The Effect of Internal Limiting Membrane Peeling in Epiretinal Membrane Including Pseudolamellar Macular Hole

Yeop Oh Shin; Jung Lee Soo; Min Park Jung

doi:10.3341/jkos.2013.54.7.1038

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Shin, Soo, and Jung: The Effect of Internal Limiting Membrane Peeling in Epiretinal Membrane Including Pseudolamellar Macular Hole

Original Article

J Korean Ophthalmol Soc 2013;54(7):1038-1045.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.7.1038

The Effect of Internal Limiting Membrane Peeling in Epiretinal Membrane Including Pseudolamellar Macular Hole

Yeop Oh Shin, MD¹, Jung Lee Soo, MD, PhD², Min Park Jung, MD, PhD¹

¹Department of Ophthalmology, Maryknoll Hospital¹, Busan, Korea

²Department of Ophthalmology, Haeundae Paek Hospital, Inje University College of Medicine², Busan, Korea

Address reprint requests to Jung Min Park, MD, PhD Department of Ophthalmology, Maryknoll Hospital, #121 Junggu-ro, Jung-gu, Busan 600-730, Korea Tel: 82-51-461-2469, Fax: 82-51-462-3534 E-mail: pjm1438@hanmail.net

* This study was presented as a poster at the 108th Annual Meeting of the Korean Ophthalmology Society 2012.

Received 8 December 201231 January 2013 Accepted 22 April 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the effect and visual improvement of internal limiting membrane (ILM) peeling, and epiretinal mem-brane (ERM) peeling in symptomatic ERM with pseudolamellar macular hole.

Methods

This study included 27 eyes in 26 consecutive patients with ERM including pseudolamellar macular hole that un-derwent vitrectomy, ERM peeling, intravitreal gas tamponade, and maintained a face-down position for 7 days. ILM peel-ing was performed only in 13 eyes of 13 patients. The patients were divided into 2 groups: eyes with or without ILM peeling (14 eyes and 13 eyes, respectively) and the follow-up period was 12 months or more in all cases. The postoperative ana-tomic results based on optical coherence tomography (OCT) and improvement of best corrected visual acuity (BCVA) were retrospectively compared between the 2 groups.

Results

Anatomic closure after surgery was achieved in 11 eyes (78.6%) in the ILM without peeling group and in 12 eyes (92.3%) in the ILM with peeling group ( p = 0.596). The BCVA improved from 0.41 ± 0.31 (log MAR) to 0.33 ± 0.21 in the ILM without peeling group ( p = 0.479) and from 0.46 ± 0.41 (log MAR) to 0.28 ± 0.25 in the ILM with peeling group ( p = 0.001).

Conclusions

ILM peeling with the addition of ERM peeling is an effective technique for BCVA improvement in the ERM with pseudolamellar macular hole. Vitrectomy, ERM peeling, gas tamponade, and ILM peeling are important for anatomic and functional success in the ERM with pseudolamellar macular hole.

Keywords: Epiretinal membrane, Internal limiting membrane peeling, Pseudolamellar macular hole

References

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Figure 1.

(A) Preoperative OCT image with visual acuity log MAR 0.52. This image shows the ERM and fulfills the criteria for OCT diagnosis of lamellar macular hole (1) irregular foveal contour; (2) dehiscence in the inner fovea; (3) separation of the inner from the outer fovea retinal layers, leading to an intraretinal split; (4) absence of a full-thickness foveal defect. (B) OCT at 12 months after operation with visual acuity log MAR 0.22. This image shows the postoperative normalization of the fovea contour.

Figure 2.

(A) Preoperative OCT image with visual acuity log MAR 0.40. This image shows the ERM and fulfills the OCT diagnosis of macular pseudohole (1) centripetal contraction of an ERM; (2) steepened foveal pit; (3) well-demarcated round or oval shape. (B) OCT at 12 months after operation with visual acuity log MAR 0.22. This image shows the postoperative normalization of the fovea contour.

Table 1.

