Internal limiting membrane peeling as prophylaxis of macular pucker formation in eyes undergoing retinectomy for severe proliferative vitreoretinopathy.

BACKGROUND: The purpose of this was to analyze the effect of internal limiting membrane (ILM) peeling on the anatomical and functional outcomes in patients undergoing retinectomy for proliferative vitreoretinopathy-related retinal detachment, especially regarding the postoperative development of macular pucker.
METHODS: In all, a consecutive and prospective series of 84 eyes of 84 patients were included in the study. All eyes underwent retinectomy with silicone oil tamponade for retinal detachment because of proliferative vitreoretinopathy. In Group A (33 eyes), the ILM was also peeled; in Group B (51 eyes), the ILM was left intact. Each patient gave consent to be included in the study, and no patient was lost to follow-up. Postoperatively, careful slit-lamp examination with a contact lens was used to determine whether primary ILM peeling was effective in preventing macular pucker formation. Various statistical methods were used to analyze the significance of the results with a P value of ≤ 0.05 interpreted as significant.
RESULTS: In Group A, the mean age of the patients was 57.2 ± 12.8 years and in Group B 54.6 ± 14.5 years. Median follow-up in Group A was 28.2 ± 7.2 months and in Group B 27.4 ± 6.5 months. The mean time interval between the last retinectomy and silicone oil removal was 9.2 ± 6.1 months in Group A and 8.8 ± 3.0 months in Group B. The mean follow-up after silicone oil removal was 17.4 ± 10.3 months in Group A and 15.1 ± 9.3 months in Group B. The mean logarithm of the minimum angle of resolution visual acuity at the final follow-up visit was 1.89 ± 0.87 in Group A and 1.85 ± 0.83 in Group B (P = 0.6, t-test). Extramacular epiretinal cellular proliferation occurred in 3 eyes (9%) in Group A in the first month after retinectomy and in 3 eyes (5.8%) in Group B (P = 0.27, Fisher exact test). These epiretinal membranes, extending to the edge of the retinotomy, were stable during the follow-up period. No case of macular pucker was observed in Group A, but macular pucker was observed in 9 eyes (17.6%) in Group B at the final examination (P = 0.008, Fisher exact test).
CONCLUSION: Primary peeling of the ILM allowed complete removal of all the epiretinal membranes and successfully prevented the development of macular pucker. Retinectomy and silicone oil tamponade proved an effective treatment modality for eyes with retinal detachment due to proliferative vitreoretinopathy.