Randomized Trial Comparing Immediate vs. Deferred Surgery for Symptomatic ERM

NCT ID: NCT05145491

Last Updated: 2026-01-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

400 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-02-22

Study Completion Date

2026-12-31

Brief Summary

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Vitrectomy to remove an epiretinal membrane (ERM) is one of the most common procedures performed by retinal surgeons. Patients who present with significant macular changes on optical coherence tomography (OCT) but relatively good vision are often advised to defer surgery until vision declines to 20/40 or worse. However, it is unknown if delaying surgery, which allows the foveal architecture to remain compromised and potentially to deteriorate, results in worse visual acuity outcomes than if surgery is performed earlier. In addition, there is a need to better understand predictors of outcomes when surgery is performed and predictors of progression when surgery is deferred. Finally, one of the most common presenting symptoms from an ERM is distortion or metamorphopsia. There are several objective measures of metamorphopsia but none have ever been employed to evaluate ERMs in a randomized clinical trial (RCT) and their usefulness is unknown. The purposes of this study are to better understand the optimal timing of surgery to produce the best visual result, to better understand predictors of outcomes in those who undergo surgery and predictors of progression in those whose are observed, and to better characterize and evaluate the usefulness of metamorphopsia and reading speed measures.

Detailed Description

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Conditions

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Epiretinal Membrane

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Immediate Vitrectomy

Group Type ACTIVE_COMPARATOR

Immediate Vitrectomy

Intervention Type PROCEDURE

Surgery to remove epiretinal membrane (ERM). Vitrectomy will be performed on eyes within 1 month of randomization

Deferred Vitrectomy

Group Type OTHER

Deferred Vitrectomy

Intervention Type PROCEDURE

Vitrectomy may be performed only if at least one of the following criteria is met:

1. Decrease in visual acuity ≥10 letters from baseline at a single visit presumed to be from ERM
2. Decrease in visual acuity ≥5 letters from baseline at two consecutive visits presumed to be from ERM

a. Visits must be at least one month apart
3. Participant actively requests surgery due to worsening symptoms
4. Complication requires prompt surgical intervention (e.g., macular hole, retinal detachment, non-clearing vitreous hemorrhage)

Interventions

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Immediate Vitrectomy

Surgery to remove epiretinal membrane (ERM). Vitrectomy will be performed on eyes within 1 month of randomization

Intervention Type PROCEDURE

Deferred Vitrectomy

Vitrectomy may be performed only if at least one of the following criteria is met:

1. Decrease in visual acuity ≥10 letters from baseline at a single visit presumed to be from ERM
2. Decrease in visual acuity ≥5 letters from baseline at two consecutive visits presumed to be from ERM

a. Visits must be at least one month apart
3. Participant actively requests surgery due to worsening symptoms
4. Complication requires prompt surgical intervention (e.g., macular hole, retinal detachment, non-clearing vitreous hemorrhage)

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age ≥ 45 years
* E-ETDRS visual acuity 20/40 or better (≥69 letters)

o ERM must be thought to be the primary cause of vision loss
* ERM meeting the following criteria, according to the investigator

* ERM is not secondary to another condition
* Symptoms of visual loss and/or distortion (in the opinion of the investigator, the ERM is contributing to the participant's symptoms); either new or worsening in the past 24 months
* Epiretinal membrane involving or altering the central 3 mm of the macula on OCT
* Distortion within the central subfield due to ERM on OCT
* Immediate vitrectomy not required (investigator and participant are willing to wait at least 4 weeks to see if vision remains stable without having to proceed to vitrectomy)
* No known medical problems that will be a contraindication to surgery

Exclusion Criteria

* History of retinal vascular disease
* History of vitreous hemorrhage if vitreous hemorrhage is thought to have caused the ERM

o History of vitreous hemorrhage is permitted provided the vitreous hemorrhage did not cause the ERM in the investigator's opinion
* History of inflammatory disease unless mild and completely resolved at least one year prior to randomization
* History of diabetic macular edema (DME), retinal vein occlusion (RVO), or uveitis (except mild uveitis that resolved \>1 year prior to randomization)
* Prior intraocular surgery (except uncomplicated cataract extraction)
* Cataract extraction within prior 3 months
* Laser or cryosurgical retinopexy within one month of randomization
* Pneumatic retinopexy within one year of randomization
* Current untreated retinal tear or detachment

o A previously treated retinal tear with up to one disc diameter radius of subretinal fluid is permitted
* Macular hole
* Degenerative lamellar macular hole

o ERM foveoschisis ("tractional" lamellar hole) is permitted
* Vitreomacular traction within 1,500 microns of foveal center
* Central serous chorioretinopathy
* Nonproliferative diabetic retinopathy or worse (DR severity \>20)
Minimum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institutes of Health (NIH)

