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Chen G, Tzekov R, Fang Y, Tong Y, Li W. Internal limiting membrane peeling in rhegmatogenous retinal detachment: A meta-analysis. PLoS One 2024; 19:e0297230. [PMID: 38489304 PMCID: PMC10942048 DOI: 10.1371/journal.pone.0297230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/29/2023] [Indexed: 03/17/2024] Open
Abstract
PURPOSE To determine whether pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for rhegmatogenous retinal detachment (RRD) could get better functional and anatomical outcomes. METHODS A comprehensive literature search was performed to find relevant studies. A meta-analysis was conducted by comparing the weighted mean differences (WMD) in the mean change of best corrected visual acuity (BCVA) from baseline and calculating the odd ratios (OR) for rates of epiretinal membrane (ERM) formation and recurrence of retinal detachment (RD). RESULTS Fourteen studies were selected, including 2259 eyes (825 eyes in the ILM peeling group and 1434 eyes in the non-ILM peeling group). There was no significant difference in terms of mean change in BCVA from baseline and the rate of RD recurrence (WMD = 0.02, 95% CI, -0.20 to 0.24, P = 0.86, and OR = 0.55, 95% CI, 0.24 to 1.26, P = 0.16), but ILM peeling was associated with a significantly lower frequency of postoperative ERM formation (OR = 0.13, 95% CI, 0.06 to 0.26, P<0.00001). Similar results were obtained in a sub-analysis based on macula-off RRD. CONCLUSION ILM peeling results in similar BCVA, with same rate of RD recurrence, but lower rate of postoperative ERM development. ILM peeling could be considered in selected cases with risk factors that are likely to develop an ERM.
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Affiliation(s)
- Guohai Chen
- Department of Ophthalmology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, PR China
| | - Radouil Tzekov
- Department of Ophthalmology, University of South Florida, Tampa, Florida, United States of America
| | - Yan Fang
- Department of Ophthalmology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, PR China
| | - Yuhua Tong
- Department of Ophthalmology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, PR China
| | - Wensheng Li
- Shanghai Aier Eye Hospital, Shanghai, PR China
- Shanghai Aier Eye Institute, Shanghai, PR China
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, PR China
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Rush RB, Gomez PL, Rush SW, Gomez Bastar P. INTERNAL LIMITING MEMBRANE PEELING IN PATIENTS UNDERGOING VITRECTOMY FOR TRACTIONAL RETINAL DETACHMENT SECONDARY TO DIABETIC RETIONPATHY. Retina 2023; 43:1282-1290. [PMID: 37071830 DOI: 10.1097/iae.0000000000003812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
PURPOSE To assess the merits of internal limiting membrane (ILM) peeling during pars plana vitrectomy in subjects with a tractional retinal detachment secondary to proliferative diabetic retinopathy. METHODS One hundred and ninety-one proliferative diabetic retinopathy subjects undergoing pars plana vitrectomy for the principal indication of tractional retinal detachment were enrolled into this randomized controlled trial. Study subjects were intraoperatively randomized into one of the following treatment groups: Cohort A patients underwent ILM peeling, whereas Cohort B patients did not undergo ILM peeling. The main outcome was postsurgical epiretinal membrane development at 6 months. The secondary outcome was attainment of ≥ 20/50 visual acuity (Snellen) at 6 months. RESULTS One hundred and thirty-nine subjects underwent randomization and completed the study's 6-month trial period. Cohort A had 3.1% (2 of 64) of subjects developing an epiretinal membrane postoperatively, whereas Group B had 26.7% (20 of 75) of subjects developing an epiretinal membrane postoperatively at 6 months ( P < 0.001). Attainment of ≥ 20/50 visual acuity (Snellen) at 6 months was found in 21.9% (14 of 64) of subjects in Cohort A and 9.3% (7 of 75) of subjects in Cohort B ( P = 0.039). CONCLUSION Proliferative diabetic retinopathy patients undergoing pars plana vitrectomy for tractional retinal detachment have a lower frequency of postsurgical epiretinal membrane formation and a greater likelihood of attaining ≥20/50 Snellen visual acuity at 6 months when ILM peeling is conducted. Specialists may consider peeling of the ILM during pars plana vitrectomy an important surgical maneuver in this patient population.
