Gisbert Richard Lecture Preview: Macular surgery enters era of tailored treatment

Catherine Creuzot-Garcher MD, PhD, FEBO will deliver the Gisbert Richard Lecture in Hall 1 (Level 2) at 13:00 on Saturday 3 September 2022. 

The principal outcomes and complications of macular surgery is the vast theme of the Gisbert Richard Lecture to be delivered by Catherine Creuzot-Garcher MD, PhD, FEBO at the 22nd EURETINA Congress.

In a wide-ranging review of the surgical management of a range of macular diseases, Prof Creuzot-Garcher will show how the evidence accumulated in recent landmark collaborative randomised studies has enabled surgeons to make more informed choices about the potential risks and benefits of certain types of macular surgery.

“In my lecture, I will try to answer the question that patients usually ask me: what are my chances of good visual recovery after macular surgery, what is the risk for me to lose vision or worse to lose my sight completely,” explained Prof Creuzot-Garcher. “With all the epidemiological studies, retrospective studies and big data analysis, I think we are now in a position to give some clear answers to our patients on these fundamental questions,” she said.

For epiretinal membrane, for instance, which is one of the more common retinal pathologies in older patients, the likelihood of recovering good visual acuity after surgery depends on a number of factors, said Prof Creuzot-Garcher.

“Studies show that the patients with the greatest chance of recovering 20/20 are those of younger age, with a good visual acuity at presentation, short duration of symptoms, and good integrity of the ellipsoid zone,” she said.

Deciding whether observation rather than surgery is the best option is a more delicate issue to resolve, said Prof Creuzot-Garcher, as it remains difficult to predict which cases of ERM will progress to the point where vision is compromised and intervention is warranted.

For macular hole surgery, the success rate has improved dramatically in the past decade with patients usually attaining successful hole closure and good visual acuity outcomes which are sustained long term, she said.

“We can now offer more tailored surgery and we know that the success rate of surgery for idiopathic macular holes of 400 μm or smaller is not significantly reduced if facedown positioning is replaced by simply taking care to avoid the supine position,” she said.

Prof Creuzot-Garcher’s lecture will also focus on the risk for severe complications associated with macular surgery, particularly endophthalmitis and retinal detachment.

A large-scale retrospective French study of 152,034 macular surgery procedures for epiretinal membranes or macular holes between 2006 and 2016 recorded an overall incidence of acute postoperative endophthalmitis of 0.25%. However, the risk was twice as high for epiretinal membrane surgery than for macular hole surgery.

“We need to take this into account in our surgical planning and what we tell our patients, and then to take care during the surgery, avoiding vitreous incarceration in the wound for instance and to be very rigorous performing the sclerotomy while doing epiretinal membrane surgery,” she said.

Catherine Creuzot-Garcher MD, PhD, FEBO will deliver the Gisbert Richard Lecture in Hall 1 (Level 2) at 13:00 on Saturday 3 September 2022.