Internal limiting membrane peeling to prevent epiretinal membrane growth after retinal detachment repair: retinal surface wrinkling as a sign of proliferation

Abstract

Purpose : Internal limiting membrane (ILM) peeling has been reported to prevent epiretinal membrane (ERM) growth after rhegmatogenous retinal detachment (RRD) repair; however, its indication is still controversial. We hypothesized that fine retinal surface wrinkling (RSW), sometimes observed on the attached macula of eyes with RRDs, is a sign of postsurgical ERM growth and conducted a prospective, interventional clinical study to select relevant cases for ILM peeling.

Methods : Thirty-nine consecutive cases (mean age: 56.5 years) undergoing vitrectomy for RRDs were assessed prospectively. Inclusion criteria were primary vitrectomy for RRDs and a follow-up period for 6 months. Exclusion criteria were RRDs involving the whole area in the vascular arcade, pre-existing macular disorders, RRDs with macular holes and proliferative vitreoretinopathy (PVR) formation, since RSW was distinguished from PVR grade B in this study. OCT images were obtained at each visit. During vitrectomy, the macula was observed extensively using a magnifying contact lens. Residual vitreous cortex, if present, was peeled-off facilitated with triamcinolone acetonide. Presence of RSW was assessed carefully both on intra-operative observation and pre-operative OCT. As the surgical intervention, ILM was peeled if RSW was present in the posterior pole. Outcomes were measured with the prevalence of post-surgical ERM growth with/without visual loss. Best-corrected visual acuities (BCVAs) at baseline and 6 months were converted to logarithm of minimum angle of resolution (logMAR) and compared between ILM-peeled cases (Group 1) and ILM-not-peeled cases (Group 2) to assess the safety of this procedure (Mann-Whitney U-test).

Results : There were 11 cases with RSW (28.2 %; Group 1, ILM-peeled) and 28 cases without RSW (71.8%; Group 2, ILM-not-peeled). ERM with visual loss developed in no case (0.0 % in both groups) post-surgically. Slight ERMs without visual loss were observed in 4 cases (10.3 %) of Group 2 at 6 months. BCVA was maintained at 20/25 or better in these 4 cases. BCVAs in Group 1/Group 2 at baseline and 6 months were 0.96±0.96/0.40±0.72 (p=0.124) and 0.14±0.24/0.001±0.17 (p=0.124) in logMAR, respectively.

Conclusions : ILM peeling based on presence of RSW prevented visual loss caused by post-surgical ERM growth with favorable visual outcomes during 6-months follow-up.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.