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Affiliation(s)
- Ryan B Rush
- Instituto de la Visión-Hospital La Carlota, Montemorelos, Nuevo León, México
- Panhandle Eye Group, Amarillo, Texas
- Texas Tech University Health Science Center, Amarillo, Texas; and
- Southwest Retina Specialists, Amarillo, Texas
| | - Pedro Luis Gomez
- Instituto de la Visión-Hospital La Carlota, Montemorelos, Nuevo León, México
| | - Sloan W Rush
- Panhandle Eye Group, Amarillo, Texas
- Texas Tech University Health Science Center, Amarillo, Texas; and
| | - Pedro Gomez Bastar
- Instituto de la Visión-Hospital La Carlota, Montemorelos, Nuevo León, México
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Martens RK, Chen C, Ehmann DS, Greve M, Seamone ME. Effect of Macular Internal Limiting Membrane Peeling on Single Surgery Success Rates of Vitrectomy for Uncomplicated, Primary Macula-Off Retinal Detachment. JOURNAL OF VITREORETINAL DISEASES 2023; 7:193-198. [PMID: 37181757 PMCID: PMC10170614 DOI: 10.1177/24741264231155352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Purpose: To determine the anatomic and visual outcomes of pars plana vitrectomy for uncomplicated, primary macula-off rhegmatogenous retinal detachment (RRD) with and without internal limiting membrane (ILM) peeling. Methods: This retrospective chart review comprised 129 patients with uncomplicated, primary macula-off RRD presenting between January 1, 2016, and May 31, 2021. Thirty-six patients (27.9%) had ILM peeling and 93 (72.0%) did not. The primary outcome was the rate of recurrent RRD. Secondary outcomes included preoperative and postoperative best-corrected visual acuity (BCVA), epiretinal membrane (ERM) formation, and macular thickness. Results: No significant difference was found in the risk for recurrent RRD between patients who had ILM peeling and those who did not (2.8% [1/36] and 5.4% [5/93], respectively) (P = 1.00). The final postoperative BCVA was better in eyes that did not have ILM peeling (P< .001). No ERM occurred in the group with ILM peeling, whereas ERM occurred in 27 patients (29.0%) who did not have ILM peeling. The temporal macular retina was thinner in eyes in which ILM peeling was performed. Conclusions: The risk for recurrent RRD was not statistically lower in eyes having ILM peeling of the macula in uncomplicated, primary macula-off RRD. Despite a reduction in postoperative ERM formation, eyes having macular ILM peeling had worse postoperative VA.
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Affiliation(s)
- Rosanna K. Martens
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB, Canada
- Rosanna K. Martens, MD, Department of Ophthalmology and Visual Sciences, University of Alberta, 10924 107 Ave, Ste 400, Edmonton, AB T5H 0X5, Canada.
| | - Chao Chen
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB, Canada
| | - David S. Ehmann
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB, Canada
| | - Mark Greve
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB, Canada
| | - Mark E. Seamone
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, AB, Canada
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Szigiato AA, Antaki F, Javidi S, Touma S, Duval R, Cordahi G, Olivier S, Rezende FA. Risk factors for epiretinal membrane formation and peeling following pars plana vitrectomy for primary rhegmatogenous retinal detachment, an OCT guided analysis. Int J Retina Vitreous 2022; 8:70. [PMID: 36180942 PMCID: PMC9524009 DOI: 10.1186/s40942-022-00418-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate the rate and risk factors of epiretinal membrane (ERM) formation and need for ERM peeling after pars plana vitrectomy (PPV) for uncomplicated primary rhegmatogenous retinal detachment (RRD). Methods Retrospective, single-center, cohort study of 119 consecutive patients (119 eyes) that underwent RRD repair using PPV. The primary outcomes were ERM formation, classified using an optical coherence tomography grading system, and the rate of ERM peeling. Visual acuity, postoperative complications, and risk factors for ERM formation and peeling were also identified. Results Postoperative ERM formation occurred in 69 eyes (58.0%); 56 (47.1%) were stage 1, 9 (7.6%) stage 2, 3 (2.5%) stage 3, and 1 (0.8%) stage 4. Only 6 (5.0%) eyes required secondary PPV for a visually significant ERM, with a mean time to reoperation of 488 ± 351 days. Risk factors for ERM formation included intraoperative cryotherapy, more than 1000 laser shots, 360° laser photocoagulation, and choroidal detachment (p < 0.01). Eyes with more than 3 tears had a trend towards increased ERM surgery (p = 0.10). Conclusions Visually significant ERM formation following PPV for primary RRD was uncommon in this cohort (5%). Half of the ERMs were detected after the first post-operative year, indicating that this complication may be underreported in studies with only 1-year follow-up.
