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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.
Purpose:
To evaluate the efficacy of internal limiting membrane (ILM) peeling on the anatomic and visual outcomes of pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) with grade C proliferative vitreoretinopathy (PVR).
Design:
Multicenter, interventional, clinical cohort study.
Subjects:
Consecutive patients who underwent PPV for grade C PVR with a minimum of 6-month follow-up.
Methods:
We compared the anatomic and visual outcomes of grade C PVR surgery after vitrectomy with PVR membrane peeling plus, or without, ILM peeling, in patients treated at 6 institutions between January 2015 and January 2022. Internal limiting membrane peeling was performed within the macula, arcade to arcade, or beyond the arcades (extended ILM peeling).
Main Outcome Measures:
Single surgery anatomic success at 3 months and 6 months with versus without ILM peeling.
Results:
We included a total of 370 eyes (370 patients); 157 eyes (42.4%) treated with ILM peeling were compared with 213 eyes (57.6%) treated without ILM peeling. Mean follow-up was 23.2 ± 13.9 months. No differences were noted in baseline characteristics or surgical techniques. Single surgery anatomic success was significantly higher in the ILM peeling group (86.6% vs. 73.2% at 3 months [P = 0.002] and 75.2% vs. 65.3% at 6 months [P = 0.041], respectively). The retinal reattachment rate under fluid without tamponade was significantly higher in the ILM peeling group at 6 months (68.8% vs. 51.6%, P < 0.001). Both groups showed visual improvement after surgery (both P < 0.001). However, the ILM peeling group showed significantly better visual acuity and visual improvement (1.11 ± 0.70 vs. 1.29 ± 0.80 [P = 0.020] and 0.48 ± 0.77 vs. 0.24 ± 0.90 [P = 0.018], respectively). The ILM peeling group had significantly fewer subsequent vitreoretinal surgeries (P = 0.002), including subsequent epiretinal membrane surgeries (8.9% vs. 17.8%, P = 0.015). No ILM peeling was associated with more posterior breaks when the retina redetached (P = 0.045). Multivariable regression analysis showed that extended ILM peeling was significantly associated with higher likelihood of retinal reattachment without tamponade (under fluid) at 6 months and better final visual acuity (P = 0.040 and 0.031, respectively).
Conclusions:
Internal limiting membrane peeling, particularly extended ILM peeling, for RRD with grade C PVR resulted in superior anatomic and visual outcomes compared with vitrectomy without ILM peeling in this study.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
