ILM peeling in rhegmatogenous retinal detachment; does it improve the outcome?

Excerpt

Peeling of the internal limiting membrane (ILM) at the macula has been shown to improve visual outcomes in a number of diseases most notably large macular holes. Perhaps partly related to it being a surgically satisfying manoeuvre, its use has been extended to a wide variety of vitreoretinal indications, including more recently and controversially, primary rhegmatogenous retinal detachment (RRD). Previous studies have suggested that its use reduces postoperative epiretinal membrane (ERM) formation and may improve visual results, although these have largely been retrospective or small comparative but non-randomised studies [1‐5]. In this issue, however, Eissa et al., report a randomised controlled study of ILM peeling in 43 eyes undergoing vitrectomy for macula involving retinal detachment and report a detrimental effect of ILM peeling [6]. Although there was a lower incidence of ERM in the ILM peel group, visual acuity and macular sensitivity were significantly better in the no peel group. The studies generalisability can be criticised in that silicone oil was used in all eyes despite all cases having less than C PVR based on lack of access to long acting gases. There was also a significantly longer duration of macula detachment in the peel group, and a significantly greater extent of retinal detachment in the non-peel group; however, neither of these differences were significant to final visual outcome on multivariate analysis. …