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Affiliation(s)
| | - Fares Antaki
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada
| | - Simon Javidi
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada
| | - Samir Touma
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada
| | - Renaud Duval
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada
| | - Ghassan Cordahi
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada
| | - Sebastien Olivier
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada
| | - Flavio A Rezende
- Department of Ophthalmology, Hôpital Maisonneuve Rosemont, Montreal, Québec, Canada.
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Hänsli C, Lavan S, Pfister IB, Schild C, Garweg JG. Outer retinal features in OCT predict visual recovery after primary macula-involving retinal detachment repair. PLoS One 2022; 17:e0268028. [PMID: 35511781 PMCID: PMC9070941 DOI: 10.1371/journal.pone.0268028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To find predictive markers for the visual potential in optical coherence tomography (OCT) one month after surgical repair of macula-involving rhegmatogenous retinal detachment (miRD) with and without internal limiting membrane (ILM) peeling. Methods This retrospective single-center, single-surgeon cohort study included 74 patients who underwent pars plana vitrectomy (PPV) for primary miRD between January 2013 and August 2020 with follow-up examinations for at least 6 months. Patients developing recurrent detachments, media opacities, or with an axial length over 27 mm were excluded from the analysis. LogMAR visual (VA) and LogRAD reading acuity (RA) ± standard deviation (SD), and OCT measurements 6 months after surgery were compared to OCT and VA measurements one month after surgery using multiple linear regression analysis for predictions. Results VA increased from 0.34 ± 0.25 at one month to 0.22 ± 0.21 after 6 months [p < 0.001; effect size = -0.662, 95% confidence interval (CI): -(0.99–0.33)]. The continuity of the external limiting membrane (ELM) and ellipsoid zone (EZ) increased between 1 and 6 months. Subfoveal ELM integrity after one month predicted VA [adjusted R2 of 8.0%, F(2, 71) = 4.17, p = 0.018] and RA [adjusted R2 of 29%, F(2, 27) = 6.81, p = 0.002] after 6 months. EZ integrity had a less pronounced predictive effect on VA and RA. ELM integrity after 1 month correlated with better reading acuity after 6 months (p = 0.016). Conclusion VA and morphological OCT parameters improve between 1 and 6 months after surgery for miRD. The grade of ELM is a better predictor for RA than for VA, explaining more variance.
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Affiliation(s)
- Christof Hänsli
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- * E-mail:
| | - Suijana Lavan
- Medical Faculty, University of Bern, Bern, Switzerland
| | | | | | - Justus G. Garweg
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- Medical Faculty, University of Bern, Bern, Switzerland
- Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland
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Internal Limiting Membrane Peeling versus Nonpeeling to Prevent Epiretinal Membrane Formation following Vitrectomy for Posterior Segment Open-Globe Injury. J Ophthalmol 2021; 2021:3152728. [PMID: 34497723 PMCID: PMC8419486 DOI: 10.1155/2021/3152728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/20/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Approximately 30% of patients with an open-globe injury (OGI) develop a secondary epiretinal membrane (ERM). This study was performed to assess whether internal limiting membrane (ILM) peeling in the treatment of posterior segment OGI prevents ERM formation. Methods The medical records of 33 patients who underwent vitrectomy for posterior segment OGI from 2016 to 2019 were retrospectively analyzed. Of these patients, 17 underwent ILM peeling during the vitrectomy and 16 did not. The patients' demographic and surgical data were collected. The associations of ILM peeling with the preoperative findings of posterior segment OGI and development of a postoperative ERM were analyzed. Student's t-test was used to evaluate differences in continuous variables, and the chi-squared test or Fisher's exact test was used for categorical variables. Time-to-event curves were calculated from postestimation Cox proportional hazards models. Results An ERM developed in three eyes (17.6%) in the ILM peeling group and in eight eyes (50.0%) in the nonpeeling group (p < 0.05). There was no statistically significant difference between the groups in visual acuity at baseline (1.68 vs. 1.58 logMAR, p=0.68) or at final follow-up (0.72 vs. 0.78 logMAR, p=0.66). Median visual acuity significantly improved in both groups (p < 0.001). In the multivariable models, ILM peeling (odds ratio, 0.19; 95% confidence interval, 0.04–0.91; p=0.04) and worse preoperative vision (odds ratio, 0.29; 95% confidence interval, 0.10–0.80; p=0.02) were associated with lower likelihood of ERM formation. Conclusion Preventative treatment with ILM peeling contributed to decreased development of an ERM in patients with OGI involving areas near the fovea.
