Idiopathic epiretinal membrane removal with and without internal limiting membrane peeling: a prospective comparative study

Abstract

Aim This is a prospective comparative study of the macular morphology and visual outcome after epiretinal membrane (ERM) removal with and without internal limiting membrane (ILM) peeling in cases of idiopathic ERM. The study was carried out in the Research Institute of Ophthalmology, Giza, Egypt from February 2015 to February 2017.Patients and methods A total of 40 eyes of 40 patients with visually significant idiopathic ERM were included in the study. A standard three-port 23-gauge pars plana vitrectomy (PPV) was conducted in all patients. Twenty eyes (Group A) were subjected to ERM removal only, while ILM peeling with ERM removal was performed in the other 20 eyes (Group B). Central macular thickness (CMT) and foveal contour on optical coherence tomography (OCT) in addition to best-corrected visual acuity (BCVA) were obtained at baseline and at 1, 3, 6 and 12months postoperatively.Results The mean BCVA significantly improved in both groups, with no statistically significant difference between the two groups at 12 months postoperatively (P=0.053). The mean preoperative and postoperative BCVA were 0.19 and 0.50 decimal units, respectively, in group A, while in group B, the mean preoperative and postoperative BCVA were 0.13 and 0.44 decimal units, respectively. Despite a statistically significant more reduction of CMT in group A compared with group B at 1 month postoperatively (324.80 and 403.95 µm, respectively, P=0.01), no statistically significant difference was found between the two groups at 12 months postoperatively (277.40 and 306.20 µm, respectively). Normal foveal contour was achieved in 13 (65%) and 6 (30%) eyes in groups A and B, respectively.Conclusion Anatomical and functional improvements could be achieved in both groups, with no statistically significant difference at 12 months postoperatively. Adding ILM peeling to idiopathic ERM removal did not appear to improve the outcome in this cohort. Therefore, ILM should not be routinely peeled as safety remains controversial.