PURPOSE: To investigate functional and structural outcomes of internal limiting membrane (ILM) peeling during primary vitrectomy for uncomplicated macula-off rhegmatogenous retinal detachment (RRD). METHODS: In this prospective interventional randomized comparative study, 43 eyes (43 patients) were randomly divided into group A (20), and group B (23), with and without ILM peeling respectively. Patients were evaluated clinically, and by spectral-domain optical coherence tomography (SD-OCT) and microperimetry (MP) following silicone oil removal. Main outcome measures were functional-MP (mean and foveal retinal sensitivity; MRS, FRS) and best-corrected visual acuity (BCVA)-and anatomical-en-face image analysis (retinal dimples), and SD-OCT changes [epiretinal membrane (ERM), subretinal fluid (SRF), ellipsoid zone disruption, central subfoveal thickness (CSFT), and foveal contour]. RESULTS: All eyes achieved complete postoperative attachment with mean BCVA 1.0 ± 0.4 logMAR (6/60) in group A, and 0.4 ± 0.4 logMAR (6/15) in group B (p < 0.001). MRS and FRS were significantly higher in group B (p = 0.037 and 0.036 respectively). En-face OCT showed retinal dimples in all patients in group A (29.17 ± 7.67 dimples), compared to none in group B (p = 0.007). ERM did not develop in any eye in group A, while it developed in 17.4% of eyes in group B (p = 0.05). CONCLUSION: Although ILM peeling prevented ERM, it resulted in poorer visual outcome in these uncomplicated RRD cases, and might be better reserved only for complicated cases.
RCT Entities:
PURPOSE: To investigate functional and structural outcomes of internal limiting membrane (ILM) peeling during primary vitrectomy for uncomplicated macula-off rhegmatogenous retinal detachment (RRD). METHODS: In this prospective interventional randomized comparative study, 43 eyes (43 patients) were randomly divided into group A (20), and group B (23), with and without ILM peeling respectively. Patients were evaluated clinically, and by spectral-domain optical coherence tomography (SD-OCT) and microperimetry (MP) following silicone oil removal. Main outcome measures were functional-MP (mean and foveal retinal sensitivity; MRS, FRS) and best-corrected visual acuity (BCVA)-and anatomical-en-face image analysis (retinal dimples), and SD-OCT changes [epiretinal membrane (ERM), subretinal fluid (SRF), ellipsoid zone disruption, central subfoveal thickness (CSFT), and foveal contour]. RESULTS: All eyes achieved complete postoperative attachment with mean BCVA 1.0 ± 0.4 logMAR (6/60) in group A, and 0.4 ± 0.4 logMAR (6/15) in group B (p < 0.001). MRS and FRS were significantly higher in group B (p = 0.037 and 0.036 respectively). En-face OCT showed retinal dimples in all patients in group A (29.17 ± 7.67 dimples), compared to none in group B (p = 0.007). ERM did not develop in any eye in group A, while it developed in 17.4% of eyes in group B (p = 0.05). CONCLUSION: Although ILM peeling prevented ERM, it resulted in poorer visual outcome in these uncomplicated RRD cases, and might be better reserved only for complicated cases.
Authors: Arghavan Almony; Eric Nudleman; Gaurav K Shah; Kevin J Blinder; Dean B Eliott; Robert A Mittra; Asheesh Tewari Journal: Retina Date: 2012-05 Impact factor: 4.256
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Authors: Francesco Pichi; Andrea Lembo; Mariachiara Morara; Chiara Veronese; Micol Alkabes; Paolo Nucci; Antonio P Ciardella Journal: Int Ophthalmol Date: 2013-07-18 Impact factor: 2.031