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EFFECTS OF INTERNAL LIMITING MEMBRANE PEELING COMBINED WITH REMOVAL OF IDIOPATHIC EPIRETINAL MEMBRANE

A Systematic Review of Literature and Meta-Analysis

Azuma, Kunihiro MD*,†; Ueta, Takashi MD, PhD*; Eguchi, Shuichiro MD; Aihara, Makoto MD, PhD*

doi: 10.1097/IAE.0000000000001537
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Purpose: To evaluate the effects on postoperative prognosis of internal limiting membrane (ILM) peeling in conjunction with removal of idiopathic epiretinal membranes (ERMs).

Methods: MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE were systematically searched for studies that compared ILM peeling with no ILM peeling in surgery to remove idiopathic ERM. Outcome measures were best-corrected visual acuity, central macular thickness, and ERM recurrence. Studies that compared ILM peeling with no ILM peeling for the treatment of idiopathic ERM were selected.

Results: Sixteen studies that included 1,286 eyes were selected. All the included studies were retrospective or prospective comparative studies; no randomized controlled study was identified. Baseline preoperative best-corrected visual acuity and central macular thickness were equal between ILM peeling and no ILM peeling groups. Postoperatively, there was no statistically significant difference in best-corrected visual acuity (mean difference 0.01 logarithm of the minimum angle of resolution [equivalent to 0.5 Early Treatment Diabetic Retinopathy Study letter]; 95% CI −0.05 to 0.07 [−3.5 to 2.5 Early Treatment Diabetic Retinopathy Study letters]; P = 0.83) or central macular thickness (mean difference 13.13 μm; 95% CI −10.66 to 36.93; P = 0.28). However, the recurrence rate of ERM was significantly lower with ILM peeling than with no ILM peeling (odds ratio 0.25; 95% CI 0.12–0.49; P < 0.0001).

Conclusion: Currently available evidence in the literature indicates that additional ILM peeling in vitrectomy for idiopathic ERM could result in a significantly lower ERM recurrence rate, but it does not significantly influence postoperative best-corrected visual acuity and central macular thickness.

The effects of internal limiting membrane peeling for patients with epiretinal membrane have been studied with inconsistent conclusions. This systematic review and meta-analysis indicate that it may significantly lower the rate of epiretinal membrane recurrence, but not influence visual acuity and central macular thickness.

*Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan; and

Eguchi Eye Hospital, Hokkaido, Japan.

Reprint requests: Takashi Ueta, MD, PhD, Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; e-mail: ueta-tky@umin.ac.jp

None of the authors has any financial/conflicting interests to disclose.

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© 2017 by Ophthalmic Communications Society, Inc.