Purchase this article with an account.
Corey Waldman, David Ellenberg, Philip Henry Scharper; Effect of Internal Limiting Membrane Removal on Postoperative Epiretinal Membrane Formation in Diabetic Eyes Requiring a Surgical Vitreous Detachment during Vitrectomy for Vitreous Hemorrhage. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5122.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To determine whether internal limiting membrane (ILM) peeling results in a decreased incidence of epiretinal membrane (ERM) postoperatively in patients undergoing a pars plana vitrectomy (PPV) for vitreous hemorrhage (VH) secondary to proliferative diabetic retinopathy (PDR) in which the posterior vitreous detachment (PVD) was surgically-induced.
A retrospective review of all eyes undergoing PPV (Constellation, Alcon, TX) and PRP for VH from PDR was performed. Eyes with a preoperative PVD, ERM, or tractional retinal detachments were excluded. Only eyes with a surgically-induced PVD were included. Eyes that met the inclusion criteria were divided into 2 groups: PPV/PRP alone and PPV/PRP/ILM removal. Postoperative visual acuity (VA), OCT central subfield thickness (CST) and incidence of ERM formation were compared.
28 eyes of 21 patients were included; 16 eyes in the PPV/PRP group and 12 eyes in the PPV/PRP/ILM group. 7/16 eyes (44%) in the PPV/PRP group developed an ERM within 6 months postoperatively compared to 0/12(0%) in the PPV/PRP/ILM group. The postoperative VA and CST in the PPV/PRP group was 0.37 LogMAR (20/47) and 313 µm respectively, compared to 0.41 LogMAR (20/51) and 264 µm in the PPV/PRP/ILM group. Of the 7 eyes that developed an ERM, the average VA and CST prior to ERM formation was 0.57 LogMAR (20/74) and 240 µm respectively and 0.63 LogMAR (20/85) and 324 µm respectively after ERM formation.
Advances in small gauge PPV make earlier surgery feasible for eyes with diabetic VH. Because of the sticky nature of the diabetic vitreous, the PVD often has to be surgically-induced. Similar to age-related PVDs, surgically-induced PVDs may lead to ERM formation. Our results suggest that ILM removal in diabetic eyes during the initial PPV is protective against postoperative ERM formation. In addition, ILM peeling positively impacts CST and does not adversely affect VA. Additional prospective studies are needed.
This PDF is available to Subscribers Only