Functional and structural outcomes of ILM peeling in uncomplicated macula-off RRD using microperimetry & en-face OCT

Abstract

Although ILM peeling prevented ERM, it resulted in poorer visual outcome in these uncomplicated RRD cases, and might be better reserved only for complicated cases.

Internal limiting membrane peeling versus no peeling during primary vitrectomy for rhegmatogenous retinal detachment: A systematic review and meta-analysis

“…Not surprisingly, included studies featured different designs and clinical variables. Eight were retrospective and one was an RCT, which was conducted by Eissa et al [ 6 ] and enrolled only macula off RD. Similarly, Garweg et al [ 8 ], Foveau et al [ 10 ], Blanco-Teijeiro et al [ 11 ] and Aras et al [ 9 ] included only macula off RD.…”

“…The rate of macula off RD recorded by Rao et al [ 7 ], Nam et al [ 3 ], Akiyama et al [ 5 ] and Forlini et al [ 4 ] was 74%, 44%, 42% and 68%, respectively. Eissa et al [ 6 ], Garweg et al [ 8 ] and Aras et al [ 9 ] used silicone oil as endotamponade in all cases, while Foveau et al [ 10 ], Blanco-Teijeiro et al [ 11 ], Rao et al [ 7 ] and Nam et al [ 3 ] performed vitrectomy with gas in each case. Forlini et al [ 4 ] used both tamponades.…”

“…Akiyama et al [ 5 ] did not report on type of tamponade. Baseline visual acuity was also different: Nam et al [ 3 ] and Akiyama et al [ 5 ] registered a mean BCVA < 1 logMar in both the ILM peeling and non-ILM peeling group, while it was > 1 logMar in both groups of all other studies [ 4 , 6 – 11 ]. This difference in clinical aspects has to be taken into account as it might have an influence on outcomes, in particular on the functional one.…”

“…Four studies [ 6 , 8 – 10 ] in our analysis had a mean follow-up of 6 months or longer, while 5 studies [ 3 – 5 , 7 , 11 ] had a follow-up of at least one year. This period represents a fair follow-up time for evaluating the effect of the two different surgical procedures on visual function, since roughly 5 months have been reported as the mean post-vitrectomy timeframe for ERM to cause symptoms that require further surgery for removal [ 12 ].…”

“…When evaluating the recurrence rate of RD, a statistical difference has been demonstrated by this meta-analysis, with a lower rate of RD recurrence in the ILM peeling group. Although data on RD recurrence were reported from six studies [ 3 – 6 , 8 , 10 ], five studies were included in the pooled analysis since Eissa et al [ 6 ] were excluded as there was no case of RD recurrence in both groups. Rao et al [ 7 ] did not examine the rate of RD recurrence in their study, while Blanco-Teijeiro et al [ 11 ] and Aras et al [ 9 ] defined recurrence of retinal detachment as an exclusion criteria from their retrospective analysis.…”