non-ILM Peeling Group Research Articles

Negative impact of internal limiting membrane peeling in vitreous hemorrhage secondary to retinal vein occlusion with macular ischemia.

To investigate the effect of internal limiting membrane (ILM) peeling on visual outcomes and postoperative epiretinal membrane (ERM) after pars plana vitrectomy (PPV) for vitreous hemorrhage (VH) associated with retinal vein occlusion (RVO) with various degrees of macular ischemia. We compared the outcomes of eyes that underwent vitrectomy with and without ILM peeling from 2012 to 2021 with a minimum follow-up of 6months. 112 charts were analyzed, and 51 eyes met the inclusion criteria. There were 19 eyes with ILM peeling and 32 eyes with non-ILM peeling. Baseline characteristics did not differ significantly. The mean postoperative visual acuity significantly improved at 6months compared with the mean preoperative visual acuity (P < 0.001). Visual improvement was significantly greater in the non-ILM peeling group(P < 0.05). Without ischemia within the arcade, there was no significant difference in the visual improvement. In patients with ischemia, the visual improvement in the ILM peeling group was significantly worse than that in the non-ILM peeling group. The incidence of postoperative ERM was significantly higher in the non-ILM peeling; however, there was no significant change in postoperative vision due to the presence of ERM. Vitrectomy either with or without ILM peeling results in visual improvement in patients with VH associated with RVO; however, it should be uniformly avoiding ILM peeling in cases with pre-existing macular ischemia, as it may significantly lead to a deterioration in visual outcomes. What is known Pars plana vitrectomy is effective for visual improvement in vitreous hemorrhage associated with retinal vein occlusion. The incidence of postoperative epiretinal membrane is variable depending on the surgical approach. What is new Avoiding ILM peeling in cases of macular ischemia during vitrectomy is crucial for better visual outcomes. Despite higher rates of epiretinal membrane post-surgery in non-ILM peeled eyes, their visual outcomes remain superior to those with ILM peeling.

Internal limiting membrane peeling in rhegmatogenous retinal detachment: A meta-analysis.

To determine whether pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for rhegmatogenous retinal detachment (RRD) could get better functional and anatomical outcomes. A comprehensive literature search was performed to find relevant studies. A meta-analysis was conducted by comparing the weighted mean differences (WMD) in the mean change of best corrected visual acuity (BCVA) from baseline and calculating the odd ratios (OR) for rates of epiretinal membrane (ERM) formation and recurrence of retinal detachment (RD). Fourteen studies were selected, including 2259 eyes (825 eyes in the ILM peeling group and 1434 eyes in the non-ILM peeling group). There was no significant difference in terms of mean change in BCVA from baseline and the rate of RD recurrence (WMD = 0.02, 95% CI, -0.20 to 0.24, P = 0.86, and OR = 0.55, 95% CI, 0.24 to 1.26, P = 0.16), but ILM peeling was associated with a significantly lower frequency of postoperative ERM formation (OR = 0.13, 95% CI, 0.06 to 0.26, P<0.00001). Similar results were obtained in a sub-analysis based on macula-off RRD. ILM peeling results in similar BCVA, with same rate of RD recurrence, but lower rate of postoperative ERM development. ILM peeling could be considered in selected cases with risk factors that are likely to develop an ERM.

Effects of internal limiting membrane peeling versus non-internal limiting membrane peeling during vitrectomy for diabetic tractional retinal detachment on postoperative macular thickness, foveal contour, and formation of epiretinal membranes

