Changes of Optical Coherence Tomography Angiography Parameters After Internal Limiting Membrane Peeling Compared With Nonpeeling in Epiretinal Membrane Surgery

Abstract

Purpose: To prospectively compare microvascular changes of internal limiting membrane (ILM) peeled and nonpeeled eyes in patients with idiopathic epiretinal membranes using optical coherence tomography angiography.Methods: Forty-two patients with epiretinal membranes underwent vitrectomy with (n = 22) or without ILM peeling (n = 20). The mean superficial capillary plexus foveal avascular zone area change between preoperative and three-month postoperative readings served as the main outcome measure. Secondary outcome parameters included mean changes in superficial capillary plexus parafoveal vessel density, central foveal thickness, retinal volume, and best-corrected visual acuity.Results: Mean superficial capillary plexus foveal avascular zone area change (mm 2 ) was 59 ± 74 in the ILM nonpeeling group compared with 212 ± 86 in the ILM peeling group (P = 0.007). Similarly, mean superficial capillary plexus parafoveal vessel density change (%) was higher in the ILM nonpeeling group (ILM nonpeeling 4 ± 4, ILM peeling 22 ± 6, P = 0.003). The mean retinal volume reduction was higher in the ILM peeling group, and this difference also reached statistical significance (P = 0.036). There were no intergroup differences in mean central foveal thickness change and mean best-corrected visual acuity change (P = 0.409 and P = 0.440, respectively). Epiretinal membrane/ILM separation was achieved in 23 of 51 patients. Conclusion:The macular microvasculature demonstrated more remodeling in the ILM nonpeeling group after three months.

Pars Plana Vitrectomy with or without Internal Limiting Membrane Peel for Epiretinal Membrane: A Systematic Review and Meta-Analysis

“…In this subgroup, six RCTs reported on one or more outcomes comparing eyes receiving PPV with and without ILM peel [17, 23, 29–32]. All outcomes were consistent with the primary analysis, except for the outcomes described herein.…”

“…1) [3, 15–32]. Six included studies were RCTs [17, 23, 29–32], and 13 were observational studies [3, 15, 16, 18–22, 24–28]. All patients also underwent ERM removal.…”

“…A total of 7,686 studies underwent title and abstract screening, 395 underwent full-text screening and 19 studies reporting on 1,291 eyes at baseline were included in our meta-analysis (Fig. 1) [3,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Six included studies were RCTs [17,23,[29][30][31][32], and 13 were observational studies [3,15,16,[18][19][20][21][22][24][25][26][27][28].…”

“…1) [3,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Six included studies were RCTs [17,23,[29][30][31][32], and 13 were observational studies [3,15,16,[18][19][20][21][22][24][25][26][27][28]. All patients also underwent ERM removal.…”

“…In one study, patients in the non-ILM peel group received fovea-sparing ILM peel [31]. Seven studies used ICG to stain the ILM [3,15,16,[24][25][26][27], two studies used ICG or TA [20,28], one used ICG or trypan blue [22], two used trypan blue [30,31], one used trypan blue or brilliant blue [17], five used brilliant blue [18,19,23,29,32], and one used brilliant blue or TA [21]. The mean age of patients across treatment groups ranged from 62 to 77 years old.…”