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Akiyama K, Fujinami K, Watanabe K, Matsuki T, Tsunoda K, Noda T. RETINAL SURFACE WRINKLING AS AN INDICATOR FOR INTERNAL LIMITING MEMBRANE PEELING DURING VITRECTOMY FOR RETINAL DETACHMENT. Retina 2021; 41:1618-1626. [PMID: 34397965 PMCID: PMC8297538 DOI: 10.1097/iae.0000000000003094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the validity of retinal surface wrinkling (RSW) as an indicator to select patients relevant for internal limiting membrane peeling during vitrectomy for rhegmatogenous retinal detachment, to prevent postoperative visual decline due to epiretinal membrane growth. METHODS This was a prospective, interventional case series of 78 consecutive eyes that underwent initial vitrectomy to repair rhegmatogenous retinal detachments and were followed for 6 months. The presence/absence of RSW was evaluated presurgically on en face optical coherence tomographic images. The internal limiting membrane was peeled if RSW was identified. The main outcome measure was the prevalence of postsurgical epiretinal membrane growth that caused a visual decline of 0.2 or more in logarithm of the minimum angle of resolution unit. RESULTS The internal limiting membrane was peeled for RSW appearance in 22 eyes (28.2%). Mild epiretinal membranes developed in 8 of the 56 internal limiting membrane-unpeeled eyes (10.3% of total, 6 eyes at stage 1 in the classification of Govetto); however, visual decline occurred in none of them with the mean visual acuity of these 8 eyes maintained at -0.08 ± 0.11 in logarithm of the minimum angle of resolution (≈20/16). CONCLUSION Visual decline due to epiretinal membrane growth after rhegmatogenous retinal detachment repair was entirely prevented by peeling the internal limiting membrane in about 30% of cases selected for the presence of RSW.
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Affiliation(s)
- Kunihiko Akiyama
- Department of Ophthalmology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kaoru Fujinami
- Department of Ophthalmology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; and
- UCL Institute of Ophthalmology, London, United Kingdom
| | - Ken Watanabe
- Department of Ophthalmology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Takaaki Matsuki
- Department of Ophthalmology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kazushige Tsunoda
- Department of Ophthalmology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Toru Noda
- Department of Ophthalmology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
- Division of Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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The double-edged role of internal limiting membrane peeling during primary rhegmatogenous retinal detachment repair. Graefes Arch Clin Exp Ophthalmol 2021; 259:3191-3192. [PMID: 33861368 DOI: 10.1007/s00417-021-05177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/11/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022] Open
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Matoba R, Kanzaki Y, Doi S, Kanzaki S, Kimura S, Hosokawa MM, Shiode Y, Takahashi K, Morizane Y. Assessment of epiretinal membrane formation using en face optical coherence tomography after rhegmatogenous retinal detachment repair. Graefes Arch Clin Exp Ophthalmol 2021; 259:2503-2512. [PMID: 33710473 DOI: 10.1007/s00417-021-05118-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate epiretinal membrane (ERM) formation using en face optical coherence tomography (OCT) after vitrectomy for rhegmatogenous retinal detachment (RRD). METHODS We retrospectively reviewed the medical records of 64 consecutive eyes (64 patients) with RRD treated by vitrectomy without ERM and internal limiting membrane peeling. ERMs and retinal folds were detected by B-scan and en face imaging. The maximum depth of retinal folds (MDRF) was quantified using en face imaging. ERM severity was staged using B-scan imaging. Main outcome measures were ERM detection rate with B-scan and en face imaging, MDRF, ERM staging, postoperative best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution), and risk factors for ERM formation. RESULTS The detection rate for ERM formation was significantly higher with en face imaging (70.3%) than with B-scan imaging (46.9%; P = 0.007). There was no significant difference in postoperative BCVA between eyes with ERM formation (0.06 ± 0.26) and those without ERM formation (0.01 ± 0.14; P = 0.298). Forty of 45 (88.9%) eyes with ERM formation were classified as stage 1. Twenty-seven of 45 (60.0%) eyes with ERM formation developed parafoveal retinal folds. The mean MDRF was 27.4 ± 32.2 μm. Multiple retinal breaks and a maximum retinal break size of ≥ 2 disc diameters were significantly associated with ERM formation (P = 0.033 and P = 0.031, respectively). CONCLUSION Although ERM formation was observed in 70.3% patients after RRD repair, the formed ERM was not severe and had minimal impact on the postoperative visual acuity.
