Long-term Safety and Efficacy of Sutureless Vitrectomy for Combined Epiretinal and Internal Limiting Membrane Removal

Abstract

The purpose of this case series is to evaluate the long-term visual outcomes of patients undergoing epiretinal membrane (ERM) removal combined with internal limiting membrane (ILM) peeling via sutureless vitrectomy. Methods: A retrospective review was conducted of 45 patients (45 eyes) with ERMs treated with 25-gauge pars plana vitrectomy (PPV) from 2010 to 2011. Data assessed included baseline characteristics, preoperative and postoperative best-corrected visual acuity (BCVA), ERM recurrence rate during follow-up, and complications arising during follow-up. Results: PPV resulted in a statistically significant improvement in BCVA (20/61 preoperatively, 20/41 1 year postoperatively, and 20/45 at the end of follow-up). Mean duration of follow-up was 66.3 months (range, 26-89). Forty-one of 45 (91%) eyes had improved or stable vision, while 4/45 (8.9%) had worse vision. ERMs recurred in 12/45 eyes (26.7%), of which 1/45 (2.2%) required reoperation. The remaining 11 recurrent ERMs were documented as visually insignificant. Mean time to ERM recurrence was 29.3 months (range, 4-72). Conclusions: In one of the longest mean follow-up studies to date, small-gauge PPV for ERM and ILM removal results in statistically significant and stable long-term visual improvement. Despite ILM removal, ERMs did recur in a substantial proportion of patients, though the vast majority were not visually significant.

Long-Term Outcomes of Vitrectomy for Idiopathic Epiretinal Membrane With Internal Limiting Membrane Removal in Patients With Good Preoperative Visual Acuity

“…In the subset with ERM recurrence, the absence of ILM peeling was one factor associated with recurrence and reoperation. Regarding the long-term implications of this procedure, Ismail and Mason 16 found significant VA improvement after combined ERM and ILM removal over a mean follow-up of 66.3 months. Although the ERM recurred in 26.7% of eyes (12/45), only 1 eye required subsequent ERM removal.…”

“…10,[13][14][15] In a study of 40 consecutive eyes, Mason et al 1 found significant improvement in VA after ILM peeling (n = 20) vs ERM removal only (n = 20). 16 ILM peeling is also thought to help prevent ERM recurrence by removing the scaf folding for ERM proliferation. 10,13 In a study of 440 eyes receiv ing PPV for ERM removal, Sandali et al 17 found that ILM peeling was the only significant factor in preventing ERM recurrence.…”