Abstract
Purpose :
Many vitreoretinal surgeons elect to mark the internal limiting membrane (ILM) for removal during epiretinal membrane (ERM) peeling. While this practice is thought to reduce ERM recurrence, the reported toxicity of ILM-staining substances remains a concern given the variable visual significance of recurrent ERMs. We sought to examine structural and functional outcomes after surgery for ERM, comparing unassisted “naked” peels to assisted peels utilizing indocyanine green (ICG) or intravitreal Kenalog (IVK) for ILM marking.
Methods :
A retrospective analysis was conducted on all adult patients who underwent pars plana vitrectomy and ERM peel with or without ILM marking at a single vitreoretinal surgery practice from 2014 to 2016. The primary endpoints of central macular thickness (CMT) and best-corrected visual acuity (BCVA) were pre- and postoperatively assessed, and outcomes at 1 month, 3 month, and last follow-up after surgery were compared between the two groups. Presence of residual unpeeled ERM, 3-month postoperative cystoid macular edema (CME), and ERM recurrence were evaluated secondarily.
Results :
189 eyes in 183 patients met the inclusion criteria; 120 unassisted and 69 assisted (48 ICG + 21 IVK) operations were performed. Postoperatively, CMT significantly decreased for both groups (-52.9 μm assisted, p<0.001; -37.6 μm unassisted, p<0.001), and BCVA significantly improved by the same amount in both cohorts (20/45 to 20/35 assisted, p=0.002; 20/43 to 20/33 unassisted, p<0.001). The instance of residual ERM was greater in the unassisted cohort, but these findings were not statistically significant (68% vs. 57%, p=0.054). The assisted group demonstrated significantly higher rates of CME at 3 months after surgery (17.4% vs. 3.33%, p<0.001), a trend that was observed for both ICG- (16.7% vs. 3.33%, p=0.002) and IVK-assisted (19.0% vs. 3.33%, p=0.005) subgroups as well. ERM recurrence, however, only occurred in the unassisted cohort (8.33% vs. 0%, p=0.014).
Conclusions :
Regardless of visual assistance during surgery, CMT and BCVA significantly improved after membrane peeling. Interestingly, patients who underwent ICG- or IVK-assisted peels exhibited a higher incidence of CME after 3 months. Further study is needed to determine if more extensive ERM/ILM peeling may increase the presence of postoperative CME. ERM recurrence was noted only in the unassisted cohort.
This is a 2021 ARVO Annual Meeting abstract.