Role of internal limiting membrane peeling in the prevention of epiretinal membrane formation following vitrectomy for retinal detachment: a randomised trial (original) (raw)
Related papers
Pakistan Journal of Medical Sciences, 2021
Objective: To investigate the role of concomitant Internal Limiting Membrane (ILM) peeling during surgery for macula off Rhegmatogenous Retinal Detachment (RRD) in preventing postoperative Epiretinal Membrane (ERM) formation; and its effect on the visual acuity. Methods: This was a prospective, quasi-experimental study conducted from August 2018 to July 2019 at LRBT Tertiary Eye Care hospital, Karachi. Fifty-six patients with macula off RRD were divided into groups A (with ILM peeling) and B (without ILM peeling) via non-probability convenience sampling. All patients underwent standard 3 ports pars plana vitrectomy with silicon oil tamponade. In Group-A, ILM was stained using 0.5% ICG. Patients were evaluated clinically and by spectral domain optical coherence tomography (SD-OCT), pre- and post-operatively. Main outcomes recorded were best corrected visual acuity (BCVA) and occurrence of ERM on SD-OCT. Results: There were 26 patients in Group-A and 30 patients in Group-B. At six mon...
International Journal of Retina and Vitreous
Background To evaluate the rate and risk factors of epiretinal membrane (ERM) formation and need for ERM peeling after pars plana vitrectomy (PPV) for uncomplicated primary rhegmatogenous retinal detachment (RRD). Methods Retrospective, single-center, cohort study of 119 consecutive patients (119 eyes) that underwent RRD repair using PPV. The primary outcomes were ERM formation, classified using an optical coherence tomography grading system, and the rate of ERM peeling. Visual acuity, postoperative complications, and risk factors for ERM formation and peeling were also identified. Results Postoperative ERM formation occurred in 69 eyes (58.0%); 56 (47.1%) were stage 1, 9 (7.6%) stage 2, 3 (2.5%) stage 3, and 1 (0.8%) stage 4. Only 6 (5.0%) eyes required secondary PPV for a visually significant ERM, with a mean time to reoperation of 488 ± 351 days. Risk factors for ERM formation included intraoperative cryotherapy, more than 1000 laser shots, 360° laser photocoagulation, and choroi...
Retina, 2019
Purpose: To determine whether internal limiting membrane peeling in primary rhegmatogenous retinal detachment prevents epiretinal membrane (ERM) development. Secondarily, we propose a classification system for postoperative ERMs. Methods: Retrospective, interventional, comparative case series. Consecutive eyes with primary rhegmatogenous retinal detachment (n = 140) treated by a single surgeon. The presence of postoperative ERMs was assessed with swept-source optical coherence tomography. Results: An ERM was detected in 26 eyes (46.4%) in the nonpeeling group and in one eye (1.8%) in the internal limiting membrane peeling group (P ≤ 0.001). The median visual acuity significantly improved in both groups (P ≤ 0.001). Inner retinal dimples were observed in 41.1% of eyes in the internal limiting membrane peeling group versus 0% in the nonpeeling group (P ≤ 0.001), and they were not correlated with visual acuity (r = 0.011; P = 0.941). Based on swept-source optical coherence tomography f...
Retina, 2012
Background: The purpose of this was to analyze the effect of internal limiting membrane (ILM) peeling on the anatomical and functional outcomes in patients undergoing retinectomy for proliferative vitreoretinopathy-related retinal detachment, especially regarding the postoperative development of macular pucker. Methods: In all, a consecutive and prospective series of 84 eyes of 84 patients were included in the study. All eyes underwent retinectomy with silicone oil tamponade for retinal detachment because of proliferative vitreoretinopathy. In Group A (33 eyes), the ILM was also peeled; in Group B (51 eyes), the ILM was left intact. Each patient gave consent to be included in the study, and no patient was lost to follow-up. Postoperatively, careful slitlamp examination with a contact lens was used to determine whether primary ILM peeling was effective in preventing macular pucker formation. Various statistical methods were used to analyze the significance of the results with a P value of #0.05 interpreted as significant. Results: In Group A, the mean age of the patients was 57.2 6 12.8 years and in Group B 54.6 6 14.5 years. Median follow-up in Group A was 28.2 6 7.2 months and in Group B 27.4 6 6.5 months. The mean time interval between the last retinectomy and silicone oil removal was 9.2 6 6.1 months in Group A and 8.8 6 3.0 months in Group B. The mean follow-up after silicone oil removal was 17.4 6 10.3 months in Group A and 15.1 6 9.3 months in Group B. The mean logarithm of the minimum angle of resolution visual acuity at the final follow-up visit was 1.89 6 0.87 in Group A and 1.85 6 0.83 in Group B (P = 0.6, ttest). Extramacular epiretinal cellular proliferation occurred in 3 eyes (9%) in Group A in the first month after retinectomy and in 3 eyes (5.8%) in Group B (P = 0.27, Fisher exact test). These epiretinal membranes, extending to the edge of the retinotomy, were stable during the follow-up period. No case of macular pucker was observed in Group A, but macular pucker was observed in 9 eyes (17.6%) in Group B at the final examination (P = 0.008, Fisher exact test). Conclusion: Primary peeling of the ILM allowed complete removal of all the epiretinal membranes and successfully prevented the development of macular pucker. Retinectomy and silicone oil tamponade proved an effective treatment modality for eyes with retinal detachment due to proliferative vitreoretinopathy.
