Pros and cons of internal limiting membrane peeling during epiretinal membrane surgery: a randomised clinical trial...

Area of Science:

• Ophthalmology
• Retinal Surgery
• Visual Neuroscience

Background:

• The necessity of internal limiting membrane (ILM) peeling during idiopathic epiretinal membrane (iERM) removal remains debated.
• Assessing the impact of active ILM peeling on visual function and retinal integrity is crucial.

Purpose of the Study:

• To evaluate whether active ILM peeling following iERM removal induces microscotomas.
• To compare visual acuity and retinal sensitivity between active ILM peeling and no ILM peeling groups.

Main Methods:

• The PEELING study, a national randomized clinical trial, compared active ILM peeling versus no ILM peeling in patients without spontaneous ILM peeling.
• Microperimetry, best-corrected visual acuity (BCVA), and optical coherence tomography were assessed at 1, 6, and 12 months post-surgery.
• The primary outcome was the change in microscotoma number from baseline to 6 months.

Main Results:

• Active ILM peeling led to a significant increase in microscotomas at 1 month post-surgery compared to no ILM peeling.
• No significant difference in microscotoma number was observed at 6 months.
• Epiretinal membrane recurrence occurred in 19.6% of the no ILM peeling group versus 0% in the ILM peeling group, but the latter group showed delayed visual recovery and potential retinal impairments.

Conclusions:

• Spontaneous ILM peeling is frequent and may obviate the need for active peeling.
• Active ILM peeling effectively prevents ERM recurrence but may induce temporary visual deficits and retinal alterations.
• The decision for active ILM peeling should consider the trade-off between recurrence prevention and potential visual recovery delays.