First Author: J.Garweg SWITZERLAND
Co Author(s): M. Deiss I. Pfister
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Background: Visual outcomes of retinal detachment surgery for macula-involving retinal detachment are limited, the affected eyes rarely recovering reading vision. After promising outcomes in single eyes in which a peeling had additionally been performed for the treatment of an in parallel present epiretinal membrane, we decided to systematically perform ILM peeling in all cases with fovea-involving primary retinal detachment. Here, we compare the outcomes to a series of previously operated eyes not having undergone ILM peeling.
Retrospective comparative clinical case series
A series of patients (n=89, group 1) referred for macula-involving primary retinal detachment without relevant PVR (stage C1 or more) underwent vitrectomy, endolaser, membrane-blue-assisted membrane peeling, in the majority also retinotomy for the drainage of central subretinal fluid and SF6 tamponade, combined with phakomeulsification and IOL implantation in phakic instances, within 24 hours of examination between 2008-2016. A group of patients operated during this period by the same surgeon with an identical technique, but without ILM peeling, served as control (n=28, group 2). Where possible, all patients underwent full clinical examination including OCT to confirm the macular situation prior to surgery, and after one and six months of follow up. Patients with macula-involving re-detachment within one month and those needing silicone oil tamponade were excluded.
Patients were comparable regarding age, lens status and the presence of any PVR (17.0 vs. 28.6%; p=0.19). Starting from a preoperative visual acuity of 32.3±3.2 and 23.6±4.9 ETDRS letters in groups 1 and 2, respectively (p=0.17), BCVA improved to 56.1±32.6 and 30.2±31.6 ETDRS letters after 1 week (p=0.018), 80.6±9.6 and 59.1±33.1 letters at 1 month (p=0.005) and to 87.0±12.8 compared to 74.2±22.0 letters after six months of follow up (p=0.003). The re-detachment and PVR rates were similar (10.1% vs. 10.7% (p=1.0) and 14.5 vs. 27.8% (p=0.28)), whereas the re-vitrectomy incidence was higher in group 2 eyes (1.1% vs. 17.9%; p=0.03), which was namely explained by formation of secondary epiretinal membranes in the latter (1/89 vs. 10/28 instances; p=0.028).
Based on this retrospective series, we assume that peeling of the ILM in fovea-involving retinal detachment substantially contributes to visual recovery beyond a minimal foveal detachment duration and is capable of reducing secondary epiretinal membrane formation and thus the need for re-vitrectomy.