P Grimbert1, O Lebreton2, M Weber2. 1. Service d'ophtalmologie, centre hospitalier du Mans, 194, avenue Rubillard, 72000 Le Mans, France. Electronic address: pierregrimbert@hotmail.fr. 2. Service d'ophtalmologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
Abstract
INTRODUCTION: To evaluate the anatomical and functional consequences of internal limiting membrane (ILM) peeling in epiretinal membrane (ERM) surgery. METHODS: Retrospective single-center study including consecutive patients operated on for idiopathic ERM. The integrity of the ILM was assessed by ILM Blue® staining after removal of the ERM: either the peeling was spontaneous (group 1) or a complementary peeling was required (group 2). Pre- and post-operatively (1 and 6 months), all patients were analyzed using visual acuity, SD-OCT (Spectralis HRA OCT, Heidelberg, Germany) and microperimetry (OPKO/OTI, Miami, USA). RESULTS: Twenty-one eyes of 21 patients were included: 12 "active ILM peelings" and 9 "spontaneous peelings". In both groups, visual acuity increased significantly after surgery. Microperimetry revealed more microscotomata at 1 and 6 months for active peeling (P<0.05). Their location corresponded more often to the site where the ERM or ILM was grasped, based on surgical videos (P<0.05), and with the appearance of inner retinal defects using en face OCT. DISCUSSION: ILM peeling is frequently performed to reduce ERM recurrence. Despite lack of effect on visual acuity, active ILM peeling increases the incidence of microscotomas related to the site where the ERM or ILM is grasped. CONCLUSION: Active ILM peeling may be responsible for postoperative visual discomfort related to microscopic trauma during peeling.
INTRODUCTION: To evaluate the anatomical and functional consequences of internal limiting membrane (ILM) peeling in epiretinal membrane (ERM) surgery. METHODS: Retrospective single-center study including consecutive patients operated on for idiopathic ERM. The integrity of the ILM was assessed by ILM Blue® staining after removal of the ERM: either the peeling was spontaneous (group 1) or a complementary peeling was required (group 2). Pre- and post-operatively (1 and 6 months), all patients were analyzed using visual acuity, SD-OCT (Spectralis HRA OCT, Heidelberg, Germany) and microperimetry (OPKO/OTI, Miami, USA). RESULTS: Twenty-one eyes of 21 patients were included: 12 "active ILM peelings" and 9 "spontaneous peelings". In both groups, visual acuity increased significantly after surgery. Microperimetry revealed more microscotomata at 1 and 6 months for active peeling (P<0.05). Their location corresponded more often to the site where the ERM or ILM was grasped, based on surgical videos (P<0.05), and with the appearance of inner retinal defects using en face OCT. DISCUSSION: ILM peeling is frequently performed to reduce ERM recurrence. Despite lack of effect on visual acuity, active ILM peeling increases the incidence of microscotomas related to the site where the ERM or ILM is grasped. CONCLUSION: Active ILM peeling may be responsible for postoperative visual discomfort related to microscopic trauma during peeling.
Keywords:
En face OCT; Epiretinal membrane; Internal limiting membrane; Membrane limitante interne; Membranes épimaculaires; Microperimetry; Micropérimétrie; Microscotomas; Microscotomes; OCT en face