The effect of macular internal limiting membrane peeling on single surgery success rates in individuals undergoing pars plana vitrectomy for uncomplicated, primary macula-off rhegmatogenous retinal detachment

Authors: Rosanna K. Martens, Chao Chen, David Ehmann, Mark Greve, Mark E. Seamone. 
Author Disclosure Block: R.K. Martens: None. C. Chen: None. D. Ehmann: None. M. Greve: None. M.E. Seamone: None.

Purpose: To investigate the anatomic and visual outcomes of individuals undergoing pars plana vitrectomy (PPV) for uncomplicated, primary macula-off rhegmatogenous retinal detachment (RRD) with and without macular internal limiting membrane (ILM) peeling. 

Study Design: Retrospective chart review of 187 patients at a single institution with uncomplicated primary macula-off RRD presenting between Jan 01, 2016 to May 31, 2021 and undergoing PPV with and without macular ILM peeling. 

Methods: A total of 48 patients underwent macular ILM peeling and 139 did not. The primary outcome measured was the rate of recurrent RRD. Secondary outcomes included pre- and post- operative BCVA (logMAR), visual improvement from baseline (logMAR), epiretinal membrane (ERM) formation and measurement of central foveal subfield thickness.

Results: No significant difference was found in the risk of recurrent RRD between individuals who underwent macular ILM peeling and those that did not {2.1% (1/48) in the peeled group and 3.6% (5/139) in the non-peeled group, p=1.00}. There was no statistically significant difference in visual improvement from baseline between groups. The visual improvement in the peeled group was 1.08 +/- 0.64 logMAR and in the non-peeled group was 0.97 +/- 0.76 logMAR (p=0.343). The rate of ERM formation was significantly lower in the peeled group. No significant difference was found between central foveal subfield thickness which was 301.7 +/- 40.92 um in the peeled group and 300.66 +/- 34.03 um in the non-peeled group (p=0.877). 

Conclusions: ILM peeling of the macula in primary uncomplicated macula-off RRD does not show a statistical benefit in reducing the risk of recurrent RRD. Interestingly, despite a reduction in post-operative ERM formation, macular ILM peeling did not have a statistical benefit on improvement of BCVA. These results are of great clinical significance as they may guide surgical planning in the management of uncomplicated macula-off retinal detachment.