Retina (Philadelphia, Pa.)
To determine the degree of residual internal limiting membrane (ILM) after idiopathic epiretinal membrane (ERM) peeling and the usefulness of staining with brilliant blue G. A prospective, multicenter, observational study of 98 eyes undergoing pars plana vitrectomy and membrane peeling for idiopathic ERM. All eyes underwent core vitrectomy (20, 23, or 25 gauge) followed by intravitreal triamcinolone to verify that the posterior hyaloid had been removed. Brilliant blue G (0.2 mL of 0.25 mg/mL) was injected into the vitreous cavity and washed out immediately. The ERM was peeled and then the surgeon observed and recorded the characteristics of the underlying ILM. The posterior pole was restained with brilliant blue G (0.2 mL of 0.25 mg/mL), and the same observations on the characteristics of the ILM were recorded. Peeling of the remaining ILM was performed. The main outcome measured was the status of the ILM after ERM peel. Secondary outcomes included best-corrected visual acuity and c...
Eye, 2016
Purpose To correlate the frequency and extent of simultaneous inadvertent internal limiting membrane (ILM) peeling during idiopathic epiretinal membrane (ERM) removal with characteristics of ERM adherence demonstrated on pre-operative spectral domain optical coherence tomography (SD-OCT). Patients and methods This is a prospective, observational, case series of patients undergoing pars plana vitrectomy for idiopathic ERM. Inner retina-ERM adhesion was categorized as focal, broad or complete in five anatomic locations at macular area based on preoperative SD-OCT findings. The extent of spontaneous ILM peeling was quantified on a scale 0-100% in each of the aforementioned anatomic locations by the operating surgeons who were masked to the OCT characteristics. All operations were recorded with a high definition recording system and the area of simultaneous ILM peel was quantified by a second masked observer. The final extent of spontaneous ILM peel was calculated as the average of the two scores. Results Thirty consecutive subjects who underwent surgery for idiopathic ERM were included in the study. Evidence of simultaneous ILM peeling was identified in 80.3% of individuals. With regards to the type of ERM-macula adhesion, inadvertent ILM peel was observed in 70% of the patients who pre-operatively showed complete adhesion, in 43% with broad adhesion and in only 21% with focal adhesion (Po0.001). The extent of the spontaneous ILM peel during removal of ERM was also significantly dependent on the type of ERM-inner retina adhesion. Total simultaneous ILM peel was observed in 59% of locations with complete ERM-macula adhesion but only in 22% and 7% of locations with broad and focal adhesion respectively (Po0.001). Conclusions Simultaneous ILM peel is a frequent occurrence during ERM surgery, especially when there is complete or broad ERM adherence to the macula. The type of ERM-inner retina adhesion represents a valid predictor of the extent of simultaneous ILM peel during removal of ERM. Thorough evaluation of preoperative OCT may be a useful tool in determining a safer, more simplistic strategy in ERM surgery.
