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Visual Outcome of Patients with Macular Edema after Pars Plana Vitrectomy (PPV) and Indocyanine Green (ICG) Assisted Internal Limiting Membrane (ILM) Peeling
1Radetzky S., 2Walter P., 1Kirchhof B., 1Joussen A. M.,
1Universität zu Köln, Zentrum für Augenheilkunde, Abteilung für Netzhaut- und Glaskörperchirurgie (Köln)
2Universität zu Köln, Zentrum für Augenheilkunde (Köln)
Purpose: To evaluate the efficacy of internal limiting membrane (ILM) peeling in macular edema.
Method: Retrospective review of a surgical series of 25 eyes from 25 patients, 13 female and 12 male, after pars plana vitrectomy (PPV) with indocyanine green (ICG) assisted peeling of the ILM. The patients with a mean age of 56.8 ± 15.2 (24-77) years were operated between 5/2000 and 10/2001. Main diagnosis were uveitis, central retinal vein occlusion (CRVO) and diabetic retinopathy (DR), followed by vitreoretinal traction forces, vasculitis and Irvine-Gass-Syndrom. 9 eyes had undergone phacoemulsification (PE) previously and 2 eyes underwent combined PE and ILM peeling. The eyes were endotamponaded with gas (3), silicone oil (5) or air (13). In 4 cases no endotamponade was used. Visual acuity improvement was thought as significant by 2 or more lines improvement.
Results: Visual acuity improved after 8 days in 4% (1/25), 3 months in 15% (3/20), after 6 and 12 months no significant improvement was found. The preoperative diagnosis (CRVO, DR, uveitis or Irvine-Gass) seemed no to change the prognosis. Also the choice of endotamponade seemed not to change visual acuity outcome, although an air tamponade lead to tendentious best 1 year results. In isolated cases positive changes have been seen after ILM peeling because of uveitis, diabetic retinopathy or vitreoretinal traction.
Conclusions: Significant visual acuity improvement was not observed 12 months after ILM peeling for macular edema. Further investigations should evaluate the efficacy in certain diagnosis groups, and effectiveness should be evaluated in comparison to exclusive PPV. Controlled studies could also exclude a toxic effect of ICG, which increases macular edema and prevents improvement of sight. This data seem to confirm that ILM peeling may improve the outflow of intraretinal aqueous, but does not effect the process of disease which causes macular edema. Therefore no longterm improvement has been seen.