Primary ILM peeling during retinal detachment repair: a systematic review and meta-analysis

Abstract

Epiretinal membrane (ERM) formation is a known postoperative complication following retinal detachment (RD) repair surgery. Prophylactic peeling of the internal limiting membrane (ILM) during surgery has been shown to reduce the risk of developing postoperative ERM formation. Some baseline characteristics and degrees of surgical complexity may act as risk factors for ERM development. In this review we aimed to investigate the benefit of ILM peeling in patients without significant proliferative vitreoretinopathy (PVR) who underwent pars plana vitrectomy for RD repair. A literature search using PubMed and various keywords retrieved relevant papers from which data were extracted and analyzed. Finally, the results of 12 observational studies (3420 eyes) were summarized. ILM peeling significantly reduced the risk of postoperative ERM formation (RR = 0.12, 95% CI 0.05-0.28). The groups did not differ in final visual acuity (SMD 0.14 logMAR (95% CI - 0.03-0.31)). The risk of RD recurrence (RR = 0.51, 95% CI 0.28-0.94) and the need for secondary ERM surgery (RR = 0.05, 95% CI 0.02-0.17) were also higher in the non-ILM peeling groups. In summary, although prophylactic ILM peeling appears to reduce the rate of postoperative ERM, this benefit does not translate into consistent visual recovery across studies and potential complications must be considered.

Figure 1

PRISMA flow diagram for study selection.

Figure 2

A forest plot showing the rate of epiretinal membrane formation following primary RD repair with and without prophylactic ILM peeling.

Figure 3

Forest plot showing the standardized mean difference (SMD) and 95% confidence intervals (CI) for BCVA change.

Figure 4

Forest plot showing the risk ratio (RR) and 95% confidence intervals (CI) comparing the rate of RD recurrence between groups.

Figure 5

Forest plot showing the rate of secondary ERM surgery in the ILM-peeling and non-ILM peeling groups.