Internal Limiting Membrane Peeling For Primary Rhegmatogenous Retinal Detachment Repair
Ophthalmology, 2013
The formation of macular pucker (MP) can limit functional visual recovery after rhegmatogenous retinal detachment (RRD) repair. 1 The internal limiting membrane (ILM), composed of the footplate of Muller glia, has been considered a scaffold for proliferation of retinal glia, hyalocytes, and metaplastic retinal pigment epithelium after operative MP removal, contributing to recurrent MP. 2 Peeling the ILM removes the posterior hyaloid and vitreous cortex, epiretinal membrane, and can relieve tractional forces, improve macular hole closure rate, and reduce secondary MP formation. 3 We report a nonrandomized, multisurgeon, retrospective, 2-arm clinical trial evaluating the incidence of postoperative MP after primary RRD repair with or without triamcinolone-acetonide (TA)-assisted ILM peeling. After a coding search of a database from a large retina referral practice (The Retina Institute, St. Louis, MO) of 708 eyes, we identified 62 eyes with primary RRD that underwent repair without ILM peeling (n ϭ 32; group 1) or with TA-assisted ILM peeling (n ϭ 30; group 2). Patients with a history of preoperative MP, RD surgery, tractional RD, proliferative vitreoretinopathy, silicone oil tamponade, choroidal detachment, trauma, retinal dialysis, cryoretinopexy, laser retinopexy, focal or grid or pan-retinal laser photocoagulation, proliferative retinopathy owing to retinovascular disease (e.g., diabetes mellitus), infectious retinitis, intraocular lens exchange, and aphakia were excluded. In all cases, RRD repair included standard 3-port vitrectomy pars plana vitrectomy, posterior vitreous detachment, endolaser or cryotherapy for retinopexy, internal drainage of subretinal fluid via retinotomy or preexisting break, fluid-air exchange, and instillation of intraocular gas tamponade. In all cases of ILM peeling (group 2), nondiluted TA (Kenalog-40, 40 mg/ml; Bristol Myers Squibb, Princeton, NJ) was injected intravitreally to visualize the posterior vitreous cortex, hyaloid, MP, and ILM, as described previously. 4 After membrane stripping of these structures, TA was completely removed by aspiration to ensure no residual TA was present before fluid-gas exchange (Video 1, available at http://aaojournal.org). Statistical comparisons were performed using the Fischer exact test, paired t test, Student t test, or Mann-Whitney U test, depending on the nature of the variable. The mean age Ϯ standard deviation of patients was 66.1Ϯ10.5 years in group 1 and 67.5Ϯ10.2 in group 2 (P ϭ 0.65; Table 1, available at http://aaojournal.org). Baseline (20/382 vs 20/256, P ϭ 1.00) and postoperative (20/40 vs 20/58, P ϭ 0.11) Snellen visual acuities were similar in both groups (P ϭ 0.43; Table 1, available at http://aaojournal.org). The mean follow-up time Ϯ standard deviation was 633Ϯ473 days in group 1 and 434Ϯ317 days in group 2 (P ϭ 0.08; Table 1, available at http://aaojournal.org). In each group, there was a clinically and statistically significant improvement in Snellen visual acuity after RRD repair (group 1, 20/382 vs 20/40; group 2, 20/256 vs 20/58; PϽ10-3 in both groups; Table 2, available at http://aaojournal.org). There were no differences between the 2 groups with regard to gender, laterality, number of retinal breaks, macula status, duration from diagnosis to surgery, concomitant scleral buckling, or magnitude of visual acuity improvement after RRD repair. In group 1, 34.4% of eyes developed postoperative MP, with a mean Snellen acuity of 20/40. In contrast, 3.3% of eyes in group 2 developed pucker; visual acuity (n ϭ 1) was 20/25
Sohag Medical Journal
Purpose: to assess the visual result after primary vitrectomy with internal limiting membrane peeling for macula off retinal detachment. Patients and methods: this was a prospective comparative uncontrolled case series. The study included 30 eyes with rhegmatogenous retinal detachment with macula off, the case were classified into two groups; group A 15 eyes subjected to primary vitrectomy without internal limiting membrane peeling and group B eyes subjected to primary vitrectomy with internal limiting membrane peeling. Assessment of best corrected visual acuity after removal of silicone oil had been done. Results: this study included 30 eyes of 30 patients, 16 (53.33 %) were males and 14 (46.67 %) were females, the mean age of studied patients was (43.37 ± 10.40) years old. There was no statistically significant difference in mean logMAR BCVA after silicone oil removal (1.18 ± 0.29 for group A versus 0.99 ± 0.38 for group B; P = 0.12). Conclusion: primary vitrectomy with ILM peeling showed no superiority in visual results over primary vitrectomy without LIM peeling for macula off retinal detachment.