NIH

Sponsor Role collaborator

National Eye Institute (NEI)

NIH

Sponsor Role collaborator

Juvenile Diabetes Research Foundation

OTHER

Sponsor Role collaborator

Jaeb Center for Health Research

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Mayo Clinic Arizona

Scottsdale, Arizona, United States

Site Status RECRUITING

Kent W. Small, MD, AMC

Glendale, California, United States

Site Status RECRUITING

Salehi Retina Institute Inc.

Huntington Beach, California, United States

Site Status RECRUITING

Loma Linda University

Loma Linda, California, United States

Site Status RECRUITING

Retina Vitreous Associates, Northern California Retina Vitreous Assoc Medical Group, Inc.

Mountain View, California, United States

Site Status RECRUITING

East Bay Retina Consultants, Inc.

Oakland, California, United States

Site Status RECRUITING

Regents of the University of California, Davis, DBA University of California, Davis

Sacramento, California, United States

Site Status RECRUITING

Macula Retina Vitreous Institute

Torrance, California, United States

Site Status RECRUITING

Florida Retina Institute, James A. Staman, MD, PA- Jacksonville

Jacksonville, Florida, United States

Site Status RECRUITING

Sarasota Retina Institute

Sarasota, Florida, United States

Site Status RECRUITING

SEASHORE RETINA LLC DBA Retina Specialists of Tampa

Wesley Chapel, Florida, United States

Site Status RECRUITING

Southeast Retina Center, P.C.

Augusta, Georgia, United States

Site Status RECRUITING

Thomas Eye Group

Sandy Springs, Georgia, United States

Site Status RECRUITING

Northwestern University

Chicago, Illinois, United States

Site Status RECRUITING

Rush University Medical Center

Chicago, Illinois, United States

Site Status RECRUITING

Illinois Retina Associates SC - Oak Park Site

Oak Park, Illinois, United States

Site Status RECRUITING

Raj K. Maturi, M.D., P.C.

Indianapolis, Indiana, United States

Site Status RECRUITING

Mid-America Retina Consultants, P.A.

Overland Park, Kansas, United States

Site Status RECRUITING

University of Kansas Medical Center Research Institute, Inc.

Prairie Village, Kansas, United States

Site Status RECRUITING

Joseph E. Humble and Raymond Haik PTRS DBA Eye Assoc of Northeast Louisiana

West Monroe, Louisiana, United States

Site Status RECRUITING

Elman Retina Group, P.A.

Baltimore, Maryland, United States

Site Status RECRUITING

Johns Hopkins University

Baltimore, Maryland, United States

Site Status RECRUITING

Valley Eye Physicians and Surgeons

Ayer, Massachusetts, United States

Site Status RECRUITING

Joslin Diabetes Center

Boston, Massachusetts, United States

Site Status RECRUITING

Retina Associates of Michigan

Grand Blanc, Michigan, United States

Site Status RECRUITING

The Curators of the University of Missouri

Columbia, Missouri, United States

Site Status RECRUITING

Retina Research Institute, LLC

St Louis, Missouri, United States

Site Status RECRUITING

Retina-Vitreous Surgeons of Central NY, PC

Liverpool, New York, United States

Site Status RECRUITING

Retina Associates of Western NY, P.C.

Rochester, New York, United States

Site Status RECRUITING

University of North Carolina at Chapel Hill

Chapel Hill, North Carolina, United States

Site Status RECRUITING

Retina Vitreous Center

Edmond, Oklahoma, United States

Site Status RECRUITING

Verum Research LLC

Eugene, Oregon, United States

Site Status RECRUITING

Cascade Medical Research Institute, LLC

Springfield, Oregon, United States

Site Status RECRUITING

Retina-Vitreous Consultants, Inc.

Monroeville, Pennsylvania, United States

Site Status RECRUITING

The Trustees of the University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status RECRUITING

Pittsburg Clinical Trial Consortium

Sewickley, Pennsylvania, United States

Site Status RECRUITING

Hilton Head Retina Institute

Hilton Head Island, South Carolina, United States

Site Status RECRUITING

Ophthalmology Ltd.

