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Pars Plana Vitrectomy with or without Internal Limiting Membrane Peel for Epiretinal Membrane: A Systematic Review
Andrew Mihalache1, Ryan S Huang2, Haleema Ahmed3
1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada, andrewmihalache02@gmail.com.
Background:
The safety and effectiveness of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling remains poorly understood for the treatment of epiretinal membrane (ERM).
Objectives:
Our study aims to compare the safety and effectiveness of PPV with and without ILM peeling for ERM.
Methods:
A systematic literature search was conducted on Ovid MEDLINE, Embase, Cochrane Library, and Google Scholar from January 2000 to January 2023 for comparative studies reporting visual and anatomical outcomes for patients with ERM that received PPV with or without ILM peeling. Primary outcomes included best-corrected visual acuity (BCVA) at last study observation and change in BCVA from baseline. Secondary outcomes included retinal thickness (RT) at last study observation, change in RT from baseline, risk of ERM recurrence, and adverse events. A random-effects meta-analysis was performed. Risk of bias of randomized controlled trials was assessed using the Risk of Bias 2 tool of observational studies using the Risk of Bias in Non-randomized Studies of Interventions-I tool. The certainty of evidence of outcomes was evaluated using Grading of Recommendations, Assessment, Development and Evaluation criteria.
Results:
Nineteen studies reporting on 1,291 eyes at baseline were included. PPV with and without ILM peel achieved a similar BCVA at last study observation (p = 0.68) and change in BCVA from baseline (p = 0.79). These findings remained consistent irrespective of whether simultaneous phacoemulsification was performed. PPV with ILM peel achieved a significantly lower incidence of ERM recurrence (risk ratio [RR] = 0.26, 95% CI = [0.13, 0.51], p < 0.0001) and additional surgery (RR = 0.17, 95% CI = [0.04, 0.74], p = 0.02) compared to PPV without ILM peel.
Conclusion:
PPV with and without ILM peel achieved a similar BCVA at last study observation in ERM patients. Patients treated with PPV and ILM peel also had a reduced risk of ERM recurrence and lower reoperation risk. These conclusions are associated with a moderate certainty of evidence and potential for bias from multiple non-randomized studies.
Insights
Pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for epiretinal membrane (ERM) offers similar visual acuity to PPV without ILM peeling. However, ILM peeling significantly reduces the risk of ERM recurrence and the need for further surgery.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Surgical Outcomes
Background:
- The efficacy and safety of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for epiretinal membrane (ERM) treatment require further elucidation.
- Existing literature provides limited comparative data on visual and anatomical outcomes between PPV with and without ILM peeling for ERM.
Conclusions:
- Both PPV with and without ILM peeling yield comparable BCVA outcomes for ERM patients.
- ILM peeling during PPV for ERM is associated with a reduced risk of recurrence and reoperation, despite a moderate certainty of evidence.
- The findings suggest ILM peeling is beneficial for reducing recurrence and reoperation rates in ERM surgery.
