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Andrea Russo, Francesco Morescalchi, Nicolò Scaroni, Elena Gambicorti, Ciro Costagliola, Francesco Semeraro; Epiretinal Membrane Peeling with Foveal Sparing of the Internal Limiting Membrane: A Pilot Study. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5009. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the long-term efficacy of surgery for epiretinal membrane (ERM) with complete peeling of the internal limiting membrane (ILM) versus foveal sparing of the ILM.
A prospective study was performed involving 52 patients scheduled to undergo vitrectomy for idiopathic ERM by a single surgeon (F.M.). Patients were randomized to complete foveal peeling of the ILM (FP group) or to foveal sparing (FS group), in which the ILM was peeled around the fovea but leaved untouched upon it (one disc diameter). The surgeries were performed using 25-gauge transconjunctival system and microperimetry was performed at baseline and 1, 3, and 6-month after surgery.
Both groups had significant BCVA improvements, and no differences were found between FP and FS groups (0.18 ± 0.05 LogMAR and 0.15 ± 0.05 LogMAR, respectively). After 6 months, in the FS group was more likely to find recurrent ERM in the macula postoperatively (11%) compared to FP group (0%), but less likely to find foveal decrease in retinal sensitivity and microscotomas. Compared to baseline, at 6-month follow-up mean central retinal sensitivity decreased in FP group (-0.8 dB) and increased (+1.8 dB) in the FP group (P < 0.001).
Foveal sparing of the ILM in ERM surgery is a less traumatic procedure for the central fovea that allows for a greater increase in retinal light sensitivity in the central 5 degrees. Conversely, a complete peeling of the ILM results in greater likelihood of decreased retinal sensitivity and paracentral scotomas, but permits a more complete and permanent removal of ERM.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
(A) Complete peeling of the internal limiting membrane (ILM). In order to spare the foveal peeling (B), the ILM is grasped several times near the arcades and pulled in a centripetal fashion. The remaining floating flap is finally trimmed by the vitrectome.
(A) Representative OCT scan of an epiretinal membrane at baseline and (B) final aspect after 6 months, where the trimmed foveal internal limiting membrane is clearly visible.
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