Ophthalmology. Retina · 2025
Internal Limiting Membrane Peeling for Grade C Proliferative Vitreoretinopathy: An International Multicenter Study.
Clinical StudyСтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Wakabayashi Taku, Samuelson Annika G, Oshima Yusuke, Swaminathan Vishal, Shiraki Akihiko, Momenaei Bita, Sehgal Anahita, Imamura Satoshi, Ishida Yuichiro, Baba Keita, Xu David, Shiraki Nobuhiko, Fukuyama Hisashi, Tsuboi Kotaro, Torjani Ava, Abishek Robert M, Cohen Michael N, Kuriyan Ajay E, Park Carl H, Spirn Marc J, Garg Sunir J, Klufas Michael A, Gomi Fumi, Starr Matthew R, Kamei Motohiro, Yonekawa Yoshihiro
Аннотация
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.
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.