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

Abstract

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.

Current management of diabetic tractional retinal detachments

“…Removing the internal limiting membrane (ILM) during vitrectomy serves to also remove adherent cortical vitreous and may decrease the post-operative growth of ERM. [ 130 ] For this reason, more surgeons are routinely performing ILM removal during diabetic vitrectomies. [ 108 ]…”

lncRNA H19 prevents endothelial–mesenchymal transition in diabetic retinopathy

“…All specimens were centrifuged at (12,000 g for 10 min at 4°C) and pellets were collected for RNA extraction [31,32]. The pellets included fibrovascular tissue, hyalocytes and white blood cells [33,34]. Vitreous humour samples showing haemorrhage were excluded to avoid contamination with RNA from blood cells.…”

The Effect of Internal Limiting Membrane Cleaning on Epiretinal Membrane Formation after Vitrectomy for Proliferative Diabetic Retinopathy

“…Importantly however, there was no significant difference in the levels between the 2 cohorts reinforcing their matching. Other authors have proposed ILM peeling as a technique to reduce ERM formation in vitrectomy for PDR [11,12] with a reduction in the occurrence of ERM from 38-49 to 0-21%. There have been reports of reduced vision after ILM peeling in advanced diabetic retinopathy perhaps relating to the greater adherence of ILM to its underlying Müller cell endplates with greater resultant trauma in diabetic eyes [13,34,35].…”

“…The exact cause of this is uncertain although surgical and proteomic risk factors have been described [9,10]. ILM peeling has been proposed as an effective strategy to reduce the occurrence of significant ERM after surgery [11,12], but its use has been questioned because of its potential to cause harm [13]. We carried out a prospective study to assess the effect of ILM cleaning, without ILM peeling, using a flexible nitinol loop on the occurrence of ERM after surgery for PDR.…”