Results of macular pucker surgery with and without internal limiting membrane removal

Session Details

Session Title: Free Paper Session 28: Vitreoretinal Surgery VII

Session Date/Time: Sunday 10/09/2017 | 12:00-13:30

Paper Time: 12:48

Venue: Room 116

First Author: : S.Sheta EGYPT

Co Author(s): :                                 

Abstract Details

Purpose:

To evaluate the functional and anatomical results of vitrectomy and removal of epi-macular proliferations with and without peeling of the Internal Limiting Membrane (ILM) in cases of macular puckers (MP).

Setting:

A retrospective randomized study to evaluate any additive value for peeling the ILM after removal of the epi-macular proliferations both anatomically and functionally in cases of macular puckers.

Methods:

42 cases of MP were studied. Cases of MP after retinal surgery or due to vascular occlusion were excluded as they may affect functional outcome. The cases were randomly divided into two groups. In group one (20 cases) the MP was only removed. In group 2 (22 cases) both the MP and the ILM were removed. 23 gauge vitrectomy was done in all cases. After separation of the posterior hyaloid an end-gripping forceps was used to grasp and elevate the MP. If the membrane was tightly adherent to the retina without a visible edge, a bent needle, a brush, or a fenestrated loop were carefully used to create one. The membrane was then grasped and slowly peeled tangential to the surface of the retina. This is to give a chance for the retinal elasticity to separate smoothly from the MP. If the MP was not easily visible we used Tryban blue (TB) dye to stain the MP. In group 2 cases this was followed by peeling the ILM using re-staining with TB. A flap of the ILM was created by Tano scraper or the ILM was directly pinched by an ILM forceps and peeled in a circular fashion.

Results:

In cases of group 1 in which only the epi-macular proliferations were removed the average central macular thickness (CMT) 6 months after surgery was 284 microns, whereas in group 2 where both the epi-macular proliferations and the ILM were removed was 302 microns (difference not statistically significant). The retinal surface was generally more smooth in group 1 than in group 2 patients. No iatrogenic retinal breaks have occurred in both groups. Recurrence of MP was observed only in one case of group 1 (5%) but did not occur in group 2 cases. Average best post operative corrected visual acuity was slightly better in group 1 (6/18) than group 2 cases (6/24). Para central scotomas was observed by 2 patients of group 2 (9%).

Conclusions:

There has been a debate about the necessity of ILM peeling for MP. Some surgeons believe that the only sure way to remove the MP completely and decrease the incidence of its recurrence is to peel the ILM. Other surgeons feel that it might not be needed and it may even decrease the anatomical and functional outcome. Our results did not show any added advantage for removal of the ILM in MP surgery except decreasing the chance of recurrence which is already low. The CMT was slightly less and the inner retinal surface more smooth if the ILM was not removed. The functional outcome was not statistically different with a trend to fewer scotomas in group 1. We believe that ILM peeling in MP surgery may be needed in selected cases, especially in eyes with persistent wrinkles after removal of epi-macular proliferations and in recurrent cases. Through more careful selection, the risk/benefit ratio of ILM peeling can be better balanced in macular pucker surgery. A larger group of cases and a longer follow up may be needed to solve this debatable issue. I have NO financial disclosure.

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