Outcome of pars plana vitrectomy with and without internal limiting membrane peeling in proliferative diabetic...

To compare the functional and anatomical outcomes of pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling in patients suffering with non-resolving vitreous hemorrhage and tractional retinal detachment.

Fifty-seven patients (57 eyes) suffering from PDR were randomly assigned to undergo PPV with ILM peeling (n = 26) or without ILM peeling (n = 31). Outcomes assessed over a 6-month follow-up included best-corrected visual acuity (BCVA), need for additional anti-VEGF injections, frequency of reoperations, central macular thickness (CMT), development of epiretinal membrane (ERM), macular traction, and vascular parameters derived from OCT imaging.

Both groups showed statistically significant improvements in BCVA postoperatively (p < 0.001), with no significant difference between them (p = 0.846). The ILM peeling group required fewer repeat anti-VEGF injections (7.7% vs. 35.5%, p = 0.030) and exhibited a significantly lower incidence of secondary ERM (11.5% vs. 51.6%, p = 0.004). ERM formation correlated with iatrogenic retinal tears (p = 0.007) and tractional retinal detachment (TRD) (p < 0.001). Reoperations for ERM removal occurred exclusively in the non-ILM peeling group. No significant intergroup differences were found in CMT, foveal avascular zone (FAZ) area, or vessel density.

ILM peeling during diabetic vitrectomy effectively minimizes the risk of postoperative ERM formation and reduces the need for further Anti-VEGF injections for DME. However, it does not confer a significant advantage in terms of visual acuity improvements.