Internal Limiting Membrane Peeling in Primary Rhegmatogenous Retinal Detachment: Functional and Morphologic Results

Abstract

Purpose The aim of this study was to evaluate the influence of internal limiting membrane (ILM) peeling on the repair of proliferative vitreoretinopathy grade B (PVR B) primary rhegmatogenous retinal detachment (RRD).

Methods Thirteen consecutive eyes that underwent pars plana vitrectomy (ppV) with ILM peeling for PVR B (group 1) were matched to a cohort of 13 eyes with primary RRD without PVR and without ILM peeling (group 2). Minimum follow-up was 6 months, and all eyes were operated by the same surgeon. Preoperative characteristics (age, lens status, macula-ON/OFF) were similar in the two groups (p ≥ 0.113).

Results At the end of follow-up, reattachment rates were comparable, with 92.3% in group 1 and 92.3% in group 2 (p = 1.0). Postoperative epiretinal membrane formation based on OCT was significantly reduced by ILM peeling (p = 0.04). Visual acuity was also comparable (group 1: 0.26 ± 0.29, group 2: 0.15 ± 0.17 logMAR; p = 0.125).

Conclusion This study suggests that intraoperative removal of the ILM in PVR B RRD can improve functional and morphological outcomes to levels obtained in uncomplicated RRD without PVR. ILM peeling does not appear to negatively affect postoperative visual acuity. Studies with longer follow-up are warranted to gauge a potential positive impact.

Zusammenfassung

Hintergrund Ziel dieser retrospektiven Kohortenstudie war es, das funktionelle und morphologische Ergebnis nach primärer rhegmatogener Netzhautablösung zwischen Patienten mit und ohne intraoperatives Peeling der internen limitierenden Membran (ILM) zu vergleichen.

Methoden Die morphologische Datenbank der Augenklinik wurde auf Patienten untersucht, die im Zeitraum von 2020 bis 2023 an einer primär rhegmatogenen Netzhautablösung operiert wurden (Single Surgeon) und ein verfügbares Follow-up von mindestens 6 Monaten aufwiesen. Eingeschlossen wurden 13 Augen, die sich einer Pars-plana-Vitrektomie (ppV) mit ILM-Peeling bei PVR B (Gruppe 1) unterzogen, sowie 13 Augen ohne PVR und ohne ILM-Peeling (Gruppe 2). Alle Patienten wurden primär ausgewertet hinsichtlich des bestkorrigierten prä- und postoperativen Visus und der primären Netzhautanlagerate. Als sekundäre Zielvariablen wurden definiert: Endotamponande, Nachweis von PVR, intra- und postoperative OCT-Biomarker (Integrität der äußeren Netzhautschichten, Nachweis intraretinaler Flüssigkeit).

Ergebnisse Beide Gruppen unterschieden sich nicht signifikant bez. Durchschnittsalter, Vorhandensein eines Linsenimplantats und dem intraoperativen Status der Makula (Makula on vs. off) (p ≥ 0,05). Die primäre Anlagerate war mit 92,3% in Gruppe 1 und 92,3% in Gruppe 2 vergleichbar (p = 1,0). Postoperativ zeigte sich in Gruppe 1 signifikant seltener eine postoperative epiretinale Membran (p = 0.04). Hinsichtlich der postoperativen Visusveränderung zeigte sich kein signifikanter Unterschied (Gruppe 1: 0,26 ± 0,29, Gruppe 2: 0,15 ± 0,17 logMAR; p = 0,125).

Schlussfolgerung Unsere Ergebnisse deuten darauf hin, dass die intraoperative Entfernung der ILM bei rhegmatogener Netzhautablösung die Wahrscheinlichkeit des Auftretens einer postoperativen PVR-Reaktion reduzieren kann und keinen negativen Einfluss auf den postoperativen Visus zu nehmen scheint. Zusätzliche Studien mit größerer Kohorte sind zu empfehlen.

Keywords

retina - vitreous - retinal detachment - epiretinal membrane

Schlüsselwörter

Retina - Netzhautablösung - epiretinale Membran - Vitrektomie

Publication History

Received: 11 August 2024

Accepted: 16 September 2024

Article published online:
13 February 2025

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