentially obscuring glaucomatous progression. The present study aimed to determine whether glaucoma-related structural progression can still be detected over time in primary open-angle glaucoma (POAG) eyes with concomitant ERM by evaluating longitudinal changes in optic nerve head (ONH) and macular parameters. Understanding these changes may reduce the risk of delayed diagnosis and irreversible vision loss. Methods: This retrospective longitudinal study included adults (>18 years) with POAG and ERM from two tertiary care centers. Eyes with at least three visits were included, while those with macular disease unrelated to ERM were excluded. ERM morphology was staged by trained examiners using the published Govetto et al. classification. ONH and macular OCT parameters were analyzed longitudinally using mixed-effects models adjusted for baseline age and signal strength. 2 Results/Conclusions: In this cohort of POAG eyes with predominantly mild ERM, average central macular thickness increased over time, whereas average ganglion cell–inner plexiform layer (GCIPL) thickness, nasal-superior GCIPL thickness, and visual field index (VFI) showed significant decreases. These findings indicate continued structural and functional glaucomatous progression despite the presence of ERM. Thus, glaucoma progression remains detectable in patients with concomitant ERM. Limitations include a relatively small sample size (69 eyes) and limited representation of severe ERM. Future studies with larger cohorts, diverse glaucoma subtypes, and a broader range of ERM severities are warranted to further confirm and extend these findings.

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