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EPIRETINAL MEMBRANE REMOVAL WITH FOVEAL-SPARING INTERNAL LIMITING MEMBRANE PEELING: A Pilot Study

Russo, Andrea, MD, PhD*; Morescalchi, Francesco, MD*; Gambicorti, Elena, MD*; Cancarini, Anna, MD*; Costagliola, Ciro, MD; Semeraro, Francesco, MD*

doi: 10.1097/IAE.0000000000002274
Original Study: PDF Only

Purpose: To compare the retinal sensitivity after complete internal limiting membrane (ILM) peeling with that after foveal-sparing ILM peeling during vitrectomy for Type I epiretinal membrane.

Methods: This was a prospective, randomized, comparative study. Thirty-eight eyes were randomized to undergo complete peeling of the ILM (CP group) or peeling with foveal sparing (FS group). The main outcome measures were foveal and perifoveal retinal sensitivity, visual acuity, and central retinal thickness.

Results: Foveal retinal sensitivity showed a significant improvement in the FS group (2.82 ± 0.85 dB, P = 0.037) versus a slight drop in the CP group (−0.66 ± 0.48 dB, P = 1). Perifoveal retinal sensitivity slightly improved in both groups (0.47 ± 0.37 dB, P = 1 in the CP group and 0.79 ± 0.42 dB, P = 0.77 in the FS group), showing a similar trend without significant differences. Significant improvements were observed in both visual acuity and central retinal thickness in both groups. However, three cases in the FS group showed epiretinal membrane recurrence and required revision surgery with complete ILM removal.

Conclusion: Internal limiting membrane peeling may reduce retinal sensitivity and significantly increase the incidence of microscotomas. However, the higher epiretinal membrane recurrence rate after the foveal-sparing technique limits the effectiveness of this procedure. Further studies must be conducted to determine if it is safe to leave a portion of the ILM in front of the fovea.

This study discusses the effectiveness of a foveal-sparing approach in internal limiting membrane peeling performed during vitrectomy for Type I epiretinal membrane. We aimed to determine if leaving a portion of the internal limiting membrane in front of the fovea could address the issues associated with complete internal limiting membrane removal. Our findings showed that while the foveal-sparing approach did improve retinal sensitivity and reduced the incidence of microscotomas, it was also associated with a higher incidence of epiretinal membrane recurrence.

*Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia, Italy; and

Eye Clinic, Department of Health Sciences, University of Molise, Campobasso, Italy.

Reprint requests: Andrea Russo, MD, PhD, Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia Piazzale Spedale Civili, 1, 25100 Brescia, Italy; e-mail: dott.andrea.russo@gmail.com

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

© 2018 by Ophthalmic Communications Society, Inc.