ILM peeling not always necessary in diabetic vitrectomy
CHICAGO — Peeling the internal limiting membrane may not always be necessary in diabetic vitrectomy, according to an expert at Retina Subspecialty Day at the American Academy of Ophthalmology meeting.
Stanley Chang, MD, said he has seen many presentations in which surgeons will peel the internal limiting membrane (ILM) either for diabetic macular edema or proliferative diabetic retinopathy, but he does not always understand the reasoning.
“I was wondering, ‘What am I missing?’” he said. “I began to look at the role of Müller cells in the ILM in diabetic retinopathy and what is the medical evidence of ILM peeling in these conditions.”
Chang conducted a literature review, as well as a review of his own cases, to find out how ILM peeling might harm Müller cells, which are critical to maintaining retinal function, and provided recommendations on how to handle these patients.
In his literature review in DME, Chang found no difference in visual acuity or in change in central macular thickness in studies that compared ILM peeling to no ILM peeling. In his review of proliferative DR, specifically eyes with vitreous hemorrhage, the ILM peeling group had better postoperative visual acuity and other better outcomes.
Chang said that if the ILM appears normal, he recommends not trying to peel it.
“There are some benefits to leaving ILM,” he said. “If there are striae, I tend to peel locally.”
Lastly, Chang said there is no strong clinical evidence for peeling ILM in DME, and the long-term effects of ILM peeling in proliferative DR are not currently known.
“Especially in patients with type 1 diabetes that may have to suffer with the consequences of ILM peeling for 40 or 50 years,” he said. “Better studies are needed until we have that information.”
Collapse
Chang S. Is it necessary to peel internal limiting membrane in diabetic vitrectomy. Presented at: American Academy of Ophthalmology meeting; Sept. 30-Oct. 3, 2022; Chicago.
Read more about