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Indian J Ophthalmol. 2019 Sep;67(9):1448-1454. doi: 10.4103/ijo.IJO_1685_18.

Internal limiting membrane peel: Does it change the success rate of primary vitrectomy without belt buckle in rhegmatogenous retinal detachments?

Author information

1
Vitreo-Retinal Surgeon, Sarakshi Netralaya, Nagpur, Maharashtra, India.
2
Vitreo-Retinal Surgeon and ROP Specialist, Sarakshi Netralaya, Nagpur, Maharashtra, India.
3
Data Analysis Group, Maharashtra, India.

Abstract

Purpose:

To compare the anatomic success of pars plana vitrectomy (PPV) after internal limiting membrane (ILM) peeling at macular area and macular plus peripapillary area versus no peeling in rhegmatogenous retinal detachments (RRD).

Methods:

A prospective observational study between July 2014 and March 2017 conducted on 289 eyes of 287 patients with RRD were randomly assigned to three treatment procedures, viz., PPV with no ILM peeling, PPV with macular peeling, and PPV with macular plus peripapillary peeling. Recurrent RD (ReRD) was treated as an event and accordingly the overall primary (PS) and final success (FS) rates were obtained. The risk of ReRD associated with peeling procedures after adjusting for risk factors were obtained using Cox-proportional hazard analysis.

Results:

The PS percentage for no peel, macular, and macular plus peripapillary procedures were 77.78% (70/90), 82.18% (83/101), and 94.89% (93/98; maximum), respectively, which was statistically significant with a P value of 0.003. The FS percentage for no peel, macular, and macular plus peripapillary were 93.33%, 95.04%, and 100%, respectively, which was significantly different with a P value of 0.048. With reference to no peeling, the adjusted hazard ratio for macular peeling was 0.841 [95% CI: 0.44-1.60] while 0.235 [95% CI: 0.088-0.626] for macular plus peripapillary peeling.

Conclusion:

The anatomic success rate of PPV with macular plus peripapillary ILM peeling was significantly higher as compared to no peel category. The hazard of ReRD in patients undergoing macular plus peripapillary peel was significantly reduced as compared to no peel procedure.

KEYWORDS:

Cox-regression; hazard ratio; macular peel; macular plus peripapillary; primary/final success

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