Internal Limiting Membrane Peeling Distorts the Retinal Layers and Induces Scotoma Formation in the Perifoveal Temporal Macula

Tao, Jiwei; Yang, Jinglei; Wu, Yubo; Ye, Xin; Zhang, Yun; Mao, Jianbo; Wang, Jun; Chen, Yiqi; Shen, Lijun

doi:10.1097/iae.0000000000003619

Cited by 7 publications

(7 citation statements)

References 30 publications

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“…32 Some microperimetryrelated studies have shown that parafovea scotoma often appears after ILMP, and sometimes the distribution of these scotomas is similar to the distribution of DONFL. 33 In fact, the present study does not prove that DONFL is merely a morphological change after surgery. More F I G U R E 5 Differences in the distribution patterns of CMDS in two ILM peeling groups were compared.…”

Section: Discussioncontrasting

confidence: 82%

“…Previous studies have shown that ILMP leads to the selective delay of recovery of the focal macular electroretinogram's b‐wave 32 . Some microperimetry‐related studies have shown that parafovea scotoma often appears after ILMP, and sometimes the distribution of these scotomas is similar to the distribution of DONFL 33 . In fact, the present study does not prove that DONFL is merely a morphological change after surgery.…”

Section: Discussioncontrasting

confidence: 82%

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Evaluation of the inner retinal layers following traditional and modified ILM peeling surgery using automatic CMDS quantification algorithm

Shen,

Ye,

et al. 2023

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Idiopathic macular hole (IMH) is a vitreoretinal disease that causes severe visual impairment, and the pars plana vitrectomy (PPV) combined with internal limiting membrane peeling (ILMP) is the traditional treatment for IMH. Since the dissociated optical nerve fiber layer (DONFL) is observed in the eyes after the surgery, a modified surgery is put forward to minimize the injury. However, the extent to which the modified surgery reduced damage is not clear. A novel automated image processing system was developed in this study to quantify the damage after the surgery, revealing how the modified surgery reduced the DONFL. Optical coherence tomography (OCT) images and visual acuity were collected from 65 eyes that underwent a vitrectomy with traditional and modified ILM peeling procedure at Zhejiang Provincial People’s Hospital preoperatively. We found that DONFL occurred in all 65 eyes of both the traditional and modified ILM peeling groups. The concentric macular dark spots (CMDS) were automatically measured by the image processing system. The mean total area of CMDS was smaller in the modified ILM peeling group (0.224 ± 0.110 mm2) than that of the traditional ILM peeling group (0.385 ± 0.237 mm2), and there is a significant difference between the two groups (p < .05). The morphological difference in the temporal quadrant of CMDS between the two surgery technology groups was significant (p < .001). This study will provide a clinical research basis for the improvement of macular hole surgery.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussioncontrasting

confidence: 82%

Evaluation of the inner retinal layers following traditional and modified ILM peeling surgery using automatic CMDS quantification algorithm

Shen,

Ye,

et al. 2023

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“…Additionally, the measure equipment or method in the above-mentioned studies may have failed to detect a mild degree of inner retinal defect in whole ILM peeling area. Using the newest Nidek’s microperimetry (MP-3), we previously confirmed high incidence of scotomas in iMH patients with IRDs [ 7 ]. Nevertheless, the natural course of IRDs after ILM peeling and its impact on visual function in other macular diseases remain uncertain.…”

Section: Introductionmentioning

confidence: 91%

“…In 2001, Tadayoni et al. [ 4 ] first found inner retinal dimples (IRDs) on a B-scan of optical coherence tomography (OCT) after epiretinal membrane removal, which coincided with the dark arcuate striae along the course of the optic nerve fibers on a C-scan of OCT, which was the so called “dissociated optic nerve fiber layer (DONFL).” Since then, IRDs (or DONFL) have been reported to appear after ILM peeling in various diseases [ 5 – 7 ]. Some studies [ 8 – 10 ] pointed out that IRDs might contribute to the decrease of visual function after ILM peeling.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Quantitative Analysis of Inner Retinal Dimples and Visual Function Post Internal Limiting Membrane Peeling in Macular Diseases

