Rates of reoperation in 10,114 Patients with Epiretinal Membranes Treated by Vitrectomy with or without Inner Limiting Membrane Peeling. Ophthalmology. Retina Rayess, N., Vail, D., Mruthyunjaya, P. 2020

Abstract

To compare rates of reoperation in patients with idiopathic epiretinal membrane (ERM) who received pars plan vitrectomy (PPV) with or without inner limiting membrane (ILM) peeling and to assess trends in the overall use of ILM peeling over time.Retrospective cohort study.Patients included in the IBM Marketscan database between January 1, 2008 and December 31, 2016 who had surgery for idiopathic ERM.Procedure claims with laterality codes were used to determine patients with idiopathic ERM who received PPV with or without ILM peel between 2008 and 2016, and to identify cases of reoperation and subsequent retinal detachment within 1 year of index surgery.The primary outcome was rate of reoperation for recurrent ERM according to whether or not patients receive an ILM peel during their index ERM surgery. We also assessed trends for index ERM surgery (ILM peel or no ILM peel) between 2008 to 2016, and the risk of developing retinal detachment within 1 year of the index ERM surgery.10,114 patients received ERM surgery and met inclusion criteria (5,310 without ILM peel and 4,804 ILM peel). The reoperation rate was significantly lower among patients who received PPV with ILM peel (0.88%) compared to patients without ILM peel (1.48%; p=0.007). In 2008, PPV without ILM peel represented 70% of ERM procedures, but PPV with ILM peeling accounted for 52% and 70% of ERM procedures in 2013 (P<0.001) and 2016 (P<0.001), respectively. The rates of retinal detachment were similar between patients who had an ILM peel (0.79%) and patients who did not receive an ILM peel (0.92%) during their primary ERM surgery (p=0.474) CONCLUSION: The increasing use of PPV with ILM peeling to address ERM removal is associated with significantly reduced reoperation rates within 1 year. Future studies are needed to determine the cost-effectiveness of performing an ILM peel for initial idiopathic ERM repairs and evaluate long term visual and structural changes related to ILM peeling.

View details for DOI 10.1016/j.oret.2020.10.013

View details for PubMedID 33127527