Evaluation of primary internal limiting membrane peeling in cases with rhegmatogenous retinal detachment

Mohamed Esmail Abdullah, Hossam Eldeen Mohammad Moharram, Ahmed Shawkat Abdelhalim, Khaled Mohamed Mourad, Mohamed Farouk Abdelkader, Mohamed Esmail Abdullah, Hossam Eldeen Mohammad Moharram, Ahmed Shawkat Abdelhalim, Khaled Mohamed Mourad, Mohamed Farouk Abdelkader

Abstract

Background: Epiretinal membranes (ERMs) have been reported after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD). Peeling of the internal limiting membrane (ILM) can prevent post-PPV ERM formation but has a potential negative impact on macular structure and function.

Purpose: To investigate the anatomical and functional outcomes of ILM peeling during PPV for primary RRD.

Methods: This was a prospective nonrandomized study that included 60 eyes of 60 patients with a primary macula-off RRD and less than grade C proliferative vitreoretinopathy (PVR). Eyes were allocated into 2 groups; Group A underwent PPV without ILM peeling and Group B had ILM peeling. At postoperative month 6, all patients underwent retinal imaging using spectral domain optical coherence tomography (OCT) and OCT angiography and macular function was assessed using multifocal electroretinogram (mfERG). Baseline characteristics and postoperative anatomical and visual outcomes were recorded and statistically analyzed.

Results: We enrolled 30 eyes of 30 patients in each group. In Group A, mean age was 44.6 years, while the mean age of Group B patients was 49.9 years. Postoperative LogMAR visual acuity was significantly better in Group A than in Group B (p < 0.001). ERMs were demonstrated on OCT in 13.3% of Group A and none of Group B patients (p = 0.04). Retinal dimples were found in 53.3% of Group B and none of Group A eyes (p < 0.001). OCTA showed a greater vessel density of the superficial capillary plexus (SCP) in Group A compared to Group B eyes (p = 0.046), while no difference was found regarding deep capillary vessel density (p = 0.7). Mean amplitude of mfERG P1 wave was significantly higher in Group A eyes than in Group B (p = 0.002). Both the SCP vessel density and P1 amplitude were positively correlated with visual acuity (p < 0.001).

Conclusion: This study suggests that ILM peeling prevents ERM development in eyes undergoing PPV for uncomplicated macula-off RRD, but potential damage to macular structure and function were found.Trial registration Retrospectively registered on 09/24/2019 on ClinicalTrials.gov with an ID of NCT04139811.

Keywords: Electroretinography; Optical coherence tomography; Peeling of internal limiting membrane (ILM); Retina; Retinal detachment; Vitrectomy; Vitreoretinal surgery; Vitreous body.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
a B-scan SD-OCT of the macula of a Group A patient showing a thick epiretinal membrane (ERM) causing macular pucker, thickening and cystoid degeneration after pars plana vitrectomy. b B-scan SD-OCT of the macula of a Group B patient showing dimples on the inner retinal surface after pars plana vitrectomy and peeling of the internal limiting membrane (ILM)
Fig. 2
Fig. 2
Top row represents a Group A eye. a An optical coherence tomography angiography (OCTA) macula 6 × 6 mm scan showing the slab representing the superficial capillary plexus (SCP). b En-face OCT image that corresponds to the OCTA slab in A. c The color-coded flow density map of the superficial vessel density (warmer colors represent greater flow density). Bottom row represents a Group B eye. d An OCTA macula 6 × 6 mm scan showing the slab representing the superficial capillary plexus (SCP). e En-face OCT image that corresponds to the OCTA slab in D showing retinal dimples at the level of the nerve fiber layer. f The color-coded flow density map of the superficial vessel density
Fig. 3
Fig. 3
a Multifocal electroretinogram (mfERG) of a Group A eye. Left. Amplitude of P1 in nV/deg2 in topographic display around the fovea. Right. Three-dimensional topography of P1 amplitude (nV/deg2). b Multifocal electroretinogram (mfERG) of a Group B eye. Left. Amplitude of P1 in nV/deg2 in topographic display around the fovea. Right. Three-dimensional topography of P1 amplitude (nV/deg2)

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