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  • ILM peeling during vitrectomy effectively treats complicated retinal detachment

    Retina/Vitreous

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    Researchers assessed the efficacy of internal limiting membrane (ILM) peeling for retinal detachments complicated by grade B proliferative vitreoretinopathy (PVR).

    Study design

    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.

    Outcomes

    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).

    Limitations

    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.

    Clinical significance

    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.