Macular pucker removal with and without internal limiting membrane peeling: pilot study

Park, Donald W.; Dugel, Pravin U.; Garda, Jennifer; Sipperley, Jack O.; Thach, Allen B.; Sneed, Scott R.; Blaisdell, Jennifer

doi:10.1016/s0161-6420(02)01440-9

Cited by 246 publications

(163 citation statements)

References 8 publications

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“…[8][9][10] Although evidence suggests that ERM formation may be inhibited after ILM removal, the results obtained from cases with idiopathic ERM or diabetic macular oedema may not be readily applied to diabetic eyes with active FVP because of certain unique features in the latter condition. First, a complex vitreoretinal relationship exists in diabetic FVP.…”

Section: Discussionmentioning

confidence: 99%

“…In this study, the 6-disc diameters ILM peeling area was wider than usually created for a macular hole or idiopathic ERM. 9 Removal of the ILM may prevent later ERM formation by removing a scaffold for proliferating astrocytes and myofibroblasts. 12,22 Furthermore, removal of the ILM guarantees complete separation of the posterior hyaloid from the macular surface.…”

Section: Discussionmentioning

confidence: 99%

“…4 This basement membrane scaffolding may play a role in the development of persistent macular oedema and in the proliferation, or reproliferation of ERM. 5 Earlier studies have suggested ILM peeling as an adjunct to macular surgery may improve surgical outcomes in certain macular diseases, such as macular holes, [6][7][8] epiretinal membranes, 9,10 and diabetic macular oedema; [11][12][13] however, the effect of ILM peeling in the prevention of postoperative ERM remains unknown in diabetic active FVP, which is characterized by a strong proproliferative biological environment. 14,15 To answer this question, we conducted a prospective, comparative case series study to evaluate the visual and functional outcomes of vitrectomy, with or without ILM removal, in eyes with progressive FVP.…”

Section: Introductionmentioning

confidence: 99%

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Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Chang

et al. 2008

Eye

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Objective To evaluate the anatomical and functional results of internal limiting membrane (ILM) peeling during pars plana vitrectomy for fibrovascular proliferation (FVP) in diabetic retinopathy. Methods The study was a prospective comparative case series in design. Patients undergoing pars plana vitrectomy for mild to moderate diabetic FVP were divided into either Group 1: vitrectomy only, or Group 2: further ILM peeling in the macular area. Best-corrected visual acuity, fundus examination, and optical coherence tomography (OCT) were conducted at 3 and 6 months postoperatively. Results There were 26 eyes of 25 patients in Group 1 (non-ILM peeling) and 23 eyes of 22 patients in Group 2 (ILM peeling). At 6 months postoperatively, OCT-identifiable epiretinal membrane (ERM) was found in 10 of 26 eyes (38.5%) in Group 1and 0 of 23 eyes in Group 2 (P ¼ 0.001) and six eyes (23.1%) in Group 1 developed biomicroscopic ERM, whereas no patients in Group 2 had ERM (P ¼ 0.02) at 6 months. OCT identifiable ERM correlated significantly with central macular thickness (r ¼ À0.58, Po0.001), the presence of intraretinal cystic space (r ¼ 0.60, Po0.001), and fovea depression reappearance (r ¼ 0.36, P ¼ 0.008). Factors associated with poor visual outcome were macular detachment (Po0.001) and non-ILM peeling (P ¼ 0.004). Conclusions This pilot study suggests that ILM peeling during vitrectomy for diabetic fibrovascular proliferative membranes may minimize postoperative ERM formation and improve visual prognosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Chang

et al. 2008

Eye

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“…It is widely accepted among vitreoretinal surgeons that removal of the internal limiting membrane (ILM) during surgery for tractional maculopathies improves both functional and anatomical success [1][2][3][4] and may help to decrease the incidence of recurrences of the disease. 4 Peeling of the ILM is a challenging procedure and requires surgical skills and experience.…”

Section: Introductionmentioning

confidence: 99%

“…4 Peeling of the ILM is a challenging procedure and requires surgical skills and experience. In order to facilitate visualization of this transparent structure and to reduce excessive and prolonged manipulation on the retina, staining substances have been introduced over the last decade.…”

Section: Introductionmentioning

confidence: 99%

Vital dyes increase the rigidity of the internal limiting membrane

Haritoglou

Mauell

Benoit

et al. 2013

Eye

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Purpose To assess the stiffness of the natural human internal limiting membrane (ILM) and evaluate potential changes of the mechanical properties following staining with brilliant blue (BB) and indocyanine green (ICG). Methods Unstained ILM specimens were obtained during ophthalmic surgical procedures. After removal, the specimens were dissected into five parts. Two fragments were stained with BB and ICG, respectively, for 1 min, another two specimens were stained similarly followed by additional subsequent illumination using a standard light source (PENTA LUX x 50, Ophthalmologische Systeme GmbH Fritz Ruck). The fifth part served as an untreated control. All specimens were then analyzed using atomic force microscopy (AFM) in contact mode with a scan rate of 0.6 Hz. Two scan regions of 10 Â 10 mm were chosen and stiffness was determined by using AFM in a force spectroscopy mode. The force curves were plotted with a data rate of 5000 Hz. In all specimens both the retinal side and vitreal side were analyzed.

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Double Peeling During Vitrectomy for Macular Pucker

Chang¹,

Gregory-Roberts²,

Sung-Pyo³

et al. 2013

JAMA Ophthalmol

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piretinal membranes are commonly encountered in retinal practice, and they result in decreased vision. The present work addresses whether peeling of the internal limiting membrane is necessary during vitrectomy for macular pucker. We performed a retrospective analysis to investigate the effects of "single peeling," in which only the epiretinal membrane was peeled, and "double peeling," in which the internal limiting membrane was also stained and peeled. Although significantly more patients in the single-peeling group had an epiretinal membrane remaining in the central fovea postoperatively, visual acuity was not found to differ between the 2 groups in the short term. Patients who had an epiretinal membrane for more than 18 months had significantly worse visual acuity outcomes. Unexpectedly, there was a greater proportional decrease in central macular thickness in the single-peeling group than in the double peeling group, a finding that deserves further study.

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Macular pucker removal with and without internal limiting membrane peeling: pilot study

Cited by 246 publications

References 8 publications

Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Pars plana vitrectomy for diabetic fibrovascular proliferation with and without internal limiting membrane peeling

Vital dyes increase the rigidity of the internal limiting membrane

Double Peeling During Vitrectomy for Macular Pucker

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