Effects of Internal Limiting Membrane Peeling Combined With Removal of Idiopathic Epiretinal Membrane

Azuma, Kunihiro; Ueta, Takashi; Eguchi, Shuichiro; Aihara, Makoto

doi:10.1097/iae.0000000000001537

Cited by 83 publications

(59 citation statements)

References 29 publications

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“…; Azuma et al. ). Yet, vitrectomy alters the intraocular environment (for example, changing oxygen transport and the local concentration of growth factors) (Stefansson ), which then might influence the physiology of the retina and choroid.…”

Section: Introductionmentioning

confidence: 97%

Macular vascular circulation and retinal oxygen saturation changes for idiopathic macular epiretinal membrane after vitrectomy

Zhang

Lin

et al. 2019

Acta Ophthalmologica

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Purpose: To investigate the postoperative changes in retinal-choroidal blood flow area and retinal vascular oxygen saturation among patients with idiopathic macular epiretinal membranes (iERMs).Methods: This study prospectively included 24 eyes of 24 consecutive patients who underwent vitrectomy for iERMs. The flow area of choriocapillary layer, retinal superficial capillary plexuses (SCPs) and retinal deep capillary plexuses (DCPs) were performed using optical coherence tomography angiography with angiovue prototype software, and retinal vascular oxygen saturation was measured using retinal oximeter with the built-in software. The flow area of choriocapillary layers and mean retinal vessel oxygen saturation before and after surgery were compared. Results: Three months after vitrectomy, the foveal flow area of choriocapillary layer increased clinically significantly from 1.5 AE 0.2 to 1.6 AE 0.2 mm 2 (p = 0.02). The retinal vascular changes of SCPs and DCPs were not statistically significant. The mean retinal arterial oxygen saturation was 89.9 AE 11.3% preoperatively and increased to 94.5 AE 9.7% postoperatively (p = 0.04). Foveal retinal thickness revealed a clinically significant decrease from 547.8 AE 88.2 lm to 403.0 AE 47.5 lm after surgery (p < 0.05). Postoperative best corrected visual acuity had no statistically significant correlation with foveal flow area of the choriocapillary layer and retinal vascular oxygen saturation.Conclusions: There was a decrease of retinal thickness, an improved flow area of choriocapillary layer in macular region, and an increase of retinal arterial vascular oxygen among iERMs patients after vitrectomy.

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Section: Introductionmentioning

confidence: 97%

Macular vascular circulation and retinal oxygen saturation changes for idiopathic macular epiretinal membrane after vitrectomy

Zhang

Lin

et al. 2019

Acta Ophthalmologica

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“…Removal of the two membranes in a single step has several advantages. It reduces the number of times the retina is grasped as well as traction on the retinal surface while simultaneously reducing the membrane removal time and diminishing phototoxicity; all of which are probable causes of iatrogenic damage to the retina 17,18 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of epiretinal membrane peel after dual staining versus en bloc peel using negative staining technique

2020

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Purpose: To compare the completeness of ILM peel in cases of Idiopathic Epiretinal Membranes following double staining and double peeling versus en bloc dissection of both using negative staining method. Study Design: Quasi experimental study. Place and Duration of Study: Jinnah Hospital Lahore, from October 2017 to March 2018. Material and Methods: Forty eyes of forty patients with Idiopathic Epiretinal membranes (ERM) were selected by non-probability convenient method and divided into two groups. In group A, the ERM was initially stained with Trypan blue and then peeled. Subsequently the macula was re-stained with Brilliant blue G (BBG). In group B, ERM and ILM were successfully peeled together as a single membrane utilizing the single block technique, after a desired negative staining effect was obtained by injecting BBG. The thoroughness of the ILM peel was established using another injection of BBG although a few remains were often identified outside the central macular area, no other dyes were used. Results: In group A, 8 of the 20 eyes (40%) had full undisturbed ILM present whereas in 10 eyes (50%) the ILM was there but damaged, only 2 eyes (10%) had near total ILM removed. In group B, the dual peeling was successful in 17 of the 20 cases (85%). There has been no recurrence of ERM until now. Conclusion: Instead of peeling twice, the single en bloc negative staining technique with Brilliant blue G is a safer and more effective method for removal of ERM together with ILM.

