Effects of Internal Limiting Membrane Peel for Idiopathic Epiretinal Membrane Surgery: A Systematic Review of Randomized Controlled Trials

Far, Parsa Mehraban; Yeung, Shanna C.; Patrick, Ellis; Hurley, Bernard; Kertes, Peter J.; You, Yuyi; Yan, Peng

doi:10.1016/j.ajo.2021.04.028

Cited by 18 publications

(12 citation statements)

References 36 publications

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“…25 26 Previous studies reported ILM peeling is associated with a reduction of recurrence rate of ERM. [27][28][29] However, ILM peeling may damage the Müller cells which connected to the ILM's basal lamina. [30][31][32][33] Ultrastructural damage to the inner retina caused by ILM peeling may be responsible for the increased macular thickness and reduced foveal light sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for epiretinal membrane in eyes with primary rhegmatogenous retinal detachment that received silicone oil tamponade

Pan

Gao

et al. 2022

Br J Ophthalmol

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Background/aimsThis study investigated the risk factors for epiretinal membrane (ERM) in eyes with primary rhegmatogenous retinal detachment (RRD) that received silicone oil (SO) tamponade.MethodsThis retrospective analysis included 1140 patients (1140 eyes) with RRD who underwent primary vitrectomy and SO tamponade. The prevalence of ERM was estimated and possible risk factors (eg, type 2 diabetes, proliferative vitreoretinopathy (PVR), SO tamponade time (SOTT), photocoagulation, vitreous haemorrhage, choroidal detachment, cryotherapy and retinal tear size) were analysed via multiple logistic regression.ResultsThe prevalence of ERM was 12.3% (140/1140), and the accuracy of preoperative ERM diagnosis was 40.5%. Multivariate logistic regression analysis showed that risk factors for ERM in eyes with SO tamponade included preoperative PVR (OR=4.336, 95% CI 2.533 to 7.424, p<0.001), type 2 diabetes (OR=3.996, 95% CI 2.013 to 7.932, p<0.001), photocoagulation energy (OR=1.785, 95% CI 1.306 to 2.439, p<0.001) and SOTT (OR=1.523, 95% CI 1.261 to 1.840, p<0.001). No statistically significant associations were observed between the incidence of ERM and other risk factors. Preoperative PVR showed the strongest association with risk of ERM. The risk of ERM was positively associated with SOTT, photocoagulation energy and preoperative PVR grade.ConclusionIn eyes with RRD that received SO tamponade, the prevalence of ERM was 12.3%, while the accuracy of preoperative ERM diagnosis was low. Preoperative PVR, type 2 diabetes, photocoagulation energy and SOTT were the main risk factors for ERM.

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Section: Discussionmentioning

confidence: 99%

Risk factors for epiretinal membrane in eyes with primary rhegmatogenous retinal detachment that received silicone oil tamponade

Pan

Gao

et al. 2022

Br J Ophthalmol

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“…From a surgical point of view, the role of ILM peeling in PPV for ERM is still debated [ 28 ], particularly in case of secondary ERM and/or CME [ 9 , 29 , 30 ]. Additional ILM removal in PPV for idiopathic ERM was proved to potentially reduce the ERM recurrence rate, but with no influence on the visual outcome and CRT postoperatively [ 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Functional and Anatomical Outcomes of Pars Plana Vitrectomy for Epiretinal Membrane in Patients with Uveitis