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Affiliation(s)
- Ryo Matoba
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama, 700-8558, Japan
| | - Yuki Kanzaki
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama, 700-8558, Japan
| | - Shinichiro Doi
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama, 700-8558, Japan
| | - Sayumi Kanzaki
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama, 700-8558, Japan
| | - Shuhei Kimura
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama, 700-8558, Japan
| | - Mio Morizane Hosokawa
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama, 700-8558, Japan
| | - Yusuke Shiode
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama, 700-8558, Japan
| | - Kosuke Takahashi
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama, 700-8558, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Okayama, 700-8558, Japan.
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Mahmood SA, Rizvi SF, Khan BAM, Khan TH. Role of Concomitant Internal Limiting Membrane (ILM) Peeling During Rhegmatogenous Retinal Detachment (RRD) Surgery in Preventing Postoperative Epiretinal Membrane (ERM) Formation. Pak J Med Sci 2021; 37:651-656. [PMID: 34104142 PMCID: PMC8155452 DOI: 10.12669/pjms.37.3.3576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: To investigate the role of concomitant Internal Limiting Membrane (ILM) peeling during surgery for macula off Rhegmatogenous Retinal Detachment (RRD) in preventing postoperative Epiretinal Membrane (ERM) formation; and its effect on the visual acuity. Methods: This was a prospective, quasi-experimental study conducted from August 2018 to July 2019 at LRBT Tertiary Eye Care hospital, Karachi. Fifty-six patients with macula off RRD were divided into groups A (with ILM peeling) and B (without ILM peeling) via non-probability convenience sampling. All patients underwent standard 3 ports pars plana vitrectomy with silicon oil tamponade. In Group-A, ILM was stained using 0.5% ICG. Patients were evaluated clinically and by spectral domain optical coherence tomography (SD-OCT), pre- and post-operatively. Main outcomes recorded were best corrected visual acuity (BCVA) and occurrence of ERM on SD-OCT. Results: There were 26 patients in Group-A and 30 patients in Group-B. At six months’ follow-up, ERM had not developed in any case in Group-A compared to five patients (16.7%) in Group-B. There was no statistical difference in mean BCVA change from baseline. Conclusion: ILM peeling during vitrectomy for RRD prevents the formation of macular ERM post-operatively. This may reduce the need of a second vitrectomy. However, visual outcomes were comparable to the non-ILM peeling vitrectomy.
