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alan sheyman, Jane Myung, Teddy Lyu, Ken Wald; Anatomical outcomes of epiretinal membrane surgery with or without internal limiting membrane peeling. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5769.
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To compare the anatomical outcomes of epiretinal membrane (ERM) surgery with or without internal limiting membrane (ILM) peeling.
A retrospective chart review was performed on 45 eyes that underwent surgery for visually-significant ERM with and without ILM peeling by a single surgeon. A total of 17 eyes underwent ERM peeling without ILM peeling (group 1) and 28 eyes underwent ERM peeling with ILM peeling (group 2). Group 1 patients underwent surgery between 2004 and 2007 while group 2 patients underwent surgery between 2009 and 2011. Primary outcome measures were anatomical characteristics and included: central macular thickness (CMT), foveal umbo contour, and retinal surface irregularities. A secondary outcome measure was change in best-corrected visual acuity (BCVA). Eyes with secondary causes of ERM were excluded from this study.
The mean follow-up was 8.4 months (range: 3 months to 12 months) for all eyes. CMT decreased significantly in both groups with a mean preoperative CMT of 460 microns to 257 microns at last visit in group 1 (p-value <0.0001) and mean preoperative CMT of 506 microns to 384 microns at last visit in group 2 (p-value <0.0001). Group 1 had a mean change of 194 microns while group 2 had a mean change of 121 microns (p-value = 0.02). The percentage of eyes with return of foveal umbo contour at one year was 80% in group 1 and 44% in group 2. The percentage of patients with resolution of surface irregularities in group 1 was 80% and 55% in group 2. Mean change in BCVA in group 1 was .23 (logMAR) and in group 2 was .19, which was not a statistically significant difference between the two groups.
The surgical technique for an ERM has evolved with the advent of vital dyes for staining the ILM. However, the functional and anatomical benefit of ILM peeling in ERM surgery remains unclear. Our data suggests that in terms of anatomical benefit, ILM peeling does not improve results as compared to without ILM peeling. Furthermore, functional outcomes as measured by improvement in BCVA appears unaffected by ILM peeling.
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