Our Summary

This research paper is about a study comparing two different surgical methods for treating a specific type of retinal detachment (an eye condition where the retina pulls away from its normal position at the back of the eye). The two methods are vitrectomy with internal limiting membrane (ILM) peeling and vitrectomy without ILM peeling. The ILM is a thin layer on the surface of the retina, and “peeling” refers to the surgical removal of this layer.

The researchers analyzed the results of nine previous studies involving a total of 769 eyes. They found that the group of patients who underwent ILM peeling during their surgery had a significantly lower rate of developing a specific complication (macular epiretinal membrane) after surgery compared to the group who did not have the ILM peeling. This complication is a kind of scar tissue that can form on the retina and cause vision problems.

The ILM peeling group also had a lower rate of the retina detaching again after surgery. However, there was no significant difference between the two groups in terms of improvement in visual acuity (sharpness of vision) after surgery.

In simpler terms, the study suggests that peeling the ILM during surgery for retinal detachment may help prevent certain complications and the recurrence of the detachment, but it doesn’t necessarily lead to better vision outcomes compared to the surgery without ILM peeling.

FAQs

  1. What is the difference between vitrectomy with ILM peeling and vitrectomy without ILM peeling?
  2. What complications can occur after vitrectomy surgery for retinal detachment?
  3. Does vitrectomy with ILM peeling result in improved vision compared to vitrectomy without ILM peeling?

Doctor’s Tip

A doctor might tell a patient undergoing vitrectomy for retinal detachment that peeling the internal limiting membrane (ILM) during surgery may reduce the risk of certain complications and the detachment recurring, but it may not necessarily improve vision outcomes. It is important to discuss the potential benefits and risks of ILM peeling with your doctor before the surgery.

Suitable For

Patients who are typically recommended vitrectomy with or without ILM peeling for retinal detachment include those who have:

  1. A history of retinal detachment
  2. Complex or severe retinal detachments
  3. Macular involvement or at risk for macular epiretinal membrane formation
  4. Proliferative vitreoretinopathy (a condition where scar tissue forms on the retina)
  5. Trauma-related retinal detachments
  6. Pseudophakic retinal detachments (retinal detachments occurring after cataract surgery)

It is important for patients to consult with their ophthalmologist to determine the most appropriate surgical approach based on their individual case and risk factors.

Timeline

Before vitrectomy:

  1. Patient experiences symptoms of retinal detachment, such as sudden onset of floaters, flashes of light, or a curtain-like shadow in their vision.
  2. Patient undergoes a comprehensive eye examination to confirm the diagnosis of retinal detachment.
  3. Patient discusses treatment options with their ophthalmologist, including the possibility of undergoing vitrectomy surgery.
  4. Patient undergoes pre-operative testing and evaluation to assess their overall health and suitability for surgery.

After vitrectomy:

  1. Patient undergoes vitrectomy surgery, which involves the removal of the vitreous gel from the center of the eye and repair of the detached retina.
  2. In some cases, the surgeon may also perform ILM peeling during the surgery to prevent complications such as macular epiretinal membrane.
  3. Patient is monitored closely in the immediate post-operative period for any signs of complications or infection.
  4. Patient may experience some discomfort, blurred vision, or sensitivity to light in the days following surgery.
  5. Patient attends follow-up appointments with their ophthalmologist to monitor their healing progress and assess their visual acuity.
  6. Over time, the patient’s vision may improve as the retina heals and stabilizes, but it can take several weeks or even months for vision to fully recover.
  7. Patient is advised to follow post-operative instructions, including using prescribed eye drops, avoiding strenuous activities, and attending scheduled follow-up appointments for monitoring and evaluation.

What to Ask Your Doctor

Some questions a patient may consider asking their doctor about vitrectomy include:

  1. What is the purpose of internal limiting membrane (ILM) peeling during vitrectomy surgery?
  2. What are the potential benefits of having ILM peeling during surgery for retinal detachment?
  3. What are the potential risks or complications associated with ILM peeling?
  4. How does the rate of developing macular epiretinal membrane compare between vitrectomy with ILM peeling and without ILM peeling?
  5. What is the likelihood of the retina detaching again after surgery with and without ILM peeling?
  6. Will having ILM peeling during surgery affect my visual acuity or overall vision outcomes?
  7. How will I know if I am a good candidate for vitrectomy with ILM peeling?
  8. Are there any alternative treatment options for retinal detachment that do not involve ILM peeling?
  9. What is the recovery process like after vitrectomy with ILM peeling compared to without ILM peeling?
  10. What other factors should I consider when deciding between the two surgical methods for treating retinal detachment?

Reference

Authors: Fallico M, Russo A, Longo A, Pulvirenti A, Avitabile T, Bonfiglio V, Castellino N, Cennamo G, Reibaldi M. Journal: PLoS One. 2018 Jul 19;13(7):e0201010. doi: 10.1371/journal.pone.0201010. eCollection 2018. PMID: 30024983