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Matthew Starr, Luv Patel, Michael J Ammar, Ed Ryan, Jason Hsu, Omesh Gupta, Yoshihiro Yonekawa; Utility of internal limiting membrane peeling during rhegmatogenous retinal detachment surgery. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3527.
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© ARVO (1962-2015); The Authors (2016-present)
Post-operative epiretinal membrane formation (ERM) and proliferative vitreoretinopathy (PVR) following rhegmatogenous retinal detachment (RRD) surgery severely limit visual acuity and can lead to additional surgical procedures. Peeling of the internal limiting membrane (ILM) at the time of RRD repair may play a role in preventing these complications.
This was a multi-institutional, retrospective review of all retinal detachment surgeries involving PPV from January 1, 2015 through December 31, 2015. Pre-operative and post-operative metrics were recorded. The primary outcomes considered were single surgery anatomic success, post-operative visual acuity, and the development of post-operative ERM formation between eyes with and without peeling of the ILM.
There were 1287 eyes that met inclusion criteria, with 87 eyes (6.8%) undergoing concomitant ILM peeling at the time of RRD surgery. At the time of surgery, 36 eyes (55.4%) in the ILM peeling cohort were recommended to undergo ILM peeling at the time of surgery versus 65 eyes (8.6%) in the non-ILM peeling cohort (p < 0.0001). pThe mean pre-operative logMAR VA for all eyes was 1.14 ± 1.1 (Snellen VA 20/276) and the mean post-operative logMAR VA was 0.45 ± 0.57 (Snellen 20/56, p value <0.0001). The single surgery success rate for all eyes was 83.2%. Eyes without ILM peeling had a significant better final visual acuity (logMAR 0.44 ± 0.57, Snellen 20/55) versus those eyes with ILM peeling (logMAR 0.64 ± 0.66, Snellen 20/87, p 0.0096). On multivariate analysis accounting for pre-operative VA, pre-operative PVR, pre-operative macular hole status, and pre-operative macular attachment status there was no difference in post-operative visual acuity between eyes with and without ILM peeling (p = 0.2373). The single surgery success rate in the ILM peeling cohort was 86.2% versus 83% in the non-ILM peeling cohort (p = 0.5571). There were 25 eyes (29.1%) in the ILM peeling cohort with ERM formation post-operatively versus 450 eyes (35.7%) in the non-ILM peeling cohort (p = 0.1330).
ILM peeling at the time of RRD surgery may not eliminate post-operative ERM formation nor increase the single surgery success rate.
This is a 2020 ARVO Annual Meeting abstract.
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