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B. K. Williams, Jr., D. F. Kiernan, R. D. Jager, R. Lin, W. F. Mieler; The Effect of Internal Limiting Membrane Peel During Epiretinal Membrane Removal on Visual Acuity and Recurrence Rate in Diabetic and Non-Diabetic Eyes. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2054.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the visual outcome and recurrence rate of epiretinal membrane (ERM) formation following vitreoretinal surgery with or without internal limiting membrane (ILM) peel in patients with idiopathic ERM or ERM secondary to diabetic eye disease.
The medical records of 61 eyes (59 patients) who had undergone surgery for macular ERM were reviewed. All patients underwent pars plana vitrectomy and ERM peel. A subset of patients underwent ILM removal. Recurrence of macular ERM within 25 months and the final visual outcome (LogMAR VA) after surgery were evaluated by comparing whether or not the ILM was removed. Statistical analysis was carried out with a Student’s t-test and Chi-squared test.
Thirty-one patients (51%) underwent ERM surgery with peeling of the ILM and thirty patients (49%) underwent ERM surgery without ILM removal. Thirteen patients (21%) had ERM secondary to diabetic retinopathy, seven of whom had ILM removal. In patients who had ILM removal mean LogMAR VA improved from 0.847 to 0.431 (p < 0.0001) In patients without ILM removal mean LogMAR VA improved from 1.09 to 0.593 (p < 0.0001.) This difference was not statistically significant (p= 0.481.) There were two ERM recurrences (6.5%) within 25 months in patients who had ILM removal whereas there were eight ERM recurrences (26.6%) in patients who had no ILM removal (X2 test, p=0.0431.) In patients with ERM secondary to diabetic eye disease, there were two patients without ILM removal who developed ERM recurrence whereas no patients with ILM removal developed ERM recurrence. (X2 test, p=0.09)
Epiretinal membrane peeling significantly improves visual acuity in patients irrespective of internal limiting membrane removal. ILM removal during macular ERM surgery may minimize the recurrence of ERM, without adverse visual outcome. In patients with ERM secondary to diabetic eye disease, ILM removal may be especially beneficial in preventing recurrence, though larger controlled studies are needed to confirm this hypothesis.
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