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Jean-Baptiste DELTOUR, Helene MASSE, Olivier LEBRETON, Michel Weber, CHU Nantes; Detrimental effect of active internal limiting membrane peeling during macular pucker surgery: microperimetry analysis. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5056.
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to evaluate the microperimetric effect of voluntary internal limiting membrane (MLI) peeling for epiretinal membrane (ERM) surgery.
retrospective single-center study including patients successively operated of idiopathic ERM by the same surgeon. The integrity of the MLI was assessed by staining ILM Blue® after removal of the ERM : either the peeling was spontaneous (group S) or an active peeling was performed (group A). Before and after surgery (1 and 6 month) all patients were analyzed using visual acuity, SD-OCT (Spectralis HRA OCT, Heidelberg, Germany) and microperimetry (OPKO/OTI, Miami, USA).
32 eyes of 31 patients were included: 22 "active ILM peeling" and 10 "spontaneous peeling". Both groups had comparable and significant improvement in visual acuity 6 months after surgery (+ 1.81 line (group A) p<0.01 and +1.51 line (group S), p <0.01) associated with a significant reduction in OCT central thickness (-99,9μm (A) p <0.01 and -62,2μm (S) p = 0.05). At 6 month after surgery, microperimetry revealed more and deeper microscotoma in the “active ILM peeling” group than in the “spontaneous peeling” group (deficit severity score variation: +13.18 dB (A) vs - 2 dB (S), p <0.01; number variation of microscotoma : +2.09 (A) vs -0.10 (S), p= 0.06)). The number of microscotoma and their severity were increased in 63.6% of the group A patients and in only 20% of the group S patients. Their location corresponded most often to the gripping area of the ERM and / or the ILM.
ILM peeling is gradually generalized in ERM surgery in order to reduce recurrences. This additional procedure does not change the postoperative visual acuity but increases the occurrence of more and deeper microscotoma. The real impact on quality of vision remains unclear.<br /> ILM active peeling in the macular pucker surgery could be responsible for visual impairment and so for detrimental effect related to micro-traumatic effect of ILM gripping.
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