VITRECTOMY WITH EPIRETINAL MEMBRANE PEELING ALONE VERSES COMBINED WITH INTERNAL LIMITING MEMBRANE PEELING FOR IDIOPATHIC EPIRETINAL MEMBRANE
Abstract
Background: The objective of this study was to determine and compare the structural and functional outcome in eyes who underwent Pars Plana Vitrectomy (PPV) with Epiretinal Membrane (ERM) peeling alone verses combined Epiretinal membrane with Internal Limiting Membrane (ILM) peeling for Idiopathic Epiretinal Membrane along with rate of recurrence. Methods: It was an interventional randomized study, conducted at Al-Ibrahaim Eye Hospital, Malir, Karachi, for two-year period from 1st August 2016 to 1st August 2018. A total of forty-four eyes of 44 patients were divided into two group equally. Group A contains 22 eyes of 22 patients who underwent PPV with ERM peeling alone. Group B also contains 22 eyes of 22 patients who underwent PPV with ERM and ILM peeling. The follow up period was 1 year. The patients having best corrected visual acuity (BCVA) less than 6/18 or symptom of metamorphopsia were included in our study. The best corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded at 3, 6 and 12-month follow up. Results: In group A, the mean preoperative BCVA was 0.148 Log MAR (6/36 Snellen chart). The mean postoperative BCVA at 3, 6, and 12 months was 0.32 (6/18), 0.49 (6/12 P) and 0.50 (6/12), respectively. In group B, the mean preoperative best corrected visual acuity was 0.161 Log MAR (6/36 P Snellen chart). The mean postoperative BCVA at 3, 6, and 12 months was 0.36 (6/18 P), 0.51 (6/12) and 0.51 (6/12) respectively. The mean preoperative Central Macular Thickness (CMT) was 398.9 μm in group A and 384.7 μm in group B. The mean CMT in group A was 271.4, 236.7 and 229.8 μm at 3, 6 and 12 months, respectively. In group B, the mean CMT was 272.1, 233.8 and 220.4 μm at 3, 6 and 12 months, respectively. No significant difference was found in visual outcome and central macular thickness between two groups. Conclusion: Pars plana vitrectomy along with ERM peeling alone or combined with ILM peeling is safe procedure. Both methods were effective functionally and structurally in treatment of idiopathic ERM, however no significant difference and no recurrence of ERM was observed in either group.Keywords: Epiretinal membrane; Pars Plana Vitrectomy; best corrected visual acuity; central macular thicknessReferences
Chang WC, Lin C, Lee CH, Sung TL, Tung TH, Liu JH. Vitrectomy with or without internal limiting membrane peeling for idiopathic epiretinal membrane: A meta-analysis. PloS One 2017;12(6):e0179105.
Demir G, Demircan A, Yasa D, Topcu H, Eris E, Erdogan G, et al. Visual and Anatomical Outcomes Following Idiopathic Epiretinal Membrane and Internal Limiting Membrane Peeling. Age (years) 2017;65:8–5.
Roh M, Eliott D. Internal limiting membrane peeling during idiopathic epiretinal membrane removal: literature review. Int Ophthalmol Clin 2015;55(4):91–101.
HAUG SJ, McDonald H. Clinical Pearls for Performing ILM Peeling in Vitreoretinal Surgery. Retin Physician 2014;11:53–7.
Shahzadi B, Rizvi SF, Latif K, Murtaza F, Naz S. Visual and anatomical outcomes following idiopathic macular epiretinal membrane surgery. J Coll Physicians Surg Pak 2016;26(12):971–4.
Semeraro F, Morescalchi F, Duse S, Gambicorti E, Russo A, Costagliola C. Current trends about inner limiting membrane peeling in surgery for epiretinal membranes. J Ophthalmol 2015;2015:1–14.
Stevenson W, Ponce CMP, Agarwal DR, Gelman R, Christoforidis JB. Epiretinal membrane: optical coherence tomography-based diagnosis and classification. Clin Ophthalmol (Auckland, NZ) 2016;10:527.
Pichi F, Lembo A, Morara M, Veronese C, Alkabes M, Nucci P, et al. Early and late inner retinal changes after inner limiting membrane peeling. Int Ophthalmol 2014;34(2):437–46.
Dal Vecchio M, Lavia C, Nassisi M, Grignolo FM, Fea AM. Microperimetric assessment after epiretinal membrane surgery: 4-year follow-up. J Ophthalmol 2016;2016:1–5.
Reilly G, Melamud A, Lipscomb P, Toussaint B. Surgical outcomes in patients with macular pucker and good preoperative visual acuity after vitrectomy with membrane peeling. Retina 2015;35(9):1817–21.
Ting F, Kwok A. Treatment of epiretinal membrane: an update. Hong Kong Med J Xianggang Yi Xue Za Zhi 2005;11(6):496–502.
Chang S, Gregory-Roberts EM, Park S, Laud K, Smith SD, Hoang QV. Double peeling during vitrectomy for macular pucker: the Charles L. Schepens Lecture. JAMA Ophthalmol 2013;131(4):525–30.
Tranos P, Koukoula S, Charteris DG, Perganda G, Vakalis A, Asteriadis S, et al. The role of internal limiting membrane peeling in epiretinal membrane surgery: a randomised controlled trial. Br J Ophthalmol 2017;101(6):719–24.
Moisseiev E, Kinori M, Moroz I, Priel E, Moisseiev J. 25-gauge vitrectomy with epiretinal membrane and internal limiting membrane peeling in eyes with very good visual acuity. Curr Eye Res 2016;41(10):1387–92.
Haseeb U, Rehman AU, Memon AF, Haseeb M, Memon N. Surgical Outcomes of Idiopathic Macular Epiretinal Membrane Peeling. J Coll Physicians Surg Pak 2019;29(3):245–8.
Obata S, Fujikawa M, Iwasaki K, Kakinoki M, Sawada O, Saishin Y, et al. Changes in retinal thickness after vitrectomy for epiretinal membrane with and without internal limiting membrane peeling. Ophthalmic Res 2017;57(2):135–40.
Jung JJ, Hoang QV, Ridley-Lane ML, Serow DB, Dharami-Gavazi E, Chang S. Long-term retrospective analysis of visual acuity and opticl coherence tomographic changes after sngle versus double peeling during vitrectomy for macular epiretnal membranes. Retina Phila Pa 2016;36(11):2101.
De Novelli FJ, Goldbaum M, Monterio MLR, Aggio FB, Nobrega MJ, Takahashi WY. Reccurence rate and need for reoperation after surgery with or without internal limiting membrane removal for the treatment of the epiretinal membrane. Int J Retina Vitr 2017;3(1):1–5.
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