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The role of internal limiting membrane peeling in epiretinal membrane surgery: a randomised controlled trial
  1. Paris Tranos1,
  2. Stavrenia Koukoula1,
  3. Davic G Charteris2,
  4. Georgia Perganda1,
  5. Athanasios Vakalis1,
  6. Solon Asteriadis1,
  7. Ilias Georgalas3,
  8. Petros Petrou2,3
  1. 1Ophthalmica Centre, Thessaloniki, Greece
  2. 2Moorfields Eye Hospital, London, UK
  3. 3First Department of Ophthalmology, “Gennimatas Hospital”, National and Kapoditrian University of Athens, Greece
  1. Correspondence to Petros Petrou, Gennimatas Hospital, Mesogeion 154, Athens 11527, Greece; petrospetrou2{at}


Purpose To compare the anatomical and functional outcomes after primary idiopathic epiretinal membrane (ERM) peeling with or without internal limiting membrane (ILM) peeling.

Design A two-centre randomised, controlled clinical trial with 12 months of follow-up.

Methods One hundred and two eyes of 102 patients were included in the analysis and were randomised into two groups (ILM peeling (P) and non-ILM peeling (NP) group). Inclusion criteria were: Idiopathic ERM confirmed on optical coherence tomography, age ≥18 years, binocular distortion, best-corrected visual acuity (BCVA) ≤90 ETDRS letters, intraocular pressure ≤23 mm Hg and informed consent. The primary outcome measure was the mean change in the ETDRS distance BCVA at 12 months' follow-up for each group.

Results The mean change in distance BCVA at 12 months was 0.30±0.24 logMAR (15 ETDRS letters) in the P group and 0.31±0.23 logMAR (14 ETDRS letters) in the NP group, a change that was not statistically significant (p=0.84). No statistically significant differences were observed when comparing the changes in distance BCVA, the changes in metamorphopsia (Amsler grid) and the changes in central retinal thickness between the two groups at any of the time points studied.

Conclusions Our analysis suggests that ILM peeling in idiopathic ERM surgery does not result in better visual improvement. The more frequent presence of an uninterrupted interdigitation zone in the P group did not result in a better functional outcome of our patients. No recurrent ERMs were noted in either group.

  • Retina
  • Vitreous

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  • Contributors PT and PP contributed to the conception and design of the work, the acquisition, analysis or interpretation of data. Also, PT, PP and DGC contributed to drafting the work for important intellectual content. SK, DGC, GP, AV, SA and IG contributed to the acquisition, analysis or interpretation of data. Also, they contributed to revising the manuscript critically for important intellectual content. All authors are responsible for the final approval of the version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval National and Kapodistrian University of Athens.

  • Provenance and peer review Not commissioned; externally peer reviewed.