Aim To investigate the impact of internal limiting membrane (ILM) peeling during vitrectomy for diabetic tractional retinal detachment (TRD) on postoperative central macular thickness, foveal contour, and creation or reformation of epiretinal membranes. Methods In a randomized trial, patients aged 40–65 years old with TRD were recruited from the outpatient clinic in Suez Canal University Hospital from August 2020 to February 2022. Patients were randomized into two groups: group 1 did vitrectomy with ILM peeling, while group 2 did vitrectomy without ILM peeling. At 1, 3, and 6 months after surgery, optical coherence tomography (OCT) was carried out to investigate the central macular thickness (CMT), foveal contour, and epiretinal membrane’s presence. For categorical variables, the Chi-squared test or Fisher’s exact test was performed, while the Student’s t-test was used to assess differences in continuous data. Results Thirty-two patients (16 in each group) completed the required follow-up. There was no significant difference between both groups concerning the affected eye (P=1.00). There was no statistically significant difference regarding the CMT recorded via optical coherence tomography at any point of follow-up in the two groups (P=0.289). Also, there was no statistically significant difference regarding the presence of foveal depression at any point of follow-up in the two groups (P=0.680). On the other hand, the percentage of patients who showed no presence of epiretinal membranes in the ILM peeling group was statistically significant when compared with the non-ILM peeling group (P&lt;0.001). Conclusions ILM peeling decreases the incidence of epiretinal membrane proliferation following diabetic vitrectomy.

Removal of sticky silicone oil adhered to the retinal surface: comparison of methodological safety and effectiveness.

To compare safety and effectiveness among methods to remove sticky silicone oil bubbles adhered to the retinal surface. This retrospective nonrandomised case series included 14 eyes of 14 patients who had sticky silicone oil residue during silicone oil removal surgery. For small sticky silicone oil bubbles (< 2-disc diameter), aspiration was performed with a 23-gauge vitreous cutter. Residual tiny oil bubbles were then removed with a silicone-tipped flute needle or internal limiting membrane (ILM) peeling. For large sticky silicone oil bubbles (≥ 2-disc diameter) that could not be removed with a 23-gauge vitreous cutter, we devised a more efficient active removal method involving a modified 22-gauge venous indwelling cannula device. The mean preoperative best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution [logMAR]) significantly improved from 1.28 ± 0.63 logMAR to 0.77 ± 0.58 logMAR (p = 0.014). The postoperative BCVA and improvement in BCVA were significantly better in the ILM peeling group than in the non-ILM peeling group (p = 0.004 and p = 0.045, respectively). Postoperative complications included residual sticky silicone oil bubbles in seven eyes without ILM peeling (50.0%), retinal neuroepithelial layer damage in two eyes (14.3%), and temporary hypotony in five eyes (35.7%). Various methods can safely and efficiently remove sticky silicone oil bubbles adhered to the retinal surface. A 22-gauge venous indwelling cannula enabled simple and safe removal of large sticky silicone oil bubbles, while small residual sticky silicone oil bubbles could be completely removed by ILM peeling.

Anatomical and functional results of ILM peeling vs. non-peeling in macula-off rhegmatogenous retinal detachment.

To compare anatomical and functional results between internal limiting membrane (ILM) peeling and non-ILM peeling in macula-off rhegmatogenous retinal detachment (RRD). We completed a retrospective cohort study of patients who underwent pars plana vitrectomy (PPV) due to macula-off RRD. ILM peeling (P) versus non-ILM peeling (NP) groups were compared regarding best-corrected visual acuity (BCVA), anatomical success, endotamponade, concomitant scleral band placement and BCVA gain for epiretinal membranes (ERM) resubjected to PPV. Statistical significance was considered when p < 0.05. PPV was conducted in 352 patients, among which 43.5% (n = 153) were in the P group and 55.6% (n = 196) were in the NP group. Both groups had significant BCVA improvement during the study period (p < 0.001), but with no significant difference between them. Anatomical success was similar between P (84.2%) and NP (87.2%) groups. No difference was found with regard to endotamponade (p = 0.07) or concomitant scleral band placement (p = 0.43). The NP group developed subsequent ERM more frequently (p = 0.004), but BCVA gains for eyes requiring repeat PPV for ERM were not found (p = 0.14). Although ERM formation and greater anatomical success are reasons to support the use of ILM peeling in RRD, we did not observe any anatomical or functional difference regarding ILM peeling or functional gain with secondary ERM peeling.

