Epiretinal membrane surgery with or without internal limiting membrane peeling

Kwok, Alex Pak Ki; Lai, Timothy Y. Y.; Yuen, Kam‐Tong

doi:10.1111/j.1442-9071.2005.01015.x

Cited by 173 publications

(126 citation statements)

References 31 publications

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“…[8][9][10] Although evidence suggests that ERM formation may be inhibited after ILM removal, the results obtained from cases with idiopathic ERM or diabetic macular oedema may not be readily applied to diabetic eyes with active FVP because of certain unique features in the latter condition. First, a complex vitreoretinal relationship exists in diabetic FVP.…”

Section: Discussionmentioning

confidence: 99%

“…4 This basement membrane scaffolding may play a role in the development of persistent macular oedema and in the proliferation, or reproliferation of ERM. 5 Earlier studies have suggested ILM peeling as an adjunct to macular surgery may improve surgical outcomes in certain macular diseases, such as macular holes, [6][7][8] epiretinal membranes, 9,10 and diabetic macular oedema; [11][12][13] however, the effect of ILM peeling in the prevention of postoperative ERM remains unknown in diabetic active FVP, which is characterized by a strong proproliferative biological environment. 14,15 To answer this question, we conducted a prospective, comparative case series study to evaluate the visual and functional outcomes of vitrectomy, with or without ILM removal, in eyes with progressive FVP.…”

Section: Introductionmentioning

confidence: 99%

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Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Chang

et al. 2008

Eye

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Objective To evaluate the anatomical and functional results of internal limiting membrane (ILM) peeling during pars plana vitrectomy for fibrovascular proliferation (FVP) in diabetic retinopathy. Methods The study was a prospective comparative case series in design. Patients undergoing pars plana vitrectomy for mild to moderate diabetic FVP were divided into either Group 1: vitrectomy only, or Group 2: further ILM peeling in the macular area. Best-corrected visual acuity, fundus examination, and optical coherence tomography (OCT) were conducted at 3 and 6 months postoperatively. Results There were 26 eyes of 25 patients in Group 1 (non-ILM peeling) and 23 eyes of 22 patients in Group 2 (ILM peeling). At 6 months postoperatively, OCT-identifiable epiretinal membrane (ERM) was found in 10 of 26 eyes (38.5%) in Group 1and 0 of 23 eyes in Group 2 (P ¼ 0.001) and six eyes (23.1%) in Group 1 developed biomicroscopic ERM, whereas no patients in Group 2 had ERM (P ¼ 0.02) at 6 months. OCT identifiable ERM correlated significantly with central macular thickness (r ¼ À0.58, Po0.001), the presence of intraretinal cystic space (r ¼ 0.60, Po0.001), and fovea depression reappearance (r ¼ 0.36, P ¼ 0.008). Factors associated with poor visual outcome were macular detachment (Po0.001) and non-ILM peeling (P ¼ 0.004). Conclusions This pilot study suggests that ILM peeling during vitrectomy for diabetic fibrovascular proliferative membranes may minimize postoperative ERM formation and improve visual prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Chang

et al. 2008

Eye

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“…16,37,[41][42][43] The presence of ERM overlying the ILM requires a sequential approach. To this end, the use of multiple vital stains during the same operation has been proposed, 44,45 where the first dye intends to stain ERM, while a second dye is injected after the removal of ERM to stain the ILM. Alternatively, we have demonstrated that sequential peeling may be attained with the use of a single ILM-specific vital dye.…”

Section: Discussionmentioning

confidence: 99%

Quantification of Contrast Recognizability in Sequential Epiretinal Membrane Removal and Internal Limiting Membrane Peeling in Trypan Blue–assisted Macular Surgery

