AUG 10, 2018
Researchers assessed the efficacy of internal limiting membrane (ILM) peeling for retinal detachments complicated by grade B proliferative vitreoretinopathy (PVR).
Medical records were used to identify patients who presented with a primary macula-off rhegmatogenous retinal detachment complicated by grade B PVR over a 5-year period. Selected eyes had undergone vitrectomy with (n=37) or without (n=38) ILM peeling.
The single-surgery anatomic success rate was 89% in the ILM peeling group versus 66% in the no-ILM peeling group (P=0.026). A second surgery was necessary for 4 eyes in the ILM peeling and for 13 eyes in the no-ILM peeling groups. More than 90% of eyes in both groups had retinal attachment by 6 months.
Average visual acuity was similar in both groups. Epiretinal membranes, however, developed in 5 patients in the no-ILM peeling group (P=0.012).
This was not a randomized study. The final visual acuity outcomes were not different between the groups, and it is unclear whether the single-surgery success rate was due to the ILM peel or simply due to chance as this was a small series. Finally, although epiretinal membrane formation is an important outcome, subsequent surgery for this indication is generally not onerous on the doctor or patient, whereas peeling ILM in a mobile retina may be technically challenging.
This study adds to the growing literature that suggests ILM peeling may increase single surgery success, particularly in eyes at risk of developing PVR-related detachments. The findings also show that peeling may reduce risk of epiretinal membrane formation.