Functional and structural outcomes of ILM peeling in uncomplicated macula-off RRD using microperimetry & en-face OCT

Abstract

Purpose: To investigate functional and structural outcomes of internal limiting membrane (ILM) peeling during primary vitrectomy for uncomplicated macula-off rhegmatogenous retinal detachment (RRD).

Methods: In this prospective interventional randomized comparative study, 43 eyes (43 patients) were randomly divided into group A (20), and group B (23), with and without ILM peeling respectively. Patients were evaluated clinically, and by spectral-domain optical coherence tomography (SD-OCT) and microperimetry (MP) following silicone oil removal. Main outcome measures were functional-MP (mean and foveal retinal sensitivity; MRS, FRS) and best-corrected visual acuity (BCVA)-and anatomical-en-face image analysis (retinal dimples), and SD-OCT changes [epiretinal membrane (ERM), subretinal fluid (SRF), ellipsoid zone disruption, central subfoveal thickness (CSFT), and foveal contour].

Results: All eyes achieved complete postoperative attachment with mean BCVA 1.0 ± 0.4 logMAR (6/60) in group A, and 0.4 ± 0.4 logMAR (6/15) in group B (p < 0.001). MRS and FRS were significantly higher in group B (p = 0.037 and 0.036 respectively). En-face OCT showed retinal dimples in all patients in group A (29.17 ± 7.67 dimples), compared to none in group B (p = 0.007). ERM did not develop in any eye in group A, while it developed in 17.4% of eyes in group B (p = 0.05).

Conclusion: Although ILM peeling prevented ERM, it resulted in poorer visual outcome in these uncomplicated RRD cases, and might be better reserved only for complicated cases.

Keywords: En-face OCT; Epiretinal membrane; Internal limiting membrane; Microperimetery; Primary vitrectomy; Uncomplicated rhegmatogenous RD.