Henrich

Priglinger

Haritoglou

et al. 2013

Retina

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Purpose: To evaluate the selectivity and strength of intraoperative trypan blue staining during removal of epiretinal membranes (ERMs) and the internal limiting membrane.Methods: Based on intraoperative videos, 51 consecutive chromovitrectomies in 51 patients with macular holes, macular pucker, vitreomacular traction syndromes, or persistent macular edema were retrospectively studied. Fifteen subjects underwent trypan blue, 14 indocyanine green, and 22 brilliant blue G chromovitrectomy. The main outcome measure was the color contrast between stained internal limiting membrane or ERM and the underlying unstained tissue by means of objective, quantitative, semiautomated chromaticity difference measurements.Results: Trypan blue stains both ERM and the internal limiting membrane (average chromaticity scores 8.51 and 7.09, respectively; P = 0.48). Internal limiting membrane chromaticity scores were similar for trypan blue (7.09) and brilliant blue G (6.81; P = 0.71) but clearly higher for indocyanine green (15.81; P = 2.45 · 10 −5 ).Conclusion: Under the premises of our study, trypan blue stains both ERM and the internal limiting membrane. Trypan blue's staining capacity of the internal limiting membrane is similar to that of brilliant blue G but significantly inferior compared with indocyanine green. Trypan blue, thus, represents a useful vital dye for chromovitrectomy, particularly in the presence of ERM, where it allows a sequential approach.

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“…Researches have also demonstrated that the surgical outcome is better and ERM recurrence is significantly lower in elderly ERM patients undergoing ILM peeling compared with those without ILM peeling. [17][18][19] The effect of intentional ILM peeling during ERM surgery in young patients has not been reported. In our cases, the improvement of postoperative BCVA is better than those in the earlier reports.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16] The incidence of ERM recurrences were significantly lower in elderly ERM patients undergoing ILM peeling compared with those without ILM peeling. [17][18][19] The purpose of this study was to determine the clinical features and surgical outcomes following the removal of an idiopathic macular ERM in young patients who underwent vitrectomy with ILM peeling for ERM removal.…”

Section: Introductionmentioning

confidence: 99%

Surgical outcome after removal of idiopathic macular epiretinal membrane in young patients

Fang

Chen

Weng

et al. 2007

Eye

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Purpose To report the clinical features of the eye of young patients with an idiopathic macular epiretinal membrane (ERM), and the visual outcomes after the surgical removal of the ERM. Methods A retrospective review of the medical records of eight young patients (age, 23-39 years; mean, 32.5 years) with an idiopathic macular ERM was performed. The patients underwent vitrectomy and removal of the ERM with peeling of the internal limiting membrane (ILM). The pre-and postoperative visual acuity and intra-and postoperative complications were investigated. Results Ophthalmoscopically, the ERMs in seven eyes were white, opaque, and dense, while one was grayish-white and less dense. A posterior vitreous detachment was not present and the ERM adhered strongly to the underlying retina in all eight eyes. The mean best-corrected visual acuity (BCVA) preoperatively was 20/140 (Snellen; range: 20/250-20/63), and the BCVA improved significantly to 20/30 (range: 20/40-20/20) postoperatively with an average follow-up of 14.6 months (range: 6-42 months; Wilcoxon sign-rank test, Po0.001). An improvement of 47 lines was observed in seven of eight eyes. A recurrence of an ERM without involving the macula was detected in one eye (12.5%). Conclusions The clinical features of the ERMs in young patients are different from those in elderly patients, eg, thicker, more adherent to the retina, and still attached to the vitreous. Vitrectomy and removal of ERM with ILM peeling are effective and safe surgical procedures. Removal of the ILM may minimize the recurrence of an ERM.

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Epiretinal membrane surgery with or without internal limiting membrane peeling

Abstract: Internal limiting membrane removal during macular ERM surgery may minimize the recurrence of ERM, without adverse visual outcome. Further controlled prospective studies are needed to determine the role of ILM peeling in ERM surgery.

Cited by 173 publications

References 31 publications

Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Quantification of Contrast Recognizability in Sequential Epiretinal Membrane Removal and Internal Limiting Membrane Peeling in Trypan Blue–assisted Macular Surgery

Surgical outcome after removal of idiopathic macular epiretinal membrane in young patients

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