Functional and structural outcomes of ILM peeling in uncomplicated macula-off RRD using microperimetry & en-face OCT

  • Mohamed Gaber Ahmed Mohamed Eissa
  • Mohamad Amr Salah Eddin Abdelhakim
  • Tamer Ahmed Macky
  • Mohamed Mahmoud Khafagy
  • Hassan Aly Mortada
Retinal Disorders



To investigate functional and structural outcomes of internal limiting membrane (ILM) peeling during primary vitrectomy for uncomplicated macula-off rhegmatogenous retinal detachment (RRD).


In this prospective interventional randomized comparative study, 43 eyes (43 patients) were randomly divided into group A (20), and group B (23), with and without ILM peeling respectively. Patients were evaluated clinically, and by spectral-domain optical coherence tomography (SD-OCT) and microperimetry (MP) following silicone oil removal. Main outcome measures were functional—MP (mean and foveal retinal sensitivity; MRS, FRS) and best-corrected visual acuity (BCVA)—and anatomical—en-face image analysis (retinal dimples), and SD-OCT changes [epiretinal membrane (ERM), subretinal fluid (SRF), ellipsoid zone disruption, central subfoveal thickness (CSFT), and foveal contour].


All eyes achieved complete postoperative attachment with mean BCVA 1.0 ± 0.4 logMAR (6/60) in group A, and 0.4 ± 0.4 logMAR (6/15) in group B (p < 0.001). MRS and FRS were significantly higher in group B (p = 0.037 and 0.036 respectively). En-face OCT showed retinal dimples in all patients in group A (29.17 ± 7.67 dimples), compared to none in group B (p = 0.007). ERM did not develop in any eye in group A, while it developed in 17.4% of eyes in group B (p = 0.05).


Although ILM peeling prevented ERM, it resulted in poorer visual outcome in these uncomplicated RRD cases, and might be better reserved only for complicated cases.


En-face OCT Epiretinal membrane Internal limiting membrane Microperimetery Primary vitrectomy Uncomplicated rhegmatogenous RD 



This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. The authors have no financial or proprietary interest in any product mentioned in this paper.

