Abstract
BackgroundInternal limiting membrane (ILM) peeling during primary vitrectomy for rhegmatogenous retinal detachment (RRD) prevents the formation of postoperative macular epiretinal membrane (ERM). However, studies that compared vitrectomy with and without ILM peeling for RRD, have reported controversial outcomes.ObjectiveTo assess the efficacy of ILM peeling versus non-ILM peeling during vitrectomy for RRD by a systematic review and meta-analysis of published studies.MethodsPubMed, Medline, Web of Science, Embase databases, and the Cochrane Library were searched up to April 2018 to identify studies that compared primary vitrectomy with and without ILM peeling for RRD with at least six months follow-up. Primary outcomes were the rate of postoperative ERM formation and mean best corrected visual acuity (BCVA) change after vitrectomy. Rate of recurrence of retinal detachment (RD) was assessed as secondary outcome. Risk ratios (RRs) with 95% confidence intervals (CIs) expressed pooled results for rate of ERM formation and rate of RD recurrence in ILM peeling and non-ILM peeling groups. Pooled results for BCVA change in the two groups were expressed as Weighted Mean Difference (WMD) with 95% CIs.ResultsNine studies, one of which was a randomized controlled trial (RCT), with a total number of 404 eyes in the ILM peeling group and 365 eyes in the non-ILM peeling group, were included. The analysis from pooled data indicated a significant lower rate of postoperative ERM formation in the ILM peeling group compared to the non-ILM peeling group (9 studies, 769 eyes, RR = 0.14; CI: 0.07 to 0.28; P < 0.001). There was no statistical difference in mean BCVA change (9 studies, 769 eyes, WMD = 0.02; CI: -0.11 to 0.16; P = 0.75). Rate of recurrence of RD was lower in the ILM peeling group (6 studies, 603 eyes, RR = 0.32; CI = 0.17 to 0.61; P< 0.001).ConclusionILM peeling during vitrectomy for RRD prevents the formation of macular epiretinal membrane postoperatively and reduces the incidence of RD recurrence, but better visual outcome was not found compared to non-ILM peeling vitrectomy.
Highlights
Since the introduction of small gauge vitrectomy, a broad change in the treatment of rhegmatogenous retinal detachment (RRD) has taken place, as a shift towards pars plana vitrectomy has made this the preferred procedure with respect to scleral buckle [1].ever-increasing attention has been paid to possible complications related to this surgery and how to limit unpleasant events
internal limiting membrane (ILM) peeling vs no peeling during vitrectomy for RRD: A systematic review and meta-analysis included
ILM peeling during vitrectomy for RRD prevents the formation of macular epiretinal membrane postoperatively and reduces the incidence of RD recurrence, but better visual outcome was not found compared to non-ILM peeling vitrectomy
Summary
Since the introduction of small gauge vitrectomy, a broad change in the treatment of rhegmatogenous retinal detachment (RRD) has taken place, as a shift towards pars plana vitrectomy has made this the preferred procedure with respect to scleral buckle [1].ever-increasing attention has been paid to possible complications related to this surgery and how to limit unpleasant events. Retinal pigment epithelial cells have been attributed a key role, migrating from retinal breaks towards the macular surface, on which they proliferate. In this context internal limiting membrane (ILM) has been assumed to act as a scaffold for the ERM to be built up [3,12]. Internal limiting membrane (ILM) peeling during primary vitrectomy for rhegmatogenous retinal detachment (RRD) prevents the formation of postoperative macular epiretinal membrane (ERM). Studies that compared vitrectomy with and without ILM peeling for RRD, have reported controversial outcomes
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