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Affiliation(s)
- Syed Asaad Mahmood
- Dr. Syed Asaad Mahmood, FCPS (Ophth) Ophthalmologist, LRBT Tertiary Eye Care Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Syed Fawad Rizvi
- Dr. Syed Fawad Rizvi, FCPS (Ophth) Chief Consultant Ophthalmologist, LRBT Tertiary Eye Care Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Burhan Abdul Majid Khan
- Dr. Burhan Abdul Majid Khan, FCPS (Ophth), FCPS (VRO) Consultant Ophthalmologist, LRBT Tertiary Eye Care Hospital, Korangi 2 ½, Karachi, Pakistan
| | - Tanweer Hasan Khan
- Dr. Tanweer Hasan Khan, FCPS (Ophth) Ophthalmologist, LRBT Tertiary Eye Care Hospital, Korangi 2 ½, Karachi, Pakistan
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Deiss M, Kaya C, Pfister IB, Garweg JG. Impact of Vitreal Tamponade on Functional Outcomes in Vitrectomy with ILM Peeling in Primary Macula-Involving Retinal Detachment: A Retrospective Analysis. Clin Ophthalmol 2020; 14:4493-4500. [PMID: 33380783 PMCID: PMC7769588 DOI: 10.2147/opth.s287107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/08/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To compare visual outcomes of vitrectomy with internal limiting membrane (ILM) peeling and failed SF6 gas tamponade requiring silicone oil (SO) in a second procedure with primary SO tamponade in fovea-involving retinal detachment (FiRD). METHODS Retrospective analysis of 82 eyes with retinal detachment and mild, but without advanced proliferative retinopathy (PVR ≥C2) requiring vitrectomy for FiRD. Group 1 comprised 23 eyes that underwent SF6 tamponade resulting in re-detachment requiring revision surgery with secondary SO tamponade. Based on the intraoperative findings, group 2 patients had primarily received SO as vitreal tamponade (n=59). Patients receiving a scleral buckle surgery or with advanced PVR as well as patients with underlying vascular diseases and uveitis were excluded. RESULTS Preoperative visual acuity (Early Treatment Diabetic Retinopathy Study letters) was 13.5 ± 19.1 in group 1 and 14.0 ± 18.3 in group 2 (p=0.44). Twelve months after first surgery for FiRD, visual acuity was 49.8 ± 19.8 in group 1 and 51.7 ± 18.7 letters in group 2 (p=0.63). Re-detachment after SO removal requiring revision surgery developed in 17.4 (n=4) and 15.3% (n=9) cases. CONCLUSION Our findings suggest that if retinal traction is completely relieved at the end of surgery, vitrectomy with ILM peeling and SF6 may, if successful, improve the functional outcomes in instances with visual potential, ie, a foveal detachment of short duration despite the presence of a mild to moderate PVR, but with the inherent increased risk of re-detachment requiring further intervention and the use of a SO tamponade. Hence, secondary SO installation during re-vitrectomy after failed primary reattachment surgery results in similar functional outcomes as primary oil filling.
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Affiliation(s)
| | - Cagdas Kaya
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Isabel B Pfister
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Justus G Garweg
- University of Bern, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
- Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Abdullah ME, Moharram HEM, Abdelhalim AS, Mourad KM, Abdelkader MF. Evaluation of primary internal limiting membrane peeling in cases with rhegmatogenous retinal detachment. Int J Retina Vitreous 2020; 6:8. [PMID: 32411388 PMCID: PMC7204288 DOI: 10.1186/s40942-020-00213-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background Epiretinal membranes (ERMs) have been reported after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). Peeling of the internal limiting membrane (ILM) can prevent post-PPV ERM formation but has a potential negative impact on macular structure and function. Purpose To investigate the anatomical and functional outcomes of ILM peeling during PPV for primary RRD. Methods This was a prospective nonrandomized study that included 60 eyes of 60 patients with a primary macula-off RRD and less than grade C proliferative vitreoretinopathy (PVR). Eyes were allocated into 2 groups; Group A underwent PPV without ILM peeling and Group B had ILM peeling. At postoperative month 6, all patients underwent retinal imaging using spectral domain optical coherence tomography (OCT) and OCT angiography and macular function was assessed using multifocal electroretinogram (mfERG). Baseline characteristics and postoperative anatomical and visual outcomes were recorded and statistically analyzed. Results We enrolled 30 eyes of 30 patients in each group. In Group A, mean age was 44.6 years, while the mean age of Group B patients was 49.9 years. Postoperative LogMAR visual acuity was significantly better in Group A than in Group B (p < 0.001). ERMs were demonstrated on OCT in 13.3% of Group A and none of Group B patients (p = 0.04). Retinal dimples were found in 53.3% of Group B and none of Group A eyes (p < 0.001). OCTA showed a greater vessel density of the superficial capillary plexus (SCP) in Group A compared to Group B eyes (p = 0.046), while no difference was found regarding deep capillary vessel density (p = 0.7). Mean amplitude of mfERG P1 wave was significantly higher in Group A eyes than in Group B (p = 0.002). Both the SCP vessel density and P1 amplitude were positively correlated with visual acuity (p < 0.001). Conclusion This study suggests that ILM peeling prevents ERM development in eyes undergoing PPV for uncomplicated macula-off RRD, but potential damage to macular structure and function were found. Trial registration Retrospectively registered on 09/24/2019 on ClinicalTrials.gov with an ID of NCT04139811.
