Prophylactic internal limiting membrane peeling during rhegmatogenous retinal detachment surgery

Starr, Matthew R.; Obeid, Anthony; Gao, Xinxiao; Ryan, Edwin H.; Shah, Gaurav K.; Ryan, Claire; Madhava, Malika; Maloney, Sean M.; Adika, Adam Z.; Peddada, Krishi; Sioufi, Kareem; Ammar, Michael; Patel, Luv; Forbes, Nora J.; Capone, Antonio; Emerson, Geoffrey G.; Joseph, Daniel P.; Eliott, Dean; Regillo, Carl D.; Hsu, Jason; Gupta, Omesh P.; Yonekawa, Yoshihiro

doi:10.1111/aos.14560

Cited by 6 publications

(2 citation statements)

References 5 publications

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“…The practice of ILM peeling in primary retinal detachments has been gaining in popularity, and publications regarding the usefulness and safety of this practice are increasing. [27][28][29][30][31] These publications have shown that ILM peeling in RDs greatly reduce postoperative ERM growth, the need for repeat ERM surgery, and the likelihood of macular PVR. The author (A.R.)…”

Section: Discussionmentioning

confidence: 99%

The effect of internal limiting membrane peeling on the inner retinal layers in patients without macular pathology

Belkin,

Harel,

Shtayer

et al. 2024

Retina

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Background: To examine the effect of internal limiting membrane (ILM) peeling on the inner retinal layers in patients without macular pathology. Methods: A prospective nonrandomized trial of patients undergoing pars plana vitrectomy with ILM peeling for pathology outside of the macula was performed. Optical coherence tomography (OCT) including macular ganglion cell layer (GCL), inner plexiform layer (IPL) and peripapillary retinal nerve fiber layer imaging was performed prior to surgery, 1,3 and 6 months post-operatively and at the end of follow up (ranges between 4-17 months). Patients with any macular pathology on OCT prior to surgery were excluded. The main outcome measure was change in thickness of the GCL and IPL. Results: Ten patients who underwent pars plana vitrectomy with ILM peeling for macula-on retinal detachment were included in the analysis. The mean age was 55 years and the mean follow up was 10.8 months. All patients completed at least 2 post-operative follow up visits that included an OCT as per the protocol (range 2-6 months). There was an immediate reduction in the global (G), infero-temporal (IT), supero-temporal (ST) and superior (S) GCL thickness at the first follow up as compared to the pre-operative state (P=0.028, P=0.027, P=0.026 and P=0.027 respectively). From the first follow up visit onward until the final follow up the thinning persisted, though there was no further statistically significant thinning. Conclusion: Peeling of the ILM causes significant GCL thinning in maculae without pathology prior to surgery. At up to 17 months of follow up, this effect seems to be immediate and non-progressive.

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Section: Discussionmentioning

confidence: 99%

The effect of internal limiting membrane peeling on the inner retinal layers in patients without macular pathology

Belkin,

Harel,

Shtayer

et al. 2024

Retina

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“…The SSSR was significantly higher in the ILM peeling cohort, both on univariate and multivariate analyses (95 versus 85%). There were no differences in visual acuity outcomes or in the development of postoperative ERM formation following ILM peeling [13 ▪ ]. Moving to a separate paper on surgical technique, the group then reported on the outcomes comparing 23-gauge PPV versus 25-gauge PPV during RRD repair.…”

Section: Introductionmentioning

confidence: 99%

Primary Retinal Detachment Outcomes Study: summary of reports number 1 to number 18

Starr

Ryan²,

Yonekawa³

2023

Current Opinion in Ophthalmology

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Purpose of reviewTo highlight the recent work published from the Primary Retinal Detachment Outcomes (PRO) Study Group. Recent findingsThe PRO database was a large dataset made up of patients with primary rhegmatogenous retinal detachments (RRD) who had surgical repair during 2015. The database was constituted of nearly 3000 eyes from 6 centers across the United States and included 61 vitreoretinal surgeons. Nearly 250 metrics were collected for each patient, creating one of the richest datasets of patients with primary rhegmatogenous detachments and their outcomes. The importance of scleral buckling was demonstrated, particularly for phakic eyes, elderly patients, and those with inferior breaks. 3608 laser may result in poorer outcomes. Cystoid macular edema was common, and risk factors were identified. We also found risk factors for vision loss in eyes presenting with good vision. A PRO Score was devised, to predict outcomes based on presenting clinical characteristics. We also identified characteristics of surgeons with the highest single surgery success rates. Overall, there were no major outcome differences between viewing systems, gauges, buckles sutured vs. scleral tunnels, drainage method, and techniques to address proliferative vitreoretinopathy. All incisional techniques were found to be very cost-effective treatment modalities. SummaryNumerous studies resulted from the PRO database that significantly added to the literature regarding the repair of primary RRDs in the current era of vitreoretinal surgery.

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Primary ILM peeling during retinal detachment repair: a systematic review and meta-analysis

Lamas-Francis

Bande-Rodríguez

Blanco-Teijeiro

2023

Sci Rep

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Epiretinal membrane (ERM) formation is a known postoperative complication following retinal detachment (RD) repair surgery. Prophylactic peeling of the internal limiting membrane (ILM) during surgery has been shown to reduce the risk of developing postoperative ERM formation. Some baseline characteristics and degrees of surgical complexity may act as risk factors for ERM development. In this review we aimed to investigate the benefit of ILM peeling in patients without significant proliferative vitreoretinopathy (PVR) who underwent pars plana vitrectomy for RD repair. A literature search using PubMed and various keywords retrieved relevant papers from which data were extracted and analyzed. Finally, the results of 12 observational studies (3420 eyes) were summarized. ILM peeling significantly reduced the risk of postoperative ERM formation (RR = 0.12, 95% CI 0.05–0.28). The groups did not differ in final visual acuity (SMD 0.14 logMAR (95% CI − 0.03–0.31)). The risk of RD recurrence (RR = 0.51, 95% CI 0.28–0.94) and the need for secondary ERM surgery (RR = 0.05, 95% CI 0.02–0.17) were also higher in the non-ILM peeling groups. In summary, although prophylactic ILM peeling appears to reduce the rate of postoperative ERM, this benefit does not translate into consistent visual recovery across studies and potential complications must be considered.

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Prophylactic internal limiting membrane peeling during rhegmatogenous retinal detachment surgery

Cited by 6 publications

References 5 publications

The effect of internal limiting membrane peeling on the inner retinal layers in patients without macular pathology

The effect of internal limiting membrane peeling on the inner retinal layers in patients without macular pathology

Primary Retinal Detachment Outcomes Study: summary of reports number 1 to number 18

Primary ILM peeling during retinal detachment repair: a systematic review and meta-analysis

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