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概要

A Critical Analysis of Non-Complicated Macula-Off Rhegmatogenous Retinal Detachment with and Without Internal Limiting Membrane Peeling

Miguel A. Quiroz-Reyes, Erick A. Quiroz-Gonzalez, Jorge Morales-Navarro, Felipe Esparza-Correa, Jorge E.Aceves-Velazquez, Jennifer H Kim-Lee, Alejandra Nieto-Jordan, Margarita Montano, Virgilio Lima-Gomez, Federico Graue-Wiechers

Background: There is abundant and even confusing information in the available literature concerning the role of Internal Limiting Membrane (ILM) removal in macular conditions secondary to non-complicated macula-off Rhegmatogenous Retinal Detachment (RRD) repair. This retrospective, multicenter, long-term study aimed to analyze the incidence of Epiretinal Membrane (ERM) proliferation and other surgical complications and to compare the postoperative microstructural and multimodal imaging findings and correlate them with the final postoperative Best-Corrected Visual Acuity (BCVA) in selected eyes.

Methods: This long-term retrospective study included 230 eyes divided into three groups according to the surgical management performed for uncomplicated macula-off RRD: 125 eyes in the buckle group underwent scleral buckle techniques; 55 eyes in the non-peeling group underwent primary vitrectomy with no ILM peeling; 50 eyes in the peeling group with primary preoperative or secondary postoperative presence of significant ERM proliferations underwent the ERM-ILM en-bloc complex removal or double-staining removal techniques.

Results: The postoperative incidence of ERM was 23.2% (29 eyes) in the buckle group, 23.6% (13 eyes) in the non-peeling group, and 2.0% (one eye) in the peeling group (p<0.05; Student’s t-test). The mean postoperative BCVA difference among the buckle group, peeling group, and non-peeling group was significant (logarithm of the minimum angle of resolution, 0.40 ± 0.33 vs. 0.47 ± 0.16 vs. 0.28 ± 0.19, respectively). Postoperative multimodal imaging tests yielded abnormal retinal thickness in the three groups, with a diffuse optic nerve fibre layer and ellipsoid band disruptions predominantly in the peeling group, and a normal foveal profile in the buckle and non-peeling groups.

Conclusion: Multiple structural alterations in spectral-domain optical coherence tomography biomarkers and a significant reduction in retinal sensitivity were observed in the peeling group. Eyes that developed secondary ERM proliferations in the buckle group and in the non-peeling group showed statistically significant upgrading in BCVA once the ERM proliferation and ILM were removed. Ultimately, our study contributes findings pertaining to severe consequences in macular structure and function. We can conclusively state that ILM removal with the main objective of avoiding macular ERM proliferation is not justified because of the high rate of potential macular complications and poor visual results.