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Zachary M. Robertson, Odette M Houghton; The Role of Internal Limiting Membrane Peeling During Surgical Repair of Diabetic Tractional Retinal Detachments as Prophylaxis for Epiretinal Membrane Formation. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1163.
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The series aims to assess the preliminary safety and feasibility of primary peeling of the internal limiting membrane (ILM) during surgical repair of diabetic tractional retinal detachment (TRD) and to suggest the application of the procedure as prophylaxis against subsequent epiretinal membrane (ERM) formation.
This study is a retrospective, interventional case series. The medical records of all patients at a North Carolina academic center who underwent simultaneous TRD repair and ILM peeling by a single surgeon between 01/01/2000 and 04/30/2013 were reviewed. Clinical and surgical data were collected and reviewed to evaluate if primary ILM peeling at time of TRD repair is safe and if it may contribute to decreased postoperative ERM formation.
A total of 10 eyes of 10 patients were included in the study. The average patient age was 49.3 ± 18.6 years (mean ± SD). The average preoperative visual acuity (VA) was LogMAR 1.49 ± 0.58 with the majority of patients noted to have preoperative foveal attachment. Two patients were noted to have preoperative epiretinal membranes. No surgical procedures were complicated by ILM peeling, regardless of the status of macular attachment. The average last recorded postoperative VA was LogMAR 1.07 ± 0.96 with an average followup of 17.5 ± 10.5 months. Only two patients were noted to have an ERM at last available followup.
Due to fibrovascular proliferation inherent in diabetic TRD and the propensity to develop ERM following panretinal photocoagulation, ERM is a common finding following TRD repair. ERM incidence following diabetic vitrectomy has been published on the order of 30-50%. ILM peeling has been shown to be safe and efficacious for primary ERM removal, macular hole repair, and diabetic macular edema. It likewise has been demonstrated to prevent postoperative ERM in both complicated retinal detachment repair and in eyes undergoing retinectomy for severe PVR. To our knowledge, the safety and efficacy of routine ILM peeling in TRD surgeries has not been evaluated. Our initial data suggests that ILM peeling during primary TRD repair is safe regardless of macular attachment status and may prevent postoperative ERM formation as seen in studies for other retinal disease states. Further research is needed, and we are moving forward with related prospective studies.
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