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Affiliation(s)
- Mohamed Esmail Abdullah
- 1Faculty of Medicine, Minia University, Minia, Egypt.,2Department of Ophthalmology, Minia University Hospital, Minia, 61111 Egypt
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Ishida Y, Iwama Y, Nakashima H, Ikeda T, Emi K. Risk Factors, Onset, and Progression of Epiretinal Membrane after 25-Gauge Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment. ACTA ACUST UNITED AC 2020; 4:284-288. [DOI: 10.1016/j.oret.2019.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
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Reply. Retina 2020; 40:e6-e7. [PMID: 31972813 DOI: 10.1097/iae.0000000000002740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Correspondence. Retina 2020; 40:e7-e8. [PMID: 31972814 DOI: 10.1097/iae.0000000000002742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Foveau P, Berrod JP, Conart JB. Reply. Am J Ophthalmol 2018; 196:213. [PMID: 30286942 DOI: 10.1016/j.ajo.2018.08.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/25/2018] [Indexed: 11/26/2022]
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Fallico M, Russo A, Longo A, Pulvirenti A, Avitabile T, Bonfiglio V, Castellino N, Cennamo G, Reibaldi M. Internal limiting membrane peeling versus no peeling during primary vitrectomy for rhegmatogenous retinal detachment: A systematic review and meta-analysis. PLoS One 2018; 13:e0201010. [PMID: 30024983 PMCID: PMC6053210 DOI: 10.1371/journal.pone.0201010] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 07/06/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Internal limiting membrane (ILM) peeling during primary vitrectomy for rhegmatogenous retinal detachment (RRD) prevents the formation of postoperative macular epiretinal membrane (ERM). However, studies that compared vitrectomy with and without ILM peeling for RRD, have reported controversial outcomes. OBJECTIVE To assess the efficacy of ILM peeling versus non-ILM peeling during vitrectomy for RRD by a systematic review and meta-analysis of published studies. METHODS PubMed, Medline, Web of Science, Embase databases, and the Cochrane Library were searched up to April 2018 to identify studies that compared primary vitrectomy with and without ILM peeling for RRD with at least six months follow-up. Primary outcomes were the rate of postoperative ERM formation and mean best corrected visual acuity (BCVA) change after vitrectomy. Rate of recurrence of retinal detachment (RD) was assessed as secondary outcome. Risk ratios (RRs) with 95% confidence intervals (CIs) expressed pooled results for rate of ERM formation and rate of RD recurrence in ILM peeling and non-ILM peeling groups. Pooled results for BCVA change in the two groups were expressed as Weighted Mean Difference (WMD) with 95% CIs. RESULTS Nine studies, one of which was a randomized controlled trial (RCT), with a total number of 404 eyes in the ILM peeling group and 365 eyes in the non-ILM peeling group, were included. The analysis from pooled data indicated a significant lower rate of postoperative ERM formation in the ILM peeling group compared to the non-ILM peeling group (9 studies, 769 eyes, RR = 0.14; CI: 0.07 to 0.28; P < 0.001). There was no statistical difference in mean BCVA change (9 studies, 769 eyes, WMD = 0.02; CI: -0.11 to 0.16; P = 0.75). Rate of recurrence of RD was lower in the ILM peeling group (6 studies, 603 eyes, RR = 0.32; CI = 0.17 to 0.61; P< 0.001). CONCLUSION ILM peeling during vitrectomy for RRD prevents the formation of macular epiretinal membrane postoperatively and reduces the incidence of RD recurrence, but better visual outcome was not found compared to non-ILM peeling vitrectomy.
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Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy
- Department of Biomedical and Biotechnological Sciences, Pathology and Oncology Section, University of Catania, Catania, Italy
| | - Andrea Russo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Antonio Longo
- Department of Ophthalmology, University of Catania, Catania, Italy
| | - Alfredo Pulvirenti
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | | | | | - Gilda Cennamo
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Michele Reibaldi
- Department of Ophthalmology, University of Catania, Catania, Italy
- * E-mail:
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