Impact of Inner Limiting Membrane Peeling on Visual Recovery After Vitrectomy for Primary Rhegmatogenous Retinal Detachment Involving the Fovea

Garweg, Justus G.; Deiss, Mario; Pfister, Isabel B.; Gerhardt, Christin

doi:10.1097/iae.0000000000002046

Cited by 22 publications

(40 citation statements)

References 37 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

“…The results of our meta-analysis showed no significant difference in visual change after a minimum follow-up of six months between eyes receiving ILM peeling and those without ILM peeling. Among the included studies, 4 out of 9 [ 3 , 4 , 8 , 9 ] described a trend towards better visual acuity in the ILM peeling group, with statistical significance in one study; on the contrary, 4 studies [ 5 – 7 , 11 ] demonstrated a trend toward worse visual acuity in the ILM peeling group, with statistical significance reported only in the RCT, which highlighted a better visual acuity change in patients without ILM peeling. The remaining study [ 10 ] showed the same visual outcome between the two procedures.…”

Section: Discussionmentioning

confidence: 99%

“…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 ].…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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BackgroundInternal limiting membrane (ILM) peeling during primary vitrectomy for rhegmatogenous retinal detachment (RRD) prevents the formation of postoperative macular epiretinal membrane (ERM). However, studies that compared vitrectomy with and without ILM peeling for RRD, have reported controversial outcomes.ObjectiveTo assess the efficacy of ILM peeling versus non-ILM peeling during vitrectomy for RRD by a systematic review and meta-analysis of published studies.MethodsPubMed, Medline, Web of Science, Embase databases, and the Cochrane Library were searched up to April 2018 to identify studies that compared primary vitrectomy with and without ILM peeling for RRD with at least six months follow-up. Primary outcomes were the rate of postoperative ERM formation and mean best corrected visual acuity (BCVA) change after vitrectomy. Rate of recurrence of retinal detachment (RD) was assessed as secondary outcome. Risk ratios (RRs) with 95% confidence intervals (CIs) expressed pooled results for rate of ERM formation and rate of RD recurrence in ILM peeling and non-ILM peeling groups. Pooled results for BCVA change in the two groups were expressed as Weighted Mean Difference (WMD) with 95% CIs.ResultsNine studies, one of which was a randomized controlled trial (RCT), with a total number of 404 eyes in the ILM peeling group and 365 eyes in the non-ILM peeling group, were included. The analysis from pooled data indicated a significant lower rate of postoperative ERM formation in the ILM peeling group compared to the non-ILM peeling group (9 studies, 769 eyes, RR = 0.14; CI: 0.07 to 0.28; P < 0.001). There was no statistical difference in mean BCVA change (9 studies, 769 eyes, WMD = 0.02; CI: -0.11 to 0.16; P = 0.75). Rate of recurrence of RD was lower in the ILM peeling group (6 studies, 603 eyes, RR = 0.32; CI = 0.17 to 0.61; P< 0.001).ConclusionILM peeling during vitrectomy for RRD prevents the formation of macular epiretinal membrane postoperatively and reduces the incidence of RD recurrence, but better visual outcome was not found compared to non-ILM peeling vitrectomy.

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