Internal limiting membrane peeling Vs no peeling in primary vitrectomy for macula off retinal detachment: A comparative study

Document Type : Original Article

Authors

Department of ophthalmology, Sohag faculty of medicine, Sohag University, Sohag

Abstract

Purpose:To compare the visual outcome and the rate of epiretinal membrane formation after primary vitrectomy with internal limiting membrane peeling Vs no peeling for patient with macula off retinal detachment.
Patients and methods: This was a Prospective comparative uncontrolled case series.  The study enrolled 30eyeswith rhegmatogenousretinaldetachmentwith macula off subjected to primaryvitrectomy   , and classifiedinto 2 groups, Group A cases subjectedtoprimaryvitrectomywithoutinternallimiting membrane peeling and group B casessubjectedto primaryvitrectomy,   with internal limiting membrane peeling, Assessment of best corrected visual acuityand rate of epiretinal membrane formation after removal of silicone oil had been done.
Results:This study included 30 eyes of 30 patients, 16 (53.33 %) were males and 14 (46.67 %) were females, the mean age of studied patients was (43.37 ± 10.40) years old. There was no statistically significant difference in mean logMAR BCVA after silicone oil removal (1.18 ± 0.29 for group A versus 0.99 ± 0.38 for group B; P = 0.12).OCT done for all cases after silicone oil removal after 6 months and show that; epiretinal membrane with cystoid macular edema is formed in 5 cases in group A while ERM is not formed in any cases in group B (P = 0.04) , IS / OS line is interrupted in 6 cases in group A and in 3 cases (P = 0.43) as regarding foveal contour; it is lost in 5 cases and preserved in 10 cases in group A while in group B the foveal contour is preserved in 13 cases ,lost in 1 case and flat in 1 case (P = 0.06) , while comparing the mean of the central foveal thickness shows no statistically significant difference 295.73±129.46 for group A versus 237.6±47.60 for group B; P = 0.66.
Conclusion:There was no statistically significant difference in mean visual acuity after silicone oil removal in both procedures.however, the epiretinal membrane formation was absent in group B with ILM peeling in comparison to group A.

Keywords


  1. Gonin J. The evolution of ideas concerning retinal detachment within the last five years: The William Mackenzie Memorial Lecture, 1933. Br J Ophthalmol. 1933;17(12):726–740.
  2. Mitry D, Charteris DG, Fleck BW, Campbell H, Singh J: The epidemiology of rhegmatogenous retinal detachment: geographical variation and clinical associations. Br J Ophthalmol 2010; 94: 678–84.
  3. Van de Put MAJ, Hooymans JMM, Los LI, Dutch Rhegmatogenous Retinal Detachment Study Group: The incidence of rhegmatogenous retinal detachment in The Netherlands. Ophthalmology. 2013; 120: 616–22.
  4. Haimann MH, Burton TC, Brown CK: Epidemiology of retinal detachment. Arch Ophthalmol 1982; 100: 289–92.
  5. Pocklinghorne PJ and Craig JP. Analysis of Symptoms associated with rhegmatogenous retinal detachments. Clinical and Experimental Ophthalmology, 1994. 32: 603-606.
  6. Burton TC. Recovery of visual acuity after retinal detachment involving the macula. Trans Am Ophthalmol Soc. 1982; 80: 475-97.
  7. MachemerR.,&Hickingbotham D. The three-port microcannular system for closed vitrectomy. Am J Ophthalmol, Vol. 100, (October 1985), pp. (590-592).
  8. Fujii GY, de Juan E. Jr, Humayun MS, Pieramici, DJ, Chang, TS, Awh, C., Ng, E., Barnes, A., Wu, SL, &Sommerville, DN.  A new 25-gauge instrument system for transconjunctivalsuturelessvitrectomy surgery. Ophthalmology, Vol. 109, No. 10, (October 2002), pp. (1807-12).
  9. Abdelkader E, Lois N. Internal limiting membrane peeling in vitreo-retinal surgery.SurvOphthalmol. 2008 Jul-Aug;53(4):368-96.
  10. Katria RC, Zamani M, Berinstein DM, et al. Incidence and Characteristics of Macular Pucker Formation After Primary Retinal Detachment Repair by Pars Plana Vitrectomy Alone. Retina, 28: 744-748; 2008.
  11. Aras C, Arici C, Akar S, et al. Peeling of Internal Limiting Membrane During Vitrectomy for Complicated Retinal Detachment Prevents Epimacular Membrane Formation. Graefes Arch ClinExpOphthalmol, 247: 619-623; 2009.
  12. Nam KY, Kim JY. Effect of Internal Limiting Membrane Peeling on the Development of Epiretinal Membrane after Pars Plana Vitrectomy for Primary Rhegmatogenous Retinal Detachment. Retina, 35: 880-885;2015.
  13. Martínez-castillo V, Boixadera A, Boixadera L, et al. Epiretinal Membrane after Pars Plana Vitrectomy for Primary Psudophakic and AphakicRhegmatogenous Retinal Detachment, Incidence and outcomes. Retina, 32: 1350-1355; 2012.