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Internal Limiting Membrane Peeling for Grade C Proliferative Vitreoretinopathy: An International Multicenter Study
Taku Wakabayashi1, Annika G Samuelson2, Yusuke Oshima3
1Wills Eye Hospital, Mid Atlantic Retina, Department of Ophthalmology, Thomas Jefferson University, Philadelphia, Pennsylvania; Wakabayashi Eye Clinic, Nonoichi, Ishikawa, Japan; Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; Department of Ophthalmology, Kanazawa University, Kanazawa, Ishikawa, Japan.
Internal limiting membrane (ILM) peeling during pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) significantly improves anatomic success and visual outcomes. This technique, especially extended ILM peeling, reduces the need for further surgeries.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Vitreoretinal Interface
Background:
- Rhegmatogenous retinal detachment (RRD) with grade C proliferative vitreoretinopathy (PVR) presents significant surgical challenges.
- Pars plana vitrectomy (PPV) is a standard treatment, but outcomes can be limited by PVR complications.
Purpose of the Study:
- To evaluate the efficacy of internal limiting membrane (ILM) peeling in improving anatomic and visual outcomes for RRD with grade C PVR undergoing PPV.
Main Methods:
- A multicenter, interventional cohort study compared outcomes of PPV with and without ILM peeling in 370 eyes with grade C PVR.
- Follow-up averaged 23.2 months, assessing single surgery anatomic success at 3 and 6 months, visual acuity, and need for subsequent surgeries.
Main Results:
- ILM peeling was associated with significantly higher single surgery anatomic success at 3 months (86.6% vs. 73.2%) and 6 months (75.2% vs. 65.3%).
- Retinal reattachment without tamponade was higher (68.8% vs. 51.6%), and visual acuity and improvement were significantly better with ILM peeling.
- Extended ILM peeling correlated with better reattachment rates and final visual acuity.
Conclusions:
- Internal limiting membrane peeling, particularly extended ILM peeling, offers superior anatomic and visual outcomes for RRD with grade C PVR compared to PPV without ILM peeling.
- The procedure reduces the rate of subsequent vitreoretinal surgeries, including epiretinal membrane surgery.
