Five-Year Outcomes of Surgically Treated Symptomatic Epiretinal Membranes With and Without Internal Limiting Membrane Peeling
Abstract
BACKGROUND AND OBJECTIVE:
The authors evaluated long-term postoperative visual outcomes and recurrence rates following surgery for symptomatic epiretinal membrane (ERM) ± internal limiting membrane (ILM) peeling.
PATIENTS AND METHODS:
This was a retrospective, consecutive case series of 78 patients undergoing vitrectomy for symptomatic ERM between 1/2010 and 4/2012 with follow-up through at least postoperative year 5 (POY5). Outcomes included visual acuity (VA) (Snellen VA converted to logMAR), central retinal thickness (CRT; μm), and ERM recurrence. Subgroup analysis evaluated outcomes related to ILM peeling.
RESULTS:
Subgroup analysis based on ILM peeling did not find VA (20/50 [0.430 logMAR ± 0.061 logMAR; mean ± SD] vs. 20/60 [0.518 logMAR ± 0.128 logMAR] for ILM vs. non-ILM peeling respectively; P = .513) nor macular thickness (355 μm ± 13 μm vs. 360 μm ± 42 μm; P = .410) to be significantly different at POY5. Recurrence requiring surgery with and without ILM peeling was not statistically significantly different at POY5 (1.6% and 11.8%; P = .118).
CONCLUSION:
Vitrectomy for symptomatic ERM led to improved visual and anatomic outcomes with sustained benefit through 5 years. ILM peeling was was associated with reduced ERM recurrence, but this benefit was not statistically significant at POY5.
[Ophthalmic Surg Lasers Imaging Retina. 2018;49:296–302.]
- 1.Klein R, Klein BE, Wang Q, Moss SE. The epidemiology of epiretinal membranes. Trans Am Ophthalmol Soc. 1994; 92:403–430. Medline, Google Scholar
- 2.Mitchell P, Smith W, Chey T, Wang JJ, Chang A. Prevalence and associations of epiretinal membranes. The Blue Mountains Eye Study, Australia. Ophthalmology. 1997; 104(6):1033–1040.
10.1016/S0161-6420(97)30190-0 Crossref Medline, Google Scholar - 3.McLeod D, Hiscott PS, Grierson I. Age-related cellular proliferation at the vitreoretinal juncture. Eye (Lond). 1987; 1 (Pt 2):263–281.
10.1038/eye.1987.46 Crossref Medline, Google Scholar - 4.Bringmann A, Wiedemann P. Involvement of Müller glial cells in epiretinal membrane formation. Graefes Arch Clin Exp Ophthalmol. 2009; 247(7):865–883.
10.1007/s00417-009-1082-x Crossref Medline, Google Scholar - 5.Arndt C, Rebollo O, Séguinet S, Debruyne P, Caputo G. Quantification of metamorphopsia in patients with epiretinal membranes before and after surgery. Graefes Arch Clin Exp Ophthalmol. 2007; 245(8):1123–1129.
10.1007/s00417-006-0505-1 Crossref Medline, Google Scholar - 6.Arimura E, Matsumoto C, Okuyama S, Takada S, Hashimoto S, Shimomura Y. Retinal contraction and metamorphopsia scores in eyes with idiopathic epiretinal membrane. Invest Ophthalmol Vis Sci. 2005; 46(8):2961–2966.
10.1167/iovs.04-1104 Crossref Medline, Google Scholar - 7.Michels RG. Vitreous surgery for macular pucker. Am J Ophthalmol. 1981; 92(5):628–639.
10.1016/S0002-9394(14)74654-9 Crossref Medline, Google Scholar - 8.Bovey EH, Uffer S, Achache F. Surgery for epimacular membrane: Impact of retinal internal limiting membrane removal on functional outcome. Retina. 2004; 24(5):728–735.
10.1097/00006982-200410000-00007 Crossref Medline, Google Scholar - 9.Kwok AK, Lai TY, Yuen KS. Epiretinal membrane surgery with or without internal limiting membrane peeling. Clin Experiment Ophthalmol. 2005; 33(4):379–385.
10.1111/j.1442-9071.2005.01015.x Crossref Medline, Google Scholar - 10.Park DW, Dugel PU, Garda J, Macular pucker removal with and without internal limiting membrane peeling: Pilot study. Ophthalmology. 2003; 110(1):62–64.
10.1016/S0161-6420(02)01440-9 Crossref Medline, Google Scholar - 11.Shimada H, Nakashizuka H, Hattori T, Mori R, Mizutani Y, Yuzawa M. Double staining with brilliant blue G and double peeling for epiretinal membranes. Ophthalmology. 2009; 116(7):1370–1376.
10.1016/j.ophtha.2009.01.024 Crossref Medline, Google Scholar - 12.Oh HN, Lee JE, Kim HW, Yun IH. Clinical outcomes of double staining and additional ILM peeling during ERM surgery. Korean J Ophthalmol. 2013; 27(4):256–260.
