Purchase this article with an account.
Andrew Hou, Kevin Leikert, Paul Hanona, Bianca Kizy, Nathan Farley, Hua Gao; The Inner Limiting Membrane Peel without special staining for Macular Pucker Removal. Invest. Ophthalmol. Vis. Sci. 2018;59(9):865.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
It is well known that the inner limiting membrane (ILM) peel in macular pucker removal can reduce the development of macular pucker recurrence. The use of brilliant blue and indocyanine green is a well-established technique to assist in the visualization of ILM, although their toxicity has been reported. There are only limited reports regarding the success rate of ILM removal without staining. In addition, it is unclear whether a non-stained approach rivals those using staining dyes.
This study is a retrospective case series review of consecutive patients with macular pucker removal by a single surgeon. All patients underwent 23- or 25-gauge vitrectomy, macular pucker removal, and ILM peel without staining, using a disposable ILM forceps (Alcon, Ft. Worth, Texas). Pre- and post-operative visual acuity, and central macular thickness (CMT) on SD-OCT were reviewed. Cataract development, and macular pucker recurrence were documented. A linear regression model was used to measure the changes in visual acuity and CMT. Post-operative follow up was obtained at regular intervals for at least 12 months (up to 40 months).
There were 51 eyes from 48 patients, 19 (39.6%) were male, 29 (60.4%) were female, with ages 70.37 ± 7.02 years old (51.0 - 83.0). 26 (51%) were right eyes, and 25 (49%) left eyes. 38 eyes (70.5%) were phakic, with 23 of them (60%) requiring post vitrectomy cataract surgery. Preoperative visual acuity was 0.35 ± 0.25 (0.0 - 1.3) Log MAR, and CMT was 397.3 microns ± 88.70 (227 - 745.0). Postoperative visual acuity averaged 0.309 Log MAR, with CMT of 313.6 microns. Thus, visual acuity improved by approximately one line (0.087 Log MAR), and CMT by 53.1 microns over the course of the 12-month follow-up. These improvements were statistically significant in the basic-mixed regression model. One patient (1.96%) developed a significant recurrent macular pucker requiring a second surgery.
Our study shows that the internal limiting membrane peeling without staining for macular pucker can improve patient vision and central macular thickness on OCT, with low incidence of macular pucker recurrence. Further comparative studies are needed to determine whether the use of staining methods provide clinically significant benefits for ILM peeling in macular pucker surgery.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
This PDF is available to Subscribers Only