Surgical Removal of Epiretinal Membrane With and Without Removal of Internal Limiting Membrane

Abstract

Epiretinal membrane removal with and without ILM peeling shows similar functional and anatomical improvements, but the group in which the ILM was not removed seemed to have a higher recurrence rate.

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

“…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. [11][12][13] Russo et al 11 found better improvement of macular sensitivity (microperimetric responses) after ILM nonpeeling while also providing evidence of ILM integrity in their ILM nonpeeling group. These superior responses may be expressions of a more sound retinal microstructure in eyes with intact ILMs and Müller cells.…”

“…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.…”

“…2,3 Further studies found ganglion cell complex (consisting of the retinal nerve fiber layer, ganglion cell layer, and inner plexiform layer) thinning after ILM peeling [4][5][6][7][8][9][10] while Russo et al 11 reported superior foveal improvement of retinal sensitivity after ILM nonpeeling compared with ILM peeling. 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.…”

“…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.…”

Vitrectomy for the removal of idiopathic epiretinal membrane with or without internal limiting membrane peeling: a meta-analysis

“…We recorded information on study characteristics and demographics such as authors, publication year and journal, sample size, treatment modality (with or without ILM peeling) preoperative and postoperative VA in LogMAR, preoperative and postoperative central macular thickness in μm. Totally 16 studies were included 16 – 31 ( Tables 1 and 2 ).…”