Session Title: Quick Fire Free Paper Session 03
Session Date/Time: Sunday 29/09/2013 | 08:30-09:30
Paper Time: 08:50
Venue: Hall C (Level 1)
First Author: N.Labauri GEORGIA
Co Author(s): N. Iskenderova T. Mamageishvili N. Tavberidze
The purpose of this study was to evaluate, compare and establish the efficiency of internal limiting membrane (ILM) peeling as an additional tool of primary pars plana vitrectomy (PPV) for the management of rhegmatogenous retinal detachment with different complexities.
“Akhali Mzera” Eye Clinic. Pvt. Ltd. Tbilisi, Georgia.
In this prospective study were recruited 155 eyes of 143 patients and divided in two main groups and four subgroups. Group I includes 66 (42.58%) eyes, which were undergone PPV for retinal detachment complicated with proliferative vitreoretinopathy (PVR). This group is divided in two sub-groups: I-A includes 32 (48.5%) eyes, where ILM peeling was performed and I-B 34 (51.5%) eyes, where ILM was left intact. Group II includes 89 (57.42%) eyes where PPV was used for simple retinal detachment repair, not complicated with PVR. This group was similarly divided in two sub-groups, which are II-A includes 47 (52.8%) eyes, where ILM peeling was used and II-B includes 42(47.2%) eyes, where ILM was left intact. For ILM staining Membrane Blue Dual (D.O.R.C.) was used and ILM was peeled under perfluorocarbon liquid. Conventional silicone oil was applied as a tamponading agent in all patients. Apart of routine ophthalmological examinations all patients underwent fundus photography and optical coherence tomography preoperatively and all the time during postoperative follow up period. Patients were evaluated for macular pucker, cystoid edema formation and complications, which possibly could related to ILM peeling procedure. Recruitment period was 20 months and mean follow up period was 21.1 ± 8.9 months.
Retinal reattachment was achieved by one surgery in 147 (94%) eyes and 8 (5.2%) eyes required two or more surgical interventions. Visual acuity (VA) improved in 144 (92.9%) eyes in both groups. At the end of follow up the mean postoperative VA in subgroup I-A was 0.2 (varied from 0.05 to 0.7) to compare to subgroup I-B, where mean VA was 0.1 (varied from 0.03 to 0.4). Unlike group I, the group II showed almost no difference between peeling and nonpeeling subgroups. In both subgroups final postoperative mean VA was 0.4 (varied from 0.05 to 0.9). Intraoperative and postoperative complications were as follow: Macular pucker in one (3.1%) eye in subgroup I-A, 7 (20.5%) eyes in subgroup I-B and 6 (14.2 %) eyes in subgroup II-B; Macular edema in 2 (6.2%) eyes in subgroup I-A, 9 (26.4%) eyes in subgroup I-B, one (2.1%) eye and 3 (7.1%) eyes in subgroup II-B; Macular hole in one (3.1%) eye in subgroup I-A and one (2.1%) eye in subgroup II-A (both of them were spontaneously closed by the next day); Iatrogenic paramacular damage of neurosensory retina during peeling procedure observed in 2 (6.2%) eyes only in subgroup I-A.
According to this study we can conclude that ILM peeling in conjunction with vitrectomy is an effective technique with a high anatomical and functional success rate in the retinal detachment cases complicated with PVR. It prevents the macular pucker and reduces the rates cystoid macular edema formation. In contrary, ILM peeling didn’t show significantly better functional outcome in simple retinal detachment cases, despite the higher rate of macular pucker or edema formation in “non peeling” subgroup during postoperative period.