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Role of internal limiting membrane peeling in the prevention of epiretinal membrane formation following vitrectomy for retinal detachment: a randomised trial
  1. Vinod Kumar,
  2. Devashish Dubey,
  3. Devesh Kumawat,
  4. Ashish Markan,
  5. Parijat Chandra,
  6. Mahesh Chandra,
  7. Atul Kumar
  1. Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Devesh Kumawat, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Delhi, India;deveshkumawat21{at}


Aim To study the role of internal limiting membrane (ILM) peeling in the prevention of macular epiretinal membrane (ERM) formation following pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD).

Methods In a randomised trial, patients with macula-off RRD (duration ≤3 months) with proliferative vitreoretinopathy grade ≤C1 and absence of pre-existing maculopathy were recruited from June 2016 to May 2018. Patients were randomised into two groups: group 1 (conventional treatment) underwent PPV alone, while group 2 underwent PPV with macular ILM peeling. The main outcome measures were macular ERM formation (detected on optical coherence tomography), corrected distance visual acuity (CDVA), retinal attachment and central macular thickness (CMT) at last follow-up (minimum 6 months).

Results Sixty patients (30 in each group) completed the required follow-up. The two groups were comparable in sex distribution, age, duration of RRD, baseline CDVA and duration of follow-up (median 15.5 vs 14 months). Macular ERM developed in 20% (n=6) and 0% of eyes in groups 1 and 2, respectively (p=0.002). Retinal reattachment was attained in all eyes. There was no statistical difference in final CDVA between the groups (p=0.43). Dissociated optic nerve fibre layer (DONFL) was found in 0% and 40% (n=12) of eyes in groups 1 and 2, respectively (p=0.0001). However, DONFL did not significantly affect the final CDVA (p=0.84). The final CMT was 266.0±37.5 µm and 270.0±73.7 µm in groups 1 and 2, respectively, with no statistical difference (p=0.62).

Conclusions ILM peeling prevents macular ERM formation following PPV for RRD but provides similar visual outcomes as compared with conventional treatment.

Trial registration number CTRI2018/04/012978.

  • internal limiting membrane peeling
  • epiretinal membrane
  • rhegmatogenous retinal detachment
  • vitrectomy
  • visual acuity
  • optical coherence tomography
  • dissociated optic nerve fibre layer
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  • Contributors Substantial contributions to the conception or design of the work: VK, DD, DK. Acquisition, analysis or interpretation of data: VK, DD, DK, AM, PC, MC, AK. Drafting the work: VK, DD, DK, AM. Revising it critically for important intellectual content: VK, PC, MC, AK. All authors approved the final manuscript and agree to be accountable for all aspects of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study adhered to the tenets of the Declaration of Helsinki. Institutional ethics committee approval was obtained. All enrolled patients gave written informed consent for participation in the study.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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