Effect of Foveal Vitreous Cortex Removal to Prevent Epiretinal Membrane after Vitrectomy for Rhegmatogenous Retinal Detachment

Abstract

To determine the effect of foveal vitreous cortex removal during pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) on the prevention of postoperative epiretinal membrane (ERM) development without internal limiting membrane (ILM) peeling. Case-control study. A total of 105 consecutive eyes of 105 patients who underwent primary PPV for RRD between September 2018 and August 2019 and were followed for at least 6 months. The presence of foveal vitreous cortex during PPV was determined by examining the images obtained by a widefield viewing system in 52 eyes (WF group) operated in the first half of the study period and obtained by a high-magnification floating lens in 53 eyes (FL group) operated in the latter half of the study period. Triamcinolone acetonide was used to make the vitreous cortex more visible during PPV. The foveal vitreous cortex was removed if detected by forceps with a high-magnification floating lens without ILM peeling or use of dye staining. The presence of postoperative ERM was examined by using OCT. The rate of detected and removed foveal vitreous cortex during PPV and the incidence of postoperative ERM of each group. The rate of detected and removed foveal vitreous cortex during PPV was significantly higher in the FL group than in the WF group (41.5% vs. 15.4%, P= 0.004). The incidence of postoperative ERM was significantly lower in the FL group than in the WF group (1.9% vs. 13.5%, P= 0.03). None of the eyes required additional surgery for the postoperative ERM during the follow-up period. The retinal reattachment rate was not significantly different (98.1% vs. 100%, P= 0.99), and the final retinal attachment rate was 100% in both groups. A dissociated optic nerve fiber layer appearance and a temporal macular thinning were not detected postoperatively in any of the eyes with removal of the foveal vitreous cortex during PPV. The detection and removal of foveal vitreous cortex with the high-magnification floating lens during PPV for RRD significantly reduce the incidence of postoperative ERM without adverse findings.