Internal limiting membrane peeling or not: a systematic review and meta-analysis of idiopathic macular pucker surgery

Fang, Xiaoling; Tong, Yao; Zhou, Yali; Zhao, Ping; Wang, Zhaoyang

doi:10.1136/bjophthalmol-2016-309768

Cited by 40 publications

(23 citation statements)

References 41 publications

(37 reference statements)

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“…Similar anatomical results in the literature support the idea of ILM peeling to minimize ERM recurrences. Recent meta-analyses (21,22) have clearly demonstrated the inhibiting effect of ILM peeling on ERM recurrence. Numerous reports, however, also point to microperimetric scotomas induced by ILM peeling associated with surgical trauma.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of factors effecting the epiretinal membrane surgery outcome

Erden¹

2019

Beyoglu Eye J

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The aim of this study was to evaluate several factors affecting the outcome of epiretinal membrane (ERM) surgery. Methods: The data of a total of 41 eyes of 40 patients (20 female, 20 male) who underwent pars plana vitrectomy (PPV) and epiretinal membrane (ERM) peeling with/without internal limiting membrane (ILM) peeling between November 2001 and October 2005 at Beyoğlu Eye Training and Research Hospital with a minimum follow-up of 6 months were included in this retrospective study. The patients' best corrected visual acuity (BCVA; Snellen) and the biomicroscopic, funduscopic, and optical coherence tomography (OCT) findings measured preoperatively and at month 1,3,6, and a final visit were recorded. The surgical technique (partial 25-gauge vs 20-gauge), ILM peeling, intraoperative dyes, and the etiology of the ERM were evaluated as separate factors in the surgical outcome. Intraoperative, peroperative, and postoperative complications were assessed and compared. Results: The mean age of the study group participants was 63.56±14.96 years. The mean BCVA had increased from 0.28±0.149 to 0.35±0.24 Snellen lines (p=0.028) at the 6-month visit. In all, 18 of 41 eyes (43.9%) had gained ≥2 Snellen lines at the final visit. Cataract progression was detected in 17 cases (54.8%) of phakic eyes. The incidence of ERM recurrence was significantly greater in the ILM Intact group (37% vs 0%) than in the ILM Peeled group (p=0.009). There was no significant difference in anatomical or functional outcome between the partial 25-gauge and 20-gauge PPV techniques. Conclusion: ILM peeling significantly reduced ERM recurrence. Follow-up observations indicated that cataract progression was the primary factor limiting visual gain.

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Section: Discussionmentioning

confidence: 99%

Evaluation of factors effecting the epiretinal membrane surgery outcome

Erden¹

2019

Beyoglu Eye J

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“…Relieving traction at specific nodes of retinal fibrosis might eliminate traction and its deleterious effects on deeper retinal structures while avoiding the risk of damaging the nerve fiber layer [27]. Indeed a meta-analysis carried out in 2017, showed little difference in visual outcome with and without ILM peeling [28]. ILM peeling was associated with a reduced rate of repeat surgery, though an increase central macular thickness was more frequently observed following an ILM peel.…”

Section: Discussionmentioning

confidence: 99%

Retinal relaxation following membrane peeling: Effect on vision, central macular thickness, and vector analysis of motion

Smet

Julian

Maurin³

et al. 2019

Preprint

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Purpose: Removal of an epiretinal membrane (ERM) leads to the outward displacement of retinal vessels and visual improvement. The direction and extent of displacement in the form of a vector analysis over the posterior pole can provide a better understanding of the dynamics and duration of this process, while the magnitude might have implications in terms of visual outcome. Methods: Scanning laser ophthalmoscope images of the retina of eyes undergoing ERM peeling were compared before and 6 months after surgery. Stratification was made between prominent and limited displacement, with assessment of visual acuity (VA), and central macular thickness (CMT). In three cases, using the optic nerve as reference, 50 landmarks were chosen within the posterior pole along large and small vascular structures allowing the construction of a vector map of displacement over 1 year. Results: Nine eyes with prominent displacement (up to 400µm) and 6 eyes with limited displacement were assessed. Three lines of improvements in VA were observed in both groups over a 6 month period. Starting vision was lower in the eyes with prominent displacement. The CMT decrease was variable in onset in both groups but when observed was present within the first 3 months. CMT decrease was most significant in eyes with the greatest vascular displacement (initial: mean 445+/- 173µm; 6 months mean 352+/- 95µm) compared to eyes with less displacement (initial 366+/- 82µm; at 6 months 317 +/- 94µm). Vector analysis showed that most vascular movements occurred over the first 6 months, and involved the whole surface of the posterior retina, extending in some cases beyond the arcades. The displacement originated around distinct nodes of contraction.Conclusions: Retinal relaxation can occur over a large surface area. The superficial displacement of structures which served as a basis for the current analysis did not correlate with the change in vision. Vision recovery is likely correlated more closely with wrinkling of outer retinal layers.

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“…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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Internal limiting membrane peeling or not: a systematic review and meta-analysis of idiopathic macular pucker surgery

Abstract: ILM peeling yielded greater anatomical success, but no improvement in functional outcomes as the treatment of choice for patients undergoing IMP surgery.

Cited by 40 publications

References 41 publications

Evaluation of factors effecting the epiretinal membrane surgery outcome

Evaluation of factors effecting the epiretinal membrane surgery outcome

Retinal relaxation following membrane peeling: Effect on vision, central macular thickness, and vector analysis of motion

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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