Macular-Pucker-Chirurgie mit und ohne Delamination der Membrana limitans interna – eine prospektive randomisierte Studie

Changes of Optical Coherence Tomography Angiography Parameters After Internal Limiting Membrane Peeling Compared With Nonpeeling in Epiretinal Membrane Surgery

“…Randomized controlled trials have reported no differences in BCVA between ILM peeled and nonpeeled eyes, 11–17 which is consistent with our results. We did not find differences in ERM recurrence at 3 months, but ERM recurrence rates have previously been reported to be higher in ILM nonpeeled eyes at 6 to 12 months and our follow-up may have been too short to detect relapses.…”

“…ILM nonpeeling may therefore not be trivial in all eyes but only two published randomized controlled trials provided verification of ILM integrity in their ILM nonpeeling groups, 11,27 while other studies did not describe how ILM nonpeeling was confirmed intraoperatively or postoperatively. [12][13][14][15][16][17] In our investigation, we defined the presence of epiretinal hemorrhages in the peeled area and the inability to stain the ILM as criteria for accidental ILM peeling because intraoperative staining has previously been shown to be comparable with postoperative histopathology for the correct identification of removed tissues. 27 The main strength of our study is its prospective and randomized design, even if randomization was not always possible because of strong ILM/ERM adherence.…”

“…However, ERM recurrence rates seem to be higher after ILM nonpeeling at 6 to 12 months, [11][12][13] but randomized controlled trials have not yet found differences in best-corrected visual acuity (BCVA) between ILM peeled and nonpeeled eyes. [11][12][13][14][15][16][17] Optical coherence tomography angiography (OCTA) has become an important modality to visualize pathologies of the retinal vasculature. Chen et al 18 have previously shown that ERMs reduce the foveal avascular zone (FAZ) area and parafoveal vessel density by exerting centripetal traction on the retina, while vitrectomy and ERM peeling can recover both parameters to some extent.…”

“…However, ERM recurrence rates seem to be higher after ILM nonpeeling at 6 to 12 months, 11–13 but randomized controlled trials have not yet found differences in best-corrected visual acuity (BCVA) between ILM peeled and nonpeeled eyes. 11–17…”

Stellungnahme von BVA, DOG und RG zur Entwicklung, Diagnostik und Behandlung der epiretinalen Gliose

“…eines "macular pucker" auch ein primäres Peeling der ILM im Rahmen der Versorgung einer rhegmatogenen Amotio bzw. einer PVR-Amotio retinae durch Vitrektomie [3,26,27,29,91,131,146].…”