Kim Bo Hee, Yoon Chang Ki, Bae Kunho, Lee Eun Kyoung, Lee Chan Ho, Kim Dong Ik, Bae Ki Woong, Park Un Chul
Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.
Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Sci Rep. 2025 May 20;15(1):17499. doi: 10.1038/s41598-025-01987-z.
In epiretinal membrane (ERM) surgery, the influence of internal limiting membrane (ILM) integrity after ERM removal is underexplored. This study investigated outcomes of idiopathic ERM surgery based on ILM condition following ERM removal and intentional peeling of residual ILM. In this prospective, randomized clinical trial, 102 patients underwent vitrectomy for idiopathic ERM. After ERM removal, ILM status was evaluated using indocyanine green staining. Patients with mostly removed ILM were allocated to group 1 (involuntary peeling), whereas those with partially removed or intact ILM were randomized 1:1 to active peeling (group 2) or non-peeling of residual ILM (group 3). Recurrence of ERM during 12-month follow-up occurred only in group 3 (36.1%), particularly when residual ILM involved the fovea. Best-corrected visual acuity, metamorphopsia, and aniseikonia did not differ among groups; however, group 3 showed significantly lower central macular thickness at all follow-ups (p < 0.05) and better macular contour restoration according to retinal thickness profiles. In patients whose residual ILM involved the fovea, non-peeling resulted in less severe vertical metamorphopsia when ERM did not recur. These findings suggest that residual ILM peeling decisions during ERM surgery should consider both anatomical and functional outcomes, as non-peeling favoring anatomical macular recovery but increasing recurrence risk.
在视网膜前膜（ERM）手术中，ERM切除后内界膜（ILM）完整性的影响尚未得到充分研究。本研究基于ERM切除后ILM的情况以及对残留ILM的有意剥离，调查了特发性ERM手术的结果。在这项前瞻性随机临床试验中，102例患者因特发性ERM接受了玻璃体切除术。ERM切除后，使用吲哚菁绿染色评估ILM状态。ILM大部分被切除的患者被分配到第1组（非自愿剥离），而ILM部分被切除或完整的患者以1:1的比例随机分为积极剥离组（第2组）或不剥离残留ILM组（第3组）。在12个月的随访期间，ERM复发仅发生在第3组（36.1%），特别是当残留ILM累及黄斑中心凹时。各组之间的最佳矫正视力、视物变形和像差没有差异；然而，第3组在所有随访中黄斑中心厚度均显著更低（p<0.05），并且根据视网膜厚度轮廓显示黄斑轮廓恢复更好。在残留ILM累及黄斑中心凹的患者中，当ERM未复发时，不剥离导致垂直性视物变形较轻。这些发现表明，ERM手术中残留ILM的剥离决策应同时考虑解剖学和功能学结果，因为不剥离有利于黄斑的解剖学恢复，但会增加复发风险。