Sioux Falls, South Dakota, United States

Site Status RECRUITING

Vanderbilt Eye Institute

Nashville, Tennessee, United States

Site Status RECRUITING

Austin Research Center for Retina

Austin, Texas, United States

Site Status RECRUITING

Retina Consultants of Texas

Bellaire, Texas, United States

Site Status RECRUITING

Baylor College of Medicine, Baylor Eye Physicians and Surgeons

Houston, Texas, United States

Site Status RECRUITING

Texas Retina Associates

Lubbock, Texas, United States

Site Status RECRUITING

Retinal Consultants of San Antonio

San Antonio, Texas, United States

Site Status RECRUITING

Spokane Eye Clinical Research, PLLC

Spokane, Washington, United States

Site Status RECRUITING

South Tyneside and Sunderland NHS Trust

Sunderland, Tyne and Wear, United Kingdom

Site Status RECRUITING

Countries

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United States United Kingdom

Facility Contacts

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Odette M. Houghton, MD

Role: primary

4803018085

Kent W. Small, MD

Role: primary

818-552-5040

Hani Salehi-Had, MD

Role: primary

657-227-9496

Kakarla V. Chalam, MD

Role: primary

9095582169

Rahul N. Khurana, MD

Role: primary

650-988-7480

Jesse J. Jung, MD

Role: primary

510-444-1600

Ala Moshiri, MD, PhD

Role: primary

9167346074

Mehran Taban, MD

Role: primary

4242479090

Benjamin J. Thomas, MD

Role: primary

904-997-9202

Melvin Chen, MD

Role: primary

9419215335

Evan N. Dunn, MD

Role: primary

813-973-3333

Dennis M. Marcus, MD

Role: primary

7066500061

Paul L. Kaufman, MD

Role: primary

404-256-1507

Alice T. Lyon, MD

Role: primary

3126952567

Mathew W. MacCumber, MD, PhD

Role: primary

3129422117

Mathew W. MacCumber, MD, PhD

Role: primary

708-660-8450

Raj K. Maturi, MD

Role: primary

3178171414

William N. Rosenthal, MD

Role: primary

(913) 663-5900

Radwan S. Ajlan, MBBCh

Role: primary

913-588-0105

Ruben A. Grigorian, MD

Role: primary

318-325-2610

Michael J. Elman, MD

Role: primary

410-686-3000

Sharon D. Solomon, MD

Role: primary

4106146908

Gisela Velez, MD,MPH,MA

Role: primary

9787724000

Mohamed A. Elmasry, MD, PhD

Role: primary

617-309-2520

Raafay Sophie, MD

Role: primary

8104874500

Ahmed M. Elkeeb, MD

Role: primary

573-882-1506

Kevin J. Blinder, MD

Role: primary

314-367-1181

Kevin I. Rosenberg, MD

Role: primary

315-445-8166

Matthew T. Witmer, MD

Role: primary

585-442-3411

Jan N. Ulrich, MD

Role: primary

919-966-5296

Sandeep N. Shah, MD

Role: primary

(405) 607-6699

Albert O. Edwards, MD, PhD

Role: primary

5417622763

Allan A. Hunter, MD

Role: primary

5416871927

Karl R. Olsen, MD

Role: primary

412-683-5300

Alexander J. Brucker, MD

Role: primary

2156629702

Leanne T. Labriola, DO,MBA

Role: primary

4123015326

Carl W. Baker, MD

Role: primary

8437152424

Elizabeth A. Atchison, MD

Role: primary

6053366294

Avni P. Finn, MD, MBA

Role: primary

6159362020

Chirag Jhaveri, MD

Role: primary

7377040130

Charles C. Wykoff, MD

Role: primary

7135243434

Christina Y. Weng, MD, MBA

Role: primary

713-798-3493

Michel Shami, MD

Role: primary

806-792-0066

Darrell E. Baskin, MD

Role: primary

210-615-1311

Shelly T. Lee

Role: primary

5094360107

Maged Habib

Role: primary

+44 191 5699065

Other Identifiers

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UG1EY014231

Identifier Type: NIH

Identifier Source: secondary_id

View Link

DRCR.net Protocol AM

Identifier Type: -

Identifier Source: org_study_id

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