Effect of Internal Limiting Membrane Peeling on Macular Structure and Metamorphopsia Scores in Idiopathic Epiretinal Membrane Surgery

Backgrounds and Objective:Pars Plana Vitrectomy (PPV) and epiretinal membrane (ERM) peeling is the standard surgical procedure of ERM surgery. However, the effect of adding Internal Limiting Membrane (ILM) peeling to the standard surgery on macular function and structure remains still controversial. This study was aimed at investigating the effect of ILM peeling on the macular function and structure in idiopathic ERM surgery.Method:Thirty-six eyes of 34 patients were evaluated in this prospective study. The patients were divided into two groups (ILM peeling and non-ILM peeling group). While the removal of ERM was undergone alone in 19 eyes, it was combined with ILM peeling in 17 eyes. Metamorphopsia scores Vertical Metamorphopsia (VM) and Horizontal Metamorphopsia (HM), were measured at preoperative and 4 months postoperatively.Results:There was a statistically significant decrease in metamorphopsia (VM and HM) scores in both groups after the surgery. However, no statistically significant difference was found between the two groups in terms of reduction in VM scores and HM scores after surgery.Conclusion:Our study indicated that ILM peeling combined with ERM did not affect metamorphopsia scores.

Comparison of Individual Retinal Layer Thicknesses after Epiretinal Membrane Surgery with or without Internal Limiting Membrane Peeling.

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.

Internal limiting membrane peeling and gas tamponade for myopic foveoschisis: a systematic review and meta-analysis

BackgroundMyopic foveoschisis (MF) is among the leading causes of visual loss in high myopia. However, it remains controversial whether internal limiting membrane (ILM) peeling or gas tamponade is necessary treatment option for MF.MethodsPubMed, EMBASE, CBM, CNKI, WANFANG DATA and VIP databases were systematically reviewed. Outcome indicators were myopic foveoschisis resolution rate, visual acuity improvement and postoperative complications.ResultsNine studies that included 239 eyes were selected. The proportion of resolution of foveoschisis was higher in ILM peeling group than non-ILM peeling group (OR = 2.15, 95% CI: 1.06–4.35; P = 0.03). The proportion of postoperative complications was higher in Tamponade group than non-Tamponade group (OR = 10.81, 95% CI: 1.26–93.02; P = 0.03). However, the proportion of visual acuity improvement (OR = 1.63, 95% CI: 0.56–4.80; P = 0.37) between ILM peeling group and non-ILM peeling group and the proportion of resolution of foveoschisis (OR = 1.80, 95% CI: 0.76–4.28; P = 0.18) between Tamponade group and non-Tamponade group were similar.ConclusionsVitrectomy with internal limiting membrane peeling could contribute to better resolution of myopic foveoschisis than non-peeling, however it does not significantly influence the proportion of visual acuity improvement and postoperative complications. Vitrectomy with gas tamponade is associated with more complications than non-tamponade and does not significantly influence the proportion of visual acuity improvement and resolution of myopic foveoschisis.

The role of internal limiting membrane peeling in epiretinal membrane surgery: a randomised controlled trial

PurposeTo compare the anatomical and functional outcomes after primary idiopathic epiretinal membrane (ERM) peeling with or without internal limiting membrane (ILM) peeling.DesignA two-centre randomised, controlled clinical trial with 12 months...

Clinical outcomes of idiopathic macular epiretinal membrane removal by 23G vitrectomy with or without internal limiting membrane peeling