Patient’s characteristics, Visual acuity and Macula status as assessed by optical coherence tomography

Patient No.	Sex/Age (years)	Preop Lens status	Preop BCVA	Final BCVA	Follow-up (months)	ILM peeling	Postop Macula status
1	F/71	IOL	20/100	20/100	21	No	Normalized
2	F/62	Phakic	20/50	20/40	32	No	Normalized
3	F/73	Phakic	20/500	20/63	13	No	Normalized
4	M/64	Phakic	20/30	20/50	17	No	Normalized
5	F/53	Phakic	20/25	20/25	12	No	Improved
6	M/66	IOL	20/50	20/100	21	No	Normalized
7	F/70	IOL	30/20	20/50	18	No	Normalized
8	F/68	IOL	20/63	20/40	12	No	Normalized
9	M/71	Phakic	20/50	20/20	14	No	Normalized
10	M/71	Phakic	20/30	20/25	12	No	Normalized
11	F/74	Phakic	20/40	20/50	14	No	Improved
12	F/74	Phakic	20/50	20/40	13	No	Normalized
13	F/53	Phakic	20/63	20/40	38	No	Progressed
14	F/64	Phakic	20/40	20/30	12	No	Normalized
15	F/50	Phakic	20/25	20/25	21	Yes	Normalized
16	M/69	Phakic	20/25	20/20	36	Yes	Normalized
17	F/70	IOL	20/50	20/30	13	Yes	Normalized
18	F/62	Phakic	20/63	20/32	13	Yes	Normalized
19	F/71	IOL	20/1000	20/100	12	Yes	Normalized
20	F/67	Phakic	20/50	20/40	15	Yes	Normalized
21	F/55	Phakic	20/40	20/30	12	Yes	Normalized
22	F/81	Phakic	20/40	20/30	13	Yes	Unchanged
23	M/75	Phakic	20/50	20/30	12	Yes	Normalized
24	F/56	Phakic	20/100	20/32	14	Yes	Normalized
25	F/54	Phakic	20/63	20/30	23	Yes	Normalized
26	F/46	Phakic	20/50	20/32	23	Yes	Normalized
27	F/73	IOL	20/30	20/30	12	Yes	Normalized

BCVA = best corrected visual acuity; ILM = internal limiting membrane; IOL = intraocular lens.

Table 2.

Patient’s demographic findings in two groups

	Group 1^*	Group 2^†	Total
Sex (M : F)	4 : 10 (14)	2 : 11 (13)	6 : 21 (27)
Age (years)	66.7 (53-74)	63.7 (46-81)	65.3
Phakic : Pseudophakic	10 : 4	10 : 3	20 : 7
Combined cataract surgery	10 (71.4%)	10 (76.9%)	20 (74.1%)
Follow-up (months)	17.9 (12-32)	16.9 (12-36)	17.4

^* No ILM peeling

^† ILM peeling.

Table 3.

Comparision of best-corrected visual acuity in two group

	Group 1^*	Group 2^†	p-value
Preoperative BCVA (log MAR)	0.41 ± 0.31	0.46 ± 0.41	0.882^§
Final BCVA (log MAR)	0.33 ± 0.21	0.28 ± 0.25	0.082^§
p-value	0.479^‡	0.001^‡

Values are presented as mean ± SD. BCVA = best corrected visual acuity.

^* No ILM peeling

^† ILM peeling

^‡ Wilcoxon signed rank test

^§ Mann-Whitney test.

Table 4.

Final visual acuity changing degree in two groups

	Same or <2 snellen lines improvement	>2 snellen lines improvement	>2 snellen lines worsening	Total
Group 1^*	5 (35.7%)	5 (35.7%)	4 (28.6%)	14
Group 2^†	4 (30.8%)	9 (69.2%)	0 (0%)	13
p‐ value		0.074^‡		27

^* No ILM peeling

^† ILM peeling

^‡ Chi-square test.

Table 5.

Comparision of anatomical success and functional success in two groups

	Group 1^*	Group 2^†	p-value
Anatomical success	11 (14) 78.6%	12 (13) 92.3%	0.596^‡
Functional success	5 (14) 35.7%	9 (13) 69.2%	0.021^‡

^* No ILM peeling

^† ILM peeling

^‡ Fisher’s exact test.

Table 6.

Comparision of mean change in best-corrected visual acuity at 3 and 6 months

	Group 1^*	Group 2^†	p-value
Mean change in BCVA at 3 months (log MAR)	0.011 ± 0.345	-0.126 ± 0.211	0.138^§
Mean change in BCVA at 6 months (log MAR)	-0.067 ± 0.289	-0.164 ± 0.151	0.068^§
p-value	0.141^‡	0.028^‡

Values are presented as mean ± SD. BCVA = best corrected visual acuity.

^* No ILM peeling

^† ILM peeling

^‡ Wilcoxon signed rank test

^§ Mann-Whitney test.

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