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“…Some observational studies found that the risk of recurrence is reduced from 7-23% without ILM peeling to 0-4% with ILM peeling during idiopathic ERM removal [1][2][3][4][5][6]. In a meta-analysis, Azuma et al [7] found a significant reduction of recurrence rate in case of ILM peeling during idiopathic ERM surgery (odds ratio 0.25; 95% CI 0.12-0.49). Two randomized clinical trial compared ILM peeling or not: De Novelli et al found a similar difference after six months (4% of recurrence with ILM peeling and 17% without) but did not reach significance; Tranos et al did not found any recurrence in both group after twelve months [8].…”

Section: Background and Rationale{6a}mentioning

confidence: 99%

“…The peeling of the ILM doesn't alter nor improve post-operative visual acuity [7][8][9][10][11]. This additional procedure lengthens the operation, increases the surgical risks (phototraumatism, retinal tear, central or eccentric macular hole) [12][13][14] and the risk of histological disorganization of the retina [15], which can result in one or more microscotomas with possible definitive visual discomfort for the patients.…”

Section: Background and Rationale{6a}mentioning

confidence: 99%

Does internal limiting membrane peeling during epiretinal membrane surgery induce microscotomas on microperimetry? Study protocol for PEELING, a randomized controlled clinical trial

Ducloyer

Ivan

Poinas

et al. 2020

Preprint

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Background The epiretinal membrane (ERM) is a degenerative condition associated with age, which can cause loss of vision and/or metamorphopsia. The treatment of symptomatic ERM involves surgical removal including a vitrectomy followed by peeling of the ERM using a microforceps. As the internal limiting membrane (ILM) is adherent to the ERM, it is sometimes removed with it (spontaneous peeling). If ILM remains in place, it can be removed to reduce ERM recurrence. However, it is important to clarify the safety of ILM peeling while it increases surgical risks and cause histological disorganization of the retina that can lead to microscotomas maybe responsible for definitive visual discomfort.Methods PEELING is a prospective, randomized, controlled, single-blind and multi-centered trial with two parallel arms. This study investigates the benefit/risk ratio of active ILM peeling among subjects undergoing ERM surgery without spontaneous ILM peeling. Randomization is done in the operating room after ERM removal if ILM remains in place. After randomization, the two groups "active peeling of the ILM" and "no peeling of the ILM" are compared during a total of three follow-up visits scheduled at M1, M6 and M12. Primary endpoint is the difference in microscotomas before surgery and 6 months after surgery. Patients with spontaneous peeling are not randomized and are included in the ancillary study with the same follow-up visits and the same examinations as the principal study. Relevant inclusion criteria involve subjects over 18 years living with idiopathic symptomatic ERM, including pseudophakic patients with transparent posterior capsule or open capsule or lensed patients with age-related cataracts. The calculated sample size corresponds to 53 randomized eyes (1eye/patient) per arm that means 106 randomized eyes (106 randomized patients) in total and a maximum of 222 included patients (116 spontaneous peeling). Discussion ILM peeling is often practiced in ERM surgery to reduce ERM recurrence. It does not impair post-operative visual acuity but it increases the surgical risks and causes anatomical damages. If active ILM peeling is significantly associated with more microscotomas, it may contraindicate the ILM peeling during primitive idiopathic ERM surgery. Trial Registration ClinicalTrials.gov NCT02146144. Registered May 22, 2014. Recruitment is still 4 ongoing Administrative InformationNote: the numbers in curly brackets in this protocol refer to SPIRIT checklist item numbers. The order of the items has been modified to group similar items (see http://www.equator-network.org/reportingguidelines/spirit-2013-statement-defining-standard-protocol-items-for-clinical-trials/). Title {1}: Prospective, randomized, controlled and single-blind study assessing the benefit/risk ratio of internal limiting membrane (ILM) peeling during Epiretinal Membrane (ERM) surgery.

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Effects of Internal Limiting Membrane Peeling Combined With Removal of Idiopathic Epiretinal Membrane

Abstract: Currently available evidence in the literature indicates that additional ILM peeling in vitrectomy for idiopathic ERM could result in a significantly lower ERM recurrence rate, but it does not significantly influence postoperative best-corrected visual acuity and central macular thickness.

Cited by 83 publications

References 29 publications

Macular vascular circulation and retinal oxygen saturation changes for idiopathic macular epiretinal membrane after vitrectomy

Macular vascular circulation and retinal oxygen saturation changes for idiopathic macular epiretinal membrane after vitrectomy

Comparison of epiretinal membrane peel after dual staining versus en bloc peel using negative staining technique

Does internal limiting membrane peeling during epiretinal membrane surgery induce microscotomas on microperimetry? Study protocol for PEELING, a randomized controlled clinical trial

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