Wu,

Chen,

Mao

et al. 2023

Ophthalmol Ther

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Introduction Inner retinal dimples (IRDs) are frequently detected after internal limiting membrane (ILM) peeling. However, the distribution of IRDs and its effect on postoperative visual function remain unclear. We aim to quantify the distribution of IRDs after ILM peeling in different macular diseases and analyze its influence on postoperative visual function. Methods We retrospectively reviewed patients undergoing vitrectomy with ILM peeling and followed up until 12 months in our center. The distribution of IRDs were quantitatively determined using optical coherence tomography (OCT) and OCT angiography in a different sector of Early Treatment Diabetic Retinopathy Study grid. Visual function was evaluated by retinal sensitivity (RS) using microperimetry. Spearman correlation was performed between RS and IRDs within the same sectors. Multivariate linear regression analysis was performed to analyze the association between baseline characteristics and IRDs. Results A total of 43 idiopathic macular hole (iMH) cases, 56 idiopathic epiretinal membrane (iERM) cases and 42 myopic foveoschisis (mFS) cases were included. IRDs increased gradually at ILM-peeled area, interrupting ganglion cell layer. Most IRDs were observed in temporal sector. A negative correlation was depicted between the increase of IRDs and the progress of RS at both perifovea and parafovea in iERM, but only at perifovea in iMH. No significant correlation between the change of IRDs and RS was found in mFS. Multivariable linear regression model showed that preoperative axial length was significantly associated with postoperative IRDs in all patients. Conclusions IRDs distributed mostly at temporal sector after ILM peeling, interrupting ganglion cell layer. IRD progression may influence postoperative RS only in iMH and iERM. Ophthalmologists may avoid temporal sector especially in eyes with normal axial length or strong ILM–ERM adherence.

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“…Although the use of these dyes may reduce mechanical trauma, some studies have shown that they may be toxic to the neurosensory retina and the retinal pigment epithelium 16 . ILM peeling can increase central macular thickness, cause distortion of retinal layers and induce scotoma formation 17 . Long-term studies on these side effects are needed to assess the extent of the damage and its functional repercussion.…”

Section: Introductionmentioning

confidence: 99%

Primary ILM peeling during retinal detachment repair: a systematic review and meta-analysis

Lamas-Francis

Bande-Rodríguez

Blanco-Teijeiro

2023

Sci Rep

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Epiretinal membrane (ERM) formation is a known postoperative complication following retinal detachment (RD) repair surgery. Prophylactic peeling of the internal limiting membrane (ILM) during surgery has been shown to reduce the risk of developing postoperative ERM formation. Some baseline characteristics and degrees of surgical complexity may act as risk factors for ERM development. In this review we aimed to investigate the benefit of ILM peeling in patients without significant proliferative vitreoretinopathy (PVR) who underwent pars plana vitrectomy for RD repair. A literature search using PubMed and various keywords retrieved relevant papers from which data were extracted and analyzed. Finally, the results of 12 observational studies (3420 eyes) were summarized. ILM peeling significantly reduced the risk of postoperative ERM formation (RR = 0.12, 95% CI 0.05–0.28). The groups did not differ in final visual acuity (SMD 0.14 logMAR (95% CI − 0.03–0.31)). The risk of RD recurrence (RR = 0.51, 95% CI 0.28–0.94) and the need for secondary ERM surgery (RR = 0.05, 95% CI 0.02–0.17) were also higher in the non-ILM peeling groups. In summary, although prophylactic ILM peeling appears to reduce the rate of postoperative ERM, this benefit does not translate into consistent visual recovery across studies and potential complications must be considered.

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Internal Limiting Membrane Peeling Distorts the Retinal Layers and Induces Scotoma Formation in the Perifoveal Temporal Macula

Cited by 7 publications

References 30 publications

Evaluation of the inner retinal layers following traditional and modified ILM peeling surgery using automatic CMDS quantification algorithm

Evaluation of the inner retinal layers following traditional and modified ILM peeling surgery using automatic CMDS quantification algorithm

Long-Term Quantitative Analysis of Inner Retinal Dimples and Visual Function Post Internal Limiting Membrane Peeling in Macular Diseases

Primary ILM peeling during retinal detachment repair: a systematic review and meta-analysis

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