scholarly journals Isolated Central Epiretinal Membrane: A Rare Complication of Fovea-Sparing Internal Limiting Membrane Peeling Technique

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Yen-Chih Chen ◽  
San-Ni Chen
Keyword(s):  
Epiretinal Membrane ◽  
High Myopia ◽  
Visual Loss ◽  
Rare Complication ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Tractional Retinal Detachment ◽  
Internal Limiting Membrane Peeling ◽  
Gradual Development ◽  
Anatomic Change

Purpose. To report a rare complication presenting as an isolated central epiretinal membrane (ERM) related to fovea-sparing internal limiting membrane (ILM) peeling technique. Methods. Five patients who received fovea-sparing ILM peeling were enrolled. Postoperatively, an isolated central ERM developed. Optical coherence tomography (OCT) was used to evaluate the serial anatomic change. Results. Among the five included patients, one patient had high myopia with foveoschisis, two patients had vitreomacular traction, and two patients had proliferative diabetic retinopathy with tractional retinal detachment and a fovea cyst. With an average of 5.80 months, OCT showed the gradual development of the isolated central ERM with severe fovea distortion. Four patients received secondary revision surgery, with improvement of the fovea contour and visual acuity. Conclusion. The fovea-sparing ILM peeling technique may cause a rare but serious complication as the isolated central ERM, which would cause significant fovea distortion as well as visual deterioration. Timely detection and intervention is recommended to prevent further visual loss. This trial is registered with NCT04445142.

scholarly journals Comparison of Individual Retinal Layer Thicknesses after Epiretinal Membrane Surgery with or without Internal Limiting Membrane Peeling

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Chul Hee Lee ◽  
Min Woo Lee ◽  
Eun Young Choi ◽  
Suk Ho Byeon ◽  
Sung Soo Kim ◽  
...  
Keyword(s):  
Epiretinal Membrane ◽  
Plexiform Layer ◽  
Internal Limiting Membrane ◽  
Retinal Layer ◽  
Inner Plexiform Layer ◽  
Ilm Peeling ◽  
Fiber Layer ◽  
Internal Limiting Membrane Peeling ◽  
Department Of Ophthalmology ◽  
Layer Segmentation

Purpose. To compare changes in the retinal layer thickness and visual outcomes in patients undergoing epiretinal membrane (ERM) surgery with or without internal limiting membrane (ILM) peeling. Methods. Seventy-six eyes of 76 patients who underwent ERM surgery from January 2013 to March 2015 at the Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea, were analyzed. While ERM removal with ILM peeling was performed in ILM peeling (P) group (n=39), ILM peeling was not performed in non-ILM peeling (NP) group (n=37). Retinal layer segmentation was performed using optical coherence tomography images. Individual retinal layer thicknesses before and at 6 months after ERM surgery were compared. The postoperative best-corrected visual acuity (BCVA) was also compared. Results. In the P group, the thicknesses of retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) were significantly reduced. In the NP group, significant decreases in the RNFL, GCL, IPL, inner nuclear layer, and outer plexiform layer were observed. The P group manifested a greater mean postoperative GCL (35.56 ± 1.53 µm vs 29.86 ± 2.16 µm; p=0.033) and less loss of GCL (−10.26 ± 1.91 µm vs −19.86 ± 2.74 µm; p=0.004) compared to the NP group. No statistically significant differences were observed when comparing the changes in BCVA. Conclusions. This study demonstrates that ILM peeling for ERM surgery may result in better preservation of GCL compared to no ILM peeling.

scholarly journals ILM removal in vitreomacular interface disorders: for or against?

2021 ◽  
pp. 83-88
Author(s):  
S.V. Kolesnik ◽  
◽  
A.I. Kolesnik ◽  
A.V. Miridonova ◽  
F.A. Avakyan ◽  
...  
Keyword(s):  
Macular Hole ◽  
Epiretinal Membrane ◽  
Functional Outcomes ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Review Literature ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
Vitreomacular Interface

Purpose. To provide data on efficacy and safety of internal limiting membrane (ILM) removal in various pathologies of the vitreomacular interface. Material and methods. To perform the review, literature sources were searched through the PubMed and Scopus databases up to year 2021 using the keywords "internal limiting membrane peeling", "macular hole", "epiretinal membrane". A total of 38 articles relevant to the topic of the review were selected. Results. Numerous studies have confirmed the efficacy of internal limiting peeling in improving anatomical and functional outcomes of treatment of various pathologies. However, even a flawlessly performed peeling can cause both anatomical and functional effects on the retina. Various studies have demonstrated that the anatomical complications of ILM peeling did not correlate with the functional outcomes of surgery. Conclusion. Available evidence supports ILM peeling as an intervention that improves anatomical and functional results of treatment and reduces rate of reoperation. However, in order to evaluate the safety of this procedure, further studies with an assessment of the visual function with a long follow-up period are required. Key words: internal limiting membrane, peeling, macular hole, epiretinal membrane

scholarly journals Does internal limiting membrane peeling during epiretinal membrane surgery induce microscotomas on microperimetry? Study protocol for PEELING, a randomized controlled clinical trial

