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  • Rewards of ILM peeling may outweigh risks in patients with epiretinal membrane

    Retina/Vitreous

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    Review of: Rates of reoperation in 10,114 patients with epiretinal membranes treated by vitrectomy with or without inner limiting membrane peeling

    Rayess N, Vail D, Mruthyunjaya P. Ophthalmology, January 2021

    In this large study of 10,114 patients, rates of reoperation were studied for patients with idiopathic epiretinal membrane (ERM) who received pars plana vitrectomy (PPV) with or without inner limiting membrane peeling (ILM).

    Study design

    This is a retrospective cohort study of patients with idiopathic ERM who received pars plana vitrectomy with or without ILM peeling between 2008 and 2016. The goal of the study was to compare rates of reoperation.

    Outcomes

    A total of 10,114 patients received ERM surgery and met inclusion criteria (5310 without ILM peel and 4804 with ILM peel). The reoperation rate was significantly lower among patients who received PPV with ILM peel (0.88%) compared with patients without ILM peel (1.48%). Other outcome measures showed that in 2008, PPV with ILM peel represented only 30% of ERM procedures, but PPV with ILM peeling accounted for 52% and 70% of ERM procedures in 2013 and 2016, respectively, indicating that ILM peel is becoming more common. The rates of retinal detachment were similar between patients who received an ILM peel (0.79%) and patients who did not receive an ILM peel (0.92%) during their primary ERM surgery.

    Limitations

    Limitations of this study are inherent in its retrospective nature and include potential inconsistent data entry, missing data, and higher reimbursement for ILM peel. Another limitation is the lack of a standardized protocol for macular surgery among surgeons. Visual outcomes between groups weren’t studied. Since this study assessed for incidence of reoperation for ERM 1 year after initial surgery, there could have been patients who might have needed surgery more than 1 year later who were not recorded. There also could have been a recurrence of the ERM, which was not visually significant or for which patients did not want further surgery.

    Clinical significance

    There has been debate whether ILM peel during ERM surgery reduces risk of recurrence of ERM. This study shows that it might indeed do that. Peeling ILM also confirms removal of all ERM. However, the risks of peeling ILM, which include possible trauma to nerve fiber layer, must be considered along with possible dye toxicity, especially if stain is applied multiple times to remove all ILM.