Effects of Internal Limiting Membrane Peel for Idiopathic Epiretinal Membrane Surgery: A Systematic Review of Randomized Controlled Trials

Parsa Mehraban Far; Shanna C Yeung; Patrick E Ma; Bernard Hurley; Peter Kertes; Yuyi You; Peng Yan

doi:10.1016/j.ajo.2021.04.028

Effects of Internal Limiting Membrane Peel for Idiopathic Epiretinal Membrane Surgery: A Systematic Review of Randomized Controlled Trials

Am J Ophthalmol. 2021 Nov:231:79-87. doi: 10.1016/j.ajo.2021.04.028. Epub 2021 May 11.

Authors

Parsa Mehraban Far¹, Shanna C Yeung², Patrick E Ma², Bernard Hurley³, Peter Kertes⁴, Yuyi You⁵, Peng Yan⁶

Affiliations

¹ From the Department of Ophthalmology (P.M.F.), Queen's University, Kingston, Ontario, Canada.
² Department of Ophthalmology and Vision Sciences (S.C.Y., P.E.M.), The University of British Columbia, Vancouver, British Columbia, Canada.
³ Department of Ophthalmology (B.H.), Ottawa Eye Institute, University of Ottawa, Ottawa, Ontario, Canada.
⁴ Department of Ophthalmology and Vision Sciences (P.K., P.Y.), University of Toronto, Toronto, Ontario, Canada.
⁵ Save Sight Institute (Y.Y.), The University of Sydney, Sydney, Australia; Department of Clinical Medicine (Y.Y.), Macquarie University, Sydney, Australia.
⁶ Department of Ophthalmology and Vision Sciences (P.K., P.Y.), University of Toronto, Toronto, Ontario, Canada; Toronto Western Hospital (P.Y.), University Health Network, University of Toronto, Toronto, Ontario, Canada; Kensington Vision and Research Center (P.Y.), Toronto, Ontario, Canada. Electronic address: pyan@kensingtonhealth.org.

PMID: 33989597
DOI: 10.1016/j.ajo.2021.04.028

Abstract

Purpose: The purpose of this study was to compare functional and anatomical outcomes after epiretinal membrane (ERM) peeling with internal limiting membrane (ERM/ILM) peeling and without for the treatment of idiopathic ERM.

Design: Systematic review and meta-analysis.

Methods: A comprehensive search of Cochrane CENTRAL, MEDLINE Ovid, and Embase Ovid for randomized controlled trials comparing ERM/ILM with ERM was performed. Two independent reviewers selected papers and extracted data. Methodological quality was assessed using the Cochrane Risk of Bias (RobVis) tool. Data was analyzed using RevMan 5.3. Quality of body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results: Seven studies reporting 387 eyes overall were included. A total of 207 eyes (53%) received ERM/ILM. A total of 180 (47%) received ERM. Post-operative visual acuities (logMAR) were not significantly different between ERM/ILM and ERM, with a mean difference (MD) of 0.02 (95% confidence interval [CI]: -0.04 to 0.09; P = .45; I²= 42%; n = 101) at 1 month; 0.03 (95% CI: -0.01 to 0.06; P = .11, I² = 15%; n = 299; High Certainty of Evidence) at 3 months; 0.01 (95% CI: -0.03 to 0.04; P = .72; I² = 21%; n = 317; High Certainty of Evidence) at 6 months; and 0.01 (95% CI: -0.02 to 0.04; P = .49; I² = 39%; n = 234) at 12 months post-operatively. ERM/ILM was significantly associated with lower ERM recurrence at 6-12 months with a relative risk of 0.16 (95% CI: 0.04-0.64; P = .01; I² = 0%; n = 155; Moderate certainty of evidence) and an increased central macular thickness (micrometers) at 12 months with an MD of 20.53 (95% CI: 4.96-36.09; P = .01; I² = 12%; n = 234).

Conclusions: ERM/ILM and ERM result in similar visual acuity despite subtle differences in anatomical outcomes (central macular thickness). ERM/ILM is associated with a significantly lower rate of ERM recurrence at 6-12 months post-operatively and should be considered where recurrence prevention is the treatment priority.

Keywords: Epiretinal membrane; Functional and anatomical visual outcomes; Internal limiting membrane; Pars plana vitrectomy.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Basement Membrane
Epiretinal Membrane* / surgery
Humans
Randomized Controlled Trials as Topic
Retina
Retrospective Studies
Visual Acuity
Vitrectomy