Department of Ophthalmology, Inje University Haeundae Paik Hospital, Inje University School of Medicine, Busan, South Korea.
Paik-Lee Eye Clinic, Busan, South Korea.
Jpn J Ophthalmol. 2024 May;68(3):216-224. doi: 10.1007/s10384-024-01056-4. Epub 2024 Apr 10.
We introduce selective internal limiting membrane (ILM) peeling, a guideline procedure to determine whether to remove the ILM during vitrectomy for rhegmatogenous retinal detachment (RRD).
Retrospective case series METHODS: Patients who underwent pars plana vitrectomy for RRD and were followed up for 12 months or longer were included. When vitreous cortex remnants (VCRs) were detected with triamcinolone acetonide, the ILM was removed; otherwise, the ILM was preserved ("selective ILM peeling"). The factors associated with the presence of VCRs and incidence of secondary epiretinal membrane (ERM) were analyzed.
VCRs were detected in 87 of 133 eyes (65.4%) in which the ILM was removed. Younger age, better preoperative visual acuity, and vitreous hemorrhage were negatively correlated with the presence of VCRs. No ERM occurred in the eyes after ILM peeling. Among the eyes with ILM preservation, subclinical ERM was noticed in 4 eyes (8.7%), and 1 eye (2.1%) required additional surgery owing to ERM. ERM occurred more commonly in eyes with the ILM preserved (P = .004). However, no differences in the rate of additional surgeries were found between the 2 groups.
Selective ILM peeling offers an alternative option to reduce the burden of ILM peeling or additional surgery.
我们介绍了选择性内界膜（ILM）剥除术，这是一种指导方针程序，用于确定在裂孔源性视网膜脱离（RRD）的玻璃体切割术中是否去除 ILM。
回顾性病例系列
纳入接受玻璃体切除术治疗 RRD 并随访 12 个月或更长时间的患者。当用曲安奈德检测到玻璃体皮质残留物（VCR）时，去除 ILM；否则，保留 ILM（“选择性 ILM 剥除”）。分析与 VCR 存在和继发性视网膜前膜（ERM）发生率相关的因素。
在 133 只眼中，有 87 只（65.4%）眼的 ILM 被去除，其中检测到 VCR。年龄较小、术前视力较好和玻璃体积血与 VCR 的存在呈负相关。ILM 剥除后无 ERM 发生。在保留 ILM 的眼中，有 4 只眼（8.7%）出现亚临床 ERM，1 只眼（2.1%）因 ERM 需要额外手术。保留 ILM 的眼中 ERM 更常见（P =.004）。然而，两组之间的额外手术率没有差异。
选择性 ILM 剥除术为减轻 ILM 剥除或额外手术的负担提供了一种替代选择。