2020 ◽  
Author(s):  
Jean-Baptiste Ducloyer ◽  
Juliette Ivan ◽  
Alexandra Poinas ◽  
Olivier Lebreton ◽  
Alexandre Bonissent ◽  
...  
Keyword(s):  
Epiretinal Membrane ◽  
Internal Limiting Membrane ◽  
Controlled Clinical Trial ◽  
Surgical Removal ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Randomized Controlled ◽  
Age Related ◽  
The Difference

Abstract Background The epiretinal membrane (ERM) is a degenerative condition associated with age, which can cause loss of vision and/or metamorphopsia. The treatment of symptomatic ERM involves surgical removal including a vitrectomy followed by peeling of the ERM using a microforceps. As the internal limiting membrane (ILM) is adherent to the ERM, it is sometimes removed with it (spontaneous peeling). If ILM remains in place, it can be removed to reduce ERM recurrence. However, it is important to clarify the safety of ILM peeling while it increases surgical risks and cause histological disorganization of the retina that can lead to microscotomas maybe responsible for definitive visual discomfort.Methods PEELING is a prospective, randomized, controlled, single-blind and multi-centered trial with two parallel arms. This study investigates the benefit/risk ratio of active ILM peeling among subjects undergoing ERM surgery without spontaneous ILM peeling. Randomization is done in the operating room after ERM removal if ILM remains in place. After randomization, the two groups “active peeling of the ILM” and “no peeling of the ILM” are compared during a total of three follow-up visits scheduled at M1, M6 and M12. Primary endpoint is the difference in microscotomas before surgery and 6 months after surgery. Patients with spontaneous peeling are not randomized and are included in the ancillary study with the same follow-up visits and the same examinations as the principal study. Relevant inclusion criteria involve subjects over 18 years living with idiopathic symptomatic ERM, including pseudophakic patients with transparent posterior capsule or open capsule or lensed patients with age-related cataracts. The calculated sample size corresponds to 53 randomized eyes (1eye/patient) per arm that means 106 randomized eyes (106 randomized patients) in total and a maximum of 222 included patients (116 spontaneous peeling).Discussion ILM peeling is often practiced in ERM surgery to reduce ERM recurrence. It does not impair post-operative visual acuity but it increases the surgical risks and causes anatomical damages. If active ILM peeling is significantly associated with more microscotomas, it may contraindicate the ILM peeling during primitive idiopathic ERM surgery.Trial Registration ClinicalTrials.gov NCT02146144. Registered May 22, 2014. Recruitment is still ongoing

scholarly journals Effect of Internal Limiting Membrane Peeling on Macular Structure and Metamorphopsia Scores in Idiopathic Epiretinal Membrane Surgery

2020 ◽  
Vol 14 (1) ◽  
pp. 1-8
Author(s):  
Tekin Aydin ◽  
Suleyman Gokhan Kerci ◽  
Omer Karti ◽  
Mehmet Ozgur Zengin ◽  
Tuncay Kusbeci
Keyword(s):  
Prospective Study ◽  
Epiretinal Membrane ◽  
Surgical Procedure ◽  
Pars Plana Vitrectomy ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Macular Function ◽  
Internal Limiting Membrane Peeling ◽  
Significant Difference ◽  
Pars Plana

Backgrounds and Objective: Pars Plana Vitrectomy (PPV) and epiretinal membrane (ERM) peeling is the standard surgical procedure of ERM surgery. However, the effect of adding Internal Limiting Membrane (ILM) peeling to the standard surgery on macular function and structure remains still controversial. This study was aimed at investigating the effect of ILM peeling on the macular function and structure in idiopathic ERM surgery. Method: Thirty-six eyes of 34 patients were evaluated in this prospective study. The patients were divided into two groups (ILM peeling and non-ILM peeling group). While the removal of ERM was undergone alone in 19 eyes, it was combined with ILM peeling in 17 eyes. Metamorphopsia scores Vertical Metamorphopsia (VM) and Horizontal Metamorphopsia (HM), were measured at preoperative and 4 months postoperatively. Results: There was a statistically significant decrease in metamorphopsia (VM and HM) scores in both groups after the surgery. However, no statistically significant difference was found between the two groups in terms of reduction in VM scores and HM scores after surgery. Conclusion: Our study indicated that ILM peeling combined with ERM did not affect metamorphopsia scores.