et al. 2022

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Purpose-To evaluate the anatomical and functional outcomes of vitrectomy and epiretinal membrane (ERM) peeling in patients with uveitis. Secondarily, we evaluated the effect of internal limiting membrane (ILM) peeling on surgical outcomes, and of surgery on uveitis activity and, thus, therapeutic regime. Methods-Bicentre, retrospective, interventional case series of 29 eyes of 29 consecutive patients affected by uveitis and ERM, that had undergone pars plana vitrectomy with ERM peel between 2012 and 2020, with a minimum postoperative follow-up (FU) of six-months. Demographic data, best-corrected visual-acuity (BCVA), clinical findings, intraoperative and postoperative complications, and macular optical-coherence-tomography scans were reviewed. Results-The mean (standard deviation) duration of follow-up was 32 (22) months. At six-month FU, mean central-retinal-thickness (CRT) significantly improved (from 456 (99) to 353 (86) microns; p < 0.001), and mean BCVA improved from 0.73 (0.3) to 0.49 (0.36) logMAR (p < 0.001), with only one (3%) patient experiencing worsening of vision. The rate of concomitant cystoid macular edema decreased from 19 (66%) eyes at presentation to eight (28%) eyes at final-FU (p = 0.003). Comparing eyes in which ILM peeling was performed in addition to ERM peeling only, BCVA or CRT reduction were comparable. Only a minority of six (21%) eyes had a worsening in uveitis activity requiring additional medications, whereas most patients resumed the same treatment (52%) or received less treatment (28%) (p = 0.673). Conclusions-Vitrectomy with ERM peeling led to favourable anatomical and functional outcomes in patients with uveitis regardless of whether the ILM is peeled or not. As in most patients, no activation of the uveitis requiring additional medications was noted, we do not recommend changes in anti-inflammatory/immunosuppressive therapy postoperatively.

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“…Indeed, ILM peeling performed after pars plana vitrectomy and staining the membrane with indocyanine green or Coomassie blue dye is a widely implemented surgical technique for treatment of the vitreomacular traction, macular hole, and epiretinal membrane. 66,67 However, it is possible that complete local ILM removal may introduce new challenges to hRGC engraftment. Neurodevelopmental studies have established that signaling between RGCs and the ILM is critical for organized patterning of the RGC layer and dendritic projection to the IPL.…”

Section: Discussionmentioning

confidence: 99%

Internal limiting membrane disruption facilitates engraftment of transplanted human stem cell derived retinal ganglion cells

Aguzzi

Zhang

Nagalingam

et al. 2022

Preprint

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Retinal ganglion cell (RGC) death causes irreversible vision loss in patients with glaucoma and other forms of optic neuropathy because the mammalian retina and optic nerve lack endogenous regenerative capacity. RGC transplantation and optic nerve regeneration represent a potential translational approach to vision restoration in glaucoma secondary to RGC loss. Functional RGC replacement requires that 1) donor RGCs integrate into the recipient retina and receive synaptic input from afferent bipolar and amacrine cells and that 2) donor RGCs extend their axons and establish synaptic connections to appropriate neurons in the brain. Here, in an effort to address retinal integration, we demonstrate that the internal limiting membrane (ILM) acts as a physical barrier to the integration of transplanted human stem cell-derived RGCs (hRGCs) into the recipient retina following intravitreal transplantation in vivo. To circumvent the ILM barrier, we intravitreally injected the nonspecific protease pronase-E in immunosuppressed adult C57BL/6J mice prior to transplantation of hRGCs. Separately, we also transplanted hRGCs into adult Lama1nmf223mice, which harbor a point mutation in their Lama-α1 gene that causes developmental ILM dysgenesis. We assessed donor hRGC survival and engraftment using 3D reconstructions of confocal z-stacks in retinal flatmounts. Migration of surviving donor RGC somas into the recipient RGC layer significantly increased after proteolytic or developmental ILM disruption. Moreover, lamination of dendritic arbors into the recipient inner plexiform layer was observed exclusively following ILM disruption. To assess the clinical translatability of this finding, we transplanted hRGCs onto postmortem organotypic human retinal explant cultures and observed significantly increased engraftment following proteolytic ILM digestion. These findings enhance our understanding of the barriers faced by transplanted hRGCs in the adult murine and human retina and provide an avenue for clinically translatable regenerative medicine approaches to vision restoration in optic neuropathy.

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Effects of Internal Limiting Membrane Peel for Idiopathic Epiretinal Membrane Surgery: A Systematic Review of Randomized Controlled Trials

Cited by 18 publications

References 36 publications

Risk factors for epiretinal membrane in eyes with primary rhegmatogenous retinal detachment that received silicone oil tamponade

Risk factors for epiretinal membrane in eyes with primary rhegmatogenous retinal detachment that received silicone oil tamponade

Functional and Anatomical Outcomes of Pars Plana Vitrectomy for Epiretinal Membrane in Patients with Uveitis

Internal limiting membrane disruption facilitates engraftment of transplanted human stem cell derived retinal ganglion cells

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