10.3341/kjo.2013.27.4.256 Crossref Medline, Google Scholar - 13.Sandali O, El Sanharawi M, Basli E, Epiretinal membrane recurrence: incidence, characteristics, evolution, and preventive and risk factors. Retina. 2013; 33(10):2032–2038.
10.1097/IAE.0b013e31828d2fd6 Crossref Medline, Google Scholar - 14.Koestinger A, Bovey EH. Visual acuity after vitrectomy and epiretinal membrane peeling with or without premacular indocyanine green injection. Eur J Ophthalmol. 2005; 15(6):795–799.
10.1177/112067210501500622 Crossref Medline, Google Scholar - 15.Azuma K, Ueta T, Eguchi S, Aihara M. Effects of internal limiting membrane peeling combined with removal of idiopathic epiretinal membrane: A systematic review of literature and meta-analysis. Retina. 2017; 37(10):1813–1819.
10.1097/IAE.0000000000001537 Crossref Medline, Google Scholar - 16.Fang XL, Tong Y, Zhou YL, Zhao PQ, Wang ZY. Internal limiting membrane peeling or not: A systematic review and meta-analysis of idiopathic macular pucker surgery. Br J Ophthalmol. 2017; 101(11):1535–1541.
10.1136/bjophthalmol-2016-309768 Crossref Medline, Google Scholar - 17.Bouwens MD, de Jong F, Mulder P, van Meurs JC. Results of macular pucker surgery: 1- and 5-year follow-up. Graefes Arch Clin Exp Ophthalmol. 2008; 246(12):1693–1697.
10.1007/s00417-008-0909-1 Crossref Medline, Google Scholar - 18.Lee JW, Kim IT. Outcomes of idiopathic macular epiretinal membrane removal with and without internal limiting membrane peeling: A comparative study. Jpn J Ophthalmol. 2010; 54(2):129–134.
10.1007/s10384-009-0778-0 Crossref Medline, Google Scholar - 19.Sivalingam A, Eagle RC, Duker JS, Visual prognosis correlated with the presence of internal-limiting membrane in histopathologic specimens obtained from epiretinal membrane surgery. Ophthalmology. 1990; 97(11):1549–1552.
10.1016/S0161-6420(90)32378-3 Crossref Medline, Google Scholar - 20.Pournaras CJ, Emarah A, Petropoulos IK. Idiopathic macular epiretinal membrane surgery and ILM peeling: Anatomical and functional outcomes. Semin Ophthalmol. 2011; 26(2):42–46.
10.3109/08820538.2010.544237 Crossref Medline, Google Scholar - 21.Ahn SJ, Ahn J, Woo SJ, Park KH. Photoreceptor change and visual outcome after idiopathic epiretinal membrane removal with or without additional internal limiting membrane peeling. Retina. 2014; 34(1):172–181.
10.1097/IAE.0b013e318295f798 Crossref Medline, Google Scholar - 22.Ripandelli G, Scarinci F, Piaggi P, Macular pucker: To peel or not to peel the internal limiting membrane? A microperimetric response. Retina. 2015; 35(3):498–507.
10.1097/IAE.0000000000000330 Crossref Medline, Google Scholar - 23.Sorcinelli R. Surgical management of epiretinal membrane with indocyanine-green-assisted peeling. Ophthalmologica. 2003; 217(2):107–110.
10.1159/000068556 Crossref Medline, Google Scholar - 24.Maguire AM, Smiddy WE, Nanda SK, Michels RG, de la Cruz Z, Green WR. Clinicopathologic correlation of recurrent epiretinal membranes after previous surgical removal. Retina. 1990; 10(3):213–222.
10.1097/00006982-199001030-00011 Crossref Medline, Google Scholar - 25.Uemura A, Kanda S, Sakamoto Y, Kita H. Visual field defects after uneventful vitrectomy for epiretinal membrane with indocyanine green-assisted internal limiting membrane peeling. Am J Ophthalmol. 2003; 136(2):252–257.
10.1016/S0002-9394(03)00157-0 Crossref Medline, Google Scholar - 26.Leung CK, Cheung CY, Weinreb RN, Comparison of macular thickness measurements between time domain and spectral domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2008; 49(11):4893–4897.
10.1167/iovs.07-1326 Crossref Medline, Google Scholar - 27.Schechet SA, DeVience E, Thompson JT. The effect of internal limiting membrane peeling on idiopathic epiretinal membrane surgery, with a review of the literature. Retina. 2017; 37(5):873–880.
10.1097/IAE.0000000000001263 Crossref Medline, Google Scholar - 28.Kang KT, Kim KS, Kim YC. Surgical results of idiopathic and secondary epiretinal membrane. Int Ophthalmol. 2014; 34(6):1227–1232.
10.1007/s10792-014-0010-1 Crossref Medline, Google Scholar

