Abstract
Purpose To compare changes in the retinal layer thickness and visual outcomes in patients undergoing epiretinal membrane (ERM) surgery with or without internal limiting membrane (ILM) peeling. Methods Seventy-six eyes of 76 patients who underwent ERM surgery from January 2013 to March 2015 at the Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea, were analyzed. While ERM removal with ILM peeling was performed in ILM peeling (P) group (n=39), ILM peeling was not performed in non-ILM peeling (NP) group (n=37). Retinal layer segmentation was performed using optical coherence tomography images. Individual retinal layer thicknesses before and at 6 months after ERM surgery were compared. The postoperative best-corrected visual acuity (BCVA) was also compared. Results In the P group, the thicknesses of retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) were significantly reduced. In the NP group, significant decreases in the RNFL, GCL, IPL, inner nuclear layer, and outer plexiform layer were observed. The P group manifested a greater mean postoperative GCL (35.56 ± 1.53 µm vs 29.86 ± 2.16 µm; p=0.033) and less loss of GCL (−10.26 ± 1.91 µm vs −19.86 ± 2.74 µm; p=0.004) compared to the NP group. No statistically significant differences were observed when comparing the changes in BCVA. Conclusions This study demonstrates that ILM peeling for ERM surgery may result in better preservation of GCL compared to no ILM peeling.
Highlights
To compare changes in the retinal layer thickness and visual outcomes in patients undergoing epiretinal membrane (ERM) surgery with or without internal limiting membrane (ILM) peeling
ILM peeling for ERM surgery resulted in less loss of ganglion cell layer (GCL) thickness compared to no ILM peeling
A novel finding of this study is that the P group than in the NP group (P group) exhibited significantly lower reduction of GCL thickness compared to the non-ILM peeling (NP) group. is contradicts many previous concerns regarding iatrogenic trauma and retinal toxicity produced by indocyanine green (ICG) dye guided ILM peeling
Summary
To compare changes in the retinal layer thickness and visual outcomes in patients undergoing epiretinal membrane (ERM) surgery with or without internal limiting membrane (ILM) peeling. E advantages of ILM removal during ERM surgery include better anatomical outcomes, lower recurrence rates, and better final visual acuity [6,7,8,9]. Previous studies indicated that preoperative integrity of the inner segment and outer segment line (IS/OS line) [16], preoperative photoreceptor outer segment length [17], and postoperative ganglion cell layer (GCL) thickness [18] are significantly correlated with postoperative bestcorrected visual acuity (BCVA). There has been no prior comparative analysis of the changes in individual retinal layers by automated segmentation between patients who have undergone ERM surgery with ILM peeling versus without ILM peeling
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