Objective To evaluate the clinical outcomes of idiopathic macular epiretinal membrane (IMEM) by 23G vitrectomy with or without internal limiting membrane peeling.Methods A total of 40 eyes in 40 patients diagnosed as IMEM underwent 23G pars plana thre-port vitrectomy (23G PPV).The macular ERM alone was removed in 20 eyes (non-ILM peeling group).Both ERM and ILM peeling were performed in another 20 eyes (ILM peeling group).All patients underwent removal of ERM with assistance of triamcinolone acetonide.For patients who underwent ILM peeling,indocyanine green dye was used to stain the ILM.ILM was peeled off up to the marginal of macular vessels arch.The patients in ILM peeling group and non-ILM peeling group had postsurgical follow-up for (15.85±3.79) months and (16.45±3.72) months respectively.There were no significant differences in gender,age,OD/OS,preoperative bestcorrected visual acuity (BCVA),preoperative central macular thickness (CMT),preoperative total macular volume (TMV) and follow-up time between the two groups (P＞0.05).Intraoperative or postoperative complication was recorded during the follow-up period.At the final visit,the differences in BCVA,CMT and TMV between the two groups were analyzed,so did the correlations between BCVA and CMT or TMV in each group at the same time.Results There was no recurrence of an ERM or severe complications,such as retinal detachment and endophthalmitis in either group.The mean BCVA of ILM peeling group and nonILM peeling group was 0.53 ± 0.27 and 0.54 ± 0.26 respectively at the final visit.Postoperative BCVA improved significantly in both groups with significant difference (t=5.035,4.964; P＜0.05).The was no difference of postoperative BCVA between two groups (t =0.176,P＞ 0.05).The mean CMT was (343.55 ± 48.74) μm and (311.70±42.48) μm,and the mean TMV was (7.78±0.40) mm3 and (7.88±0.43) mm3.CMT (t=9.508,8.549) and TMV (t =11.098、15.372) revealed a significant decrease in both groups with significant difference (P ＜ 0.05).The postoperative CMT in the ILM peeling group was significantly higher than that in the non-ILM peeling group (t=-2.203,P＜0.05).No difference was found between the two groups in terms of TMV (t =0.755,P＞0.05).Furthermore,no correlation was observed between postoperative BCVA and CMT (r =0.244,0.266 ; P ＞ 0.05) or TMV (r =-0.096,0.157; P＞0.05).Conclusions 23G PPV combined with or without ILM peeling is an efficient and safe treatment for IMEM.ILM peeling appears to have similar effect on the long-term visual outcomes comparing with non-ILM peeling,combined with much thicker postoperative CMT. Key words: Macula lutea; Membranes; Surgical procedures, minimally invasive; Vitrectomy

Outcomes of idiopathic macular epiretinal membrane removal with and without internal limiting membrane peeling: A comparative study

To compare visual acuity and macular morphology after epiretinal membrane (ERM) removal with and without internal limiting membrane (ILM) peeling. We studied a retrospective interventional case series of 40 eyes in 40 patients with ERM. All patients underwent standard three-port pars plana vitrectomy. In 19 eyes, the ERM alone was removed. In 21 eyes, the ERM was removed and ILM peeling was performed. Mean best-corrected visual acuity improved significantly in both the non-ILM peeling and the ILM peeling groups (P = 0.001, P = 0.000). Mean central macular thickness (CMT) decreased significantly in both groups (P = 0.001, P = 0.001). However, there was a significant difference in postoperative CMT between the two groups (P = 0.025). The mean postoperative CMT was significantly higher in the ILM peeling group than in the non-ILM peeling group. Sixteen eyes (84.2%) in the non-ILM peeling group had a normal foveal contour with a foveal depression on postoperative optical coherence tomography (OCT), while nine eyes (42.9%) in the ILM peeling group had a foveal depression (P = 0.01). Postoperative OCT revealed that thickening of the macula with loss of the normal foveal contour was more frequent in the ILM peeling group. However, these morphological differences did not result in functional differences in terms of visual outcome.

Long-term outcome of vitrectomy for an idiopathic macular hole performed with the use of indocyanine green

To evaluate the long-term outcome and safety of vitrectomy for the treatment of an idiopathic macular hole using indocyanine green (ICG) to peel the internal limiting membrane(ILM). By means of a retrospective study, we evaluated the outcomes of 56 eyes in 56 patients with an idiopathic macular hole who all underwent a primary vitrectomy with successful closure of macular hole. We compared the outcomes of 35 eyes in 35 patients who underwent a vitrectomy with ICG-assisted ILM peeling to those of 21 eyes in 21 patients who underwent the same procedure without ILM peeling. The main outcomes were compared between preoperative and postoperative visual acuities. The periods to achieve the postoperative best visual acuity were 11.1 months in the ILM peeling group and 8.9 months in the non-ILM peeling group. However, there were no significant differences between the two groups regarding the postoperative best visual acuity and the final visual acuity. Complications related to ILM peeling with ICG were not found. These results support the safety of ILM peeling with ICG.