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


  1. 1.
    Halfer W, Willem M, Mayer U (2005) Basement membrane-dependent survival of retinal ganglion cells. Invest Ophthalmol Vis Sci 46:2010–2014Google Scholar
  2. 2.
    Almony A, Nudelman E, Shah GK, Blinder KJ et al (2012) Techniques, rationale, and outcomes of internal limiting membrane peeling. Retina 32:877–891CrossRefPubMedGoogle Scholar
  3. 3.
    Hejsek L, Dusová J, Stepanov A, Rozsíval P (2014) Internal limiting membrane peeling as prophylaxis of epimacular membrane formation in eyes undergoing vitrectomy for rhegmatogenous retinal detachment. Cesk Slov Oftalmol 70(3):98–101PubMedGoogle Scholar
  4. 4.
    Odrobina DC, Michalewska Z, Michalewski J, Nawrocki J (2010) High-speed, high-resolution spectral optical coherence tomography in patients after vitrectomy with internal limiting membrane peeling for proliferative vitreoretinopathy retinal detachment. Retina 30(6):881–886CrossRefPubMedGoogle Scholar
  5. 5.
    Odrobina D, Bednarski M, Cisiecki S, Michalewska Z et al (2012) Internal limiting membrane peeling as prophylaxis of macular pucker formation in eyes undergoing retinectomy for severe proliferative vitreoretinopathy. Retina 32(2):226–231CrossRefPubMedGoogle Scholar
  6. 6.
    Hisatomi T, Tachibana T, Notomi S, Koyanagi Y, et al (2017) Internal limiting membrane peeling-dependent retinal structural changes after vitrectomy in RRD. Retina Feb 23 [Epub ahead of print]Google Scholar
  7. 7.
    Akiyama K, Fujinami K, Watanabe K, Tsunoda K, et al (2016) Internal limiting membrane peeling to prevent post-vitrectomy epiretinal membrane development in retinal detachment. Am J Ophthalmol 171:1–10CrossRefPubMedGoogle Scholar
  8. 8.
    Nam KY, Kim JY (2015) Effect of internal limiting peeling on development of epiretinal membrane after pars plana vitrectomy for rhegmatogenous retinal detachment. Retina 35:880–885CrossRefPubMedGoogle Scholar
  9. 9.
    Rao RC, Blinder KJ, Shah GK (2012) Triamcinolone–assisted internal limiting membrane peeling during primary rhegmatogenous retinal detachment repair reduces postoperative macular pucker. Invest Ophthalmol Vis Sci 53:5791CrossRefGoogle Scholar
  10. 10.
    Aras C, Arici C, Akar S, Muftuoglu G et al (2009) Peeling of internal limiting membrane during vitrectomy for complicated retinal detachment prevents epimacular membrane formation. Graefes Arch Clin Exp Ophthalmol 247(5):619–623CrossRefPubMedGoogle Scholar
  11. 11.
    Michels R (1982) A clinical and histopathologic study of epiretinal membranes affecting the macula and removed by vitreous surgery. Trans Am Ophthalmol Soc 80:580–656PubMedPubMedCentralGoogle Scholar
  12. 12.
    Morris R, Kuhn F (1998) Surgical treatment of macular surface disorders. In: Boyd B (ed) World Atlas Series of Ophthalmic Surgery. Vol 4. Highlights of Ophthalmology International, Panama City, pp 58–64Google Scholar
  13. 13.
    Haritoglou C, Gass CA, Schaumberger M, Ehrt O et al (2001) Macular changes after peeling of the internal limiting membrane in macular hole surgery. Am J Ophthalmol 132:363–368CrossRefPubMedGoogle Scholar
  14. 14.
    Alkabes M, Salinas C, Vitale L, Burés-Jelstrup A et al (2011) En face optical coherence tomography of inner retinal defects after internal limiting membrane peeling for idiopathic macular hole. Invest Ophthalmol Vis Sci 52:8349–8355CrossRefPubMedGoogle Scholar
  15. 15.
    Rispoli M, Le Rouic J-F, Lesnoni G, Colecchio L et al (2012) Retinal surface en face optical coherence tomography: a new imaging approach in epiretinal membrane surgery. Retina 32:2070–2076CrossRefPubMedGoogle Scholar
  16. 16.
    Spaide RF (2012) ‘Dissociated optic nerve fiber layer appearance’ after internal limiting membrane removal is inner retinal dimpling. Retina 32:1719–1726CrossRefPubMedGoogle Scholar
  17. 17.
    Sakimoto S, Ikuno Y, Fujimoto S, Sakaguchi H et al (2014) Characteristics of the retinal surface after internal limiting membrane peeling in highly myopic eyes. Am J Ophthalmol 158:762.e1–768.e1CrossRefGoogle Scholar
  18. 18.
    Tadayoni R, Svorenova I, Erginay A, Gaudric A et al (2012) Decreased retinal sensitivity after internal limiting membrane peeling for macular hole surgery. Br J Ophthalmol 96:1513–1516CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kusuhara S, Matsumiya W, Imai H, Honda S et al (2014) Evaluating dissociated optic nerve fiber layer appearance using en face layer imaging produced by optical coherence tomography. Ophthalmologica 232:170–178CrossRefPubMedGoogle Scholar
  20. 20.
    Pichi F, Lembo A, Morara M, Veronese C et al (2014) Early and late inner retinal changes after inner limiting membrane peeling. Int Ophthalmol 34:437–446CrossRefPubMedGoogle Scholar
  21. 21.
    Balducci N, Morara M, Veronese C, Torrazza C et al (2014) Retinal nerve fiber layer thickness modification after internal limiting membrane peeling. Retina 34(4):655–663CrossRefPubMedGoogle Scholar
  22. 22.
    Wolf S, Schnurbusch U, Wiedemann P, Grosche J et al (2004) Peeling of the basal membrane in the human retina: ultrastructural effects. Ophthalmology 111(2):238–243CrossRefPubMedGoogle Scholar
  23. 23.
    Chen H, Lukas TJ, Du N, Suyeoka G et al (2009) Dysfunction of PRE with age: increased iron decreases phagocytosis & lysosomal activity. Invest Ophthalmol Vis Sci 50(4):1895–1902CrossRefPubMedGoogle Scholar
  24. 24.
    Ripandelli G, Scarinci F, Piaggi P, Guidi G et al (2015) Macular pucker: to peel or not to peel the internal limiting membrane? A microperimetric response. Retina 35:498–507CrossRefPubMedGoogle Scholar
  25. 25.
    Vecchio MD, Lavia C, Nassisi M, Grignolo FM, et al (2016) Microperimetric assessment after epiretinal membrane surgery: 4-year follow-up. J Ophthalmol 2016:7030791Google Scholar
  26. 26.
    Christensen UC, La Cour M (2012) Visual loss after use of intraocular silicone oil associated with thinning of inner retinal layers. Acta Ophthalmol 90:733–737CrossRefPubMedGoogle Scholar
  27. 27.
    Koutsandrea C, Kanakis M, Papaconstantinou D, Brouzas D et al (2016) Scleral buckling versus vitrectomy for retinal detachment repair: comparison of visual fields and nerve fiber layer thickness. Ophthalmologica 235:10–17CrossRefPubMedGoogle Scholar
  28. 28.
    Fitzgerald ME, Tolley E, Frase S, Zagvazdin Y et al (2001) Functional and morphological assessment of age-related changes in the choroid and outer retina in pigeons. Vis Neurosci 18:299–317CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Mohamed Gaber Ahmed Mohamed Eissa
    • 1
  • Mohamad Amr Salah Eddin Abdelhakim
    • 1
    • 2
  • Tamer Ahmed Macky
    • 1
  • Mohamed Mahmoud Khafagy
    • 1
  • Hassan Aly Mortada
    • 1
  1. 1.Department of Ophthalmology, Kasr Al Ainy HospitalCairo UniversityCairoEgypt
  2. 2.CairoEgypt

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