To evaluate the outcomes of surgical removal of premacular fibrosis (PMF) with peeling of the internal limiting membrane (ILM). Determination of factors associated with favorable outcomes (visual acuity between 20/20 and 20/40).
Retrospective chart review, evaluating visual outcomes in 38 patients who underwent pars plana vitrectomy (PPV) and triamcinolone-assisted ILM peeling by a single surgeon between December 2003 and December 2004. Data collected included visual acuity before and 3 months after surgery, and at final follow-up, as well as complications (cataract formation, endophthalmitis, retinal detachment, vitreous hemorrhage, retinal or subretinal hemorrhage, macular hole formation, cystoid macular edema [CME], and PMF recurrence).
Pretreatment visual acuity averaged at 20/90. Vision improved or was unchanged in 89.5% of operated eyes with ILM peeling. Average follow-up was 20.2 months. The average improvement in visual acuity was 2.2 lines. The most common complication was cataract formation. There were no other complications until patients underwent cataract extraction. Two patients developed CME within 4 weeks of cataract surgery. Biomicroscopic recurrence of PMF was an asymptomatic and rare event with an incidence of 2.6% (n = 1 of 38 patients). No adverse outcomes were noted in patients with higher levels of visual acuity and these were in fact the patients with best final visual acuity.
ILM peeling may not have the harmful consequences previously attributed to it. Stripping of the ILM may reduce reformation rates of PMF. Surgical removal of PMF with ILM peeling was not associated with unfavorable outcomes in our group of patients.
Peeling of the internal limiting membrane at the time of surgical removal of premacular fibrosis may reduce the incidence of recurrence.
From *Barnes Retina Institute and †Washington University School of Medicine, Department of Ophthalmology, St. Louis, Missouri. ‡Shandiz Tehrani is currently an MD/PhD student in the Medical Scientist Training Program at Washington University School of Medicine.
The authors have no proprietary interest in this article.
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