'Double peel' appears effective for macular pucker after vitrectomy, study finds

In some epiretinal membrane specimens, internal limiting membrane may appear over the same area that an intact internal limiting membrane was subsequently peeled after a "double peel" procedure for macular pucker, according to a study.

"We speculate that the [internal limiting membrane] in the [epiretinal membrane] represent a secondary basement membrane and that the surgical plane of dissection for most [epiretinal membrane] peel is between the [epiretinal membrane] and the native [internal limiting membrane], making it feasible to double peel routinely," the authors said.

S.K. Gibran, MSc, FRCS, and colleagues performed pars plana vitrectomy followed by a double peel on 17 eyes of 17 patients with macular pucker. Surgeons stained the internal limiting membrane (ILM) and the epiretinal membrane (ERM) with trypan blue and peeled both separately over the same area to evaluate the presence of ILM in the ERM.

Of the 17 total ERM specimens, five (29%) contained ILM fragments, the authors noted.

"When ILM was present on the ERM, it represented less than 50% of the sample," they said.

An administrative error resulted in the loss of one ILM specimen.

Of the remaining 16 specimens, six had residual ERM, and six ILMs had cellular remnants on the vitreous surface, according to the study.

The researchers reported no clinical recurrence of ERM.

The study is published in the March issue of British Journal of Ophthalmology.