scholarly journals INTRAOPERATIVE BREAKAGE OF A REUSED 25 GAUGE ILM PEELING FÓRCEPS

2021 ◽  
Vol 4 (2) ◽  
pp. 178
Author(s):  
Madhurima Roy ◽  
Sangeeta Roy ◽  
Aniruddha Maiti ◽  
Nishita Yadav
Keyword(s):  
Epiretinal Membrane ◽  
Pars Plana Vitrectomy ◽  
Internal Limiting Membrane ◽  
Central Macular Thickness ◽  
Fundus Examination ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
First Case ◽  
Pars Plana ◽  
Successful Removal

A 59 years male presented with painless diminution of vision in right eye for 4 months. His vision was 20/100 in right eye and 20/30 in left eye. Fundus examination revealed epiretinal membrane  in right eye with central macular thickness of 747 μm for which he underwent 25 guage pars plana vitrectomy. Intraoperatively after internal limiting membrane peeling, during removal of the pieces of the membrane from the forceps with the endoilluminator pipe, accidentally one blade from the tip of ILM peeling forceps broke. In this report, we describe first case of inadvertent intraoperative fracture of 25- gauge Grieshaber DSP End-Grasping ILM forceps in a case of ERM who underwent vitrectomy and removal of ERM with successful removal of fractured tip of ILM forceps.

scholarly journals Efficacy of fovea-sparing internal limiting membrane peeling for epiretinal membrane foveoschisis

2021 ◽  
Author(s):  
Reio Sekine ◽  
Jiro Kogo ◽  
Tatsuya Jujo ◽  
Keiji Sato ◽  
Ibuki Arizono ◽  
...  
Keyword(s):  
Macular Edema ◽  
Epiretinal Membrane ◽  
Visual Outcome ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Shape Preserving ◽  
Internal Limiting Membrane Peeling ◽  
Full Thickness Macular Hole ◽  
Good Visual Outcome

Purpose: To investigate the outcomes of vitrectomy with fovea-sparing internal limiting membrane (ILM) peeling (FSIP) for epiretinal membrane foveoschisis based on new optical coherence tomography definitions. Methods: 27 eyes of 28 patients (67.2 ± 10.5 years old) who underwent vitrectomy with FSIP without gas tamponade for epiretinal membrane foveoschisis were included. All patients underwent follow-up examinations for at least 12 months. In the FSIP technique, the ILM is peeled off in a donut shape, preserving the foveal ILM. The logarithm of the minimal angle of resolution best-corrected visual acuity (logMAR BCVA), central macular thickness (CMT), and surgical complications were examined. Results: The BCVA at 12 months improved significantly from baseline (p < 0.001). Baseline ellipsoid zone defects were found in 3 eyes (10%), and all defective eyes had recovered at 12 months. CMT decreased significantly from baseline (p < 0.001). Acute macular edema, full-thickness macular hole, and recurrence of epiretinal membrane were not observed during follow-up. Conclusion: FSIP achieved good visual outcome and retinal morphological change. Moreover, FSIP might avoid acute macular edema in epiretinal membrane foveoschisis surgery.

Method of surgical treatment of small and medium diameter macular holes with the foveal-sparing internal limiting membrane peeling

2021 ◽  
pp. 213-216
Author(s):  
A.A. Shpak ◽  
◽  
A.I. Kolesnik ◽  
F.A. Avakyan ◽  
V.A. Pismenskaya ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Developed Countries ◽  
Clear Understanding ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Air Tamponade ◽  
Medium Diameter

Introduction and purpose. Idiopathic macular hole (IMH) is an urgent medical and social problem of the population of developed countries. It is known that microinvasive 3-port vitrectomy with gas-air tamponade is a generally accepted method of surgical treatment of IMH. There is still no clear understanding of the reasons for incomplete functional success in this category of patients, despite the anatomical success.Thus, there is a need to develop and implement in clinical practice a modification of the ILM peeling technique for the treatment of small and medium-diameter of IMH, which would not be inferior in anatomical effectiveness to existing methods and would be accompanied by a less damaging effect on the structures of the retina. Material and methods. The study included 10 patients with a diagnosis of IMH, who underwent a 3-port microinvasive 25G vitrectomy with the preservation of foveal ILM. Results. The analysis of the clinical and functional results of surgical treatment of IMH with the foveal fragment left revealed the complete closure of the macular tear, the absence of gross defects of the ellipsoid zone, an increase in the values of the average visual acuity and microperimetry from the 1st month of dynamic observation. Conclusion. The proposed low-traumatic method of fovea - sparing ILM peeling provides stable anatomical and functional result, the restoration of both morphological and functional parameters, and minimizes the mechanical impact on the retina in the fovea. Key words: macular rupture, internal limiting membrane, fovea-sparing ILM peeling.

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