The effect of removal and preservation of the internal limiting membrane on parameters of the microvascular bed and retinal thickness in the macular area after surgery for idiopathic epiretinal fibrosis in patients of the older age group

Purpose: to evaluate the effect of removal and preservation of the internal limiting membrane (ILM) on the density of the microvascular bed (in the superficial and deep vascular plexuses of the retina) and retinal thickness in the macular region in older patients operated on for idiopathic epiretinal fibrosis (ERF).

Material and methods. The retrospective study included 103 patients (103 eyes) aged from 56 to 78 years (mean 67.1 ± 7.8 years) who underwent surgical treatment of idiopathic ERF. The patients were divided into 2 groups: the main group — where the ERF was removed while preserving the ILM (67 eyes) and the control group — where the ERF was removed along with the ILM (36 eyes). The vascular density of the superficial vascular plexus (SVP), deep vascular plexus (DVP) and retinal thickness were assessed using optical coherence tomography with angiography function. The period of observation of patients ranged from 6 months to 3 years.

Results. When the ILM was preserved in all analyzed areas of the retina, the indicators of the density of the SVP and DVP were comparable with the indicators of the group of healthy individuals of the same age. The retinal thickness in all analyzed areas was not statistically different from the retinal thickness of healthy people. When the ILM was removed, the density of SVP was reduced in all analyzed areas of the retina compared with similar indicators in healthy patients. The density of DVP in the foveal area was reduced compared to this indicator in the control group and remained unchanged in other analyzed areas. Retinal thickness in all analyzed areas was reduced relative to retinal thickness in healthy people of the older age group.

Conclusion. Preservation of the ILM after removal of idiopathic ERF does not lead to a decrease in the density of the vascular bed and a decrease in retinal thickness. Removal of the ERM together with the ILM causes a decrease in the density of SVP and the retinal thickness around ILM removal. The density of DVP remains unchanged in all zones, except for the foveal area, where it decreases in the long-term postoperative period (from 6 months to 3 years). Surgery for idiopathic ERF with preservation of the ILM is a more appropriate technique in terms of preserving normal anatomical parameters of the microvascular bed and retinal thickness.

1. Fung AT, Galvin J, Tran T. Epiretinal membrane: A review. Clinical & Experimental Ophthalmology. 2021; 49 (3): 289–308. doi: 10.1111/ceo.13914

2. Jung JJ, Hoang QV, Ridley-Lane, et al. Long-term retrospective analysis of visual acuity and optical coherence topographic changes after single versus double peeling during vitrectomy for macular epiretinal membranes. Retina. 2016; 36 (11): 2101–9. doi: 10.1097/iae.0000000000001055

3. Schumann RG, Gandorfer A, Eibl KH, et al. Sequential epiretinal membrane removal with internal limiting membrane peeling in brilliant blue G-assisted macular surgery. Br J Ophthalmol. 2010; 94: 1369–72. doi: 10.1136/bjo.2010.183210

4. Mason JO III, Feist RM, Albert MA. Eccentric macular holes after vitrectomy with peeling of epimacular proliferation. Retina. 2007; 27: 45–8. doi: 10.1097/01.iae.0000256661.56617.69

5. Sandali O, El Sanharawi M, Basli E, et al. Paracentral retinal holes occurring after macular surgery: incidence, clinical features, and evolution. Graefes Arch Clin Exp Ophthalmol. 2012; 250: 1137–42. doi: 10.1007/s00417-012-1935-6

6. Rush RB, Simunovic MP, Aragon AV II, Ysasaga JE. Postoperative macular hole formation after vitrectomy with internal limiting membrane peeling for the treatment of epiretinal membrane. Retina. 2014; 34: 890–96. doi: 10.1097/IAE.0000000000000034

7. Oh HN, Lee JE, Kim HW, et al. Clinical outcomes of double staining and additional ILM peeling during ERM surgery. Korean J. Ophthalmol. 2013; 27: 256–60. doi: 10.3341/kjo.2013.27.4.256

8. Lyskin P.V., Volodin P.L., Makarenko I.R. Functional results of surgical treatment of macular holes fully preserving the internal limiting membrane as compared with the traditional method. Russian ophthalmological journal. 2023; 16 (4): 44–9 (In Russ.). https://doi.org/10.21516/2072-0076-2023-16-4-44-49

9. Spaide R.F. Dissociated optic nerve fiber layer appearance after internal limiting membrane removal is inner retinal dimpling. Retina. 2012; 32: 1719–26. doi: 10.1097/IAE.0b013e3182671191

10. Amouyal F, Shah SU, Pan CK, et al. Morphologic features and evolution of inner retinal dimples on optical coherence tomography after internal limiting membrane peeling. Retina. 2014; 34: 2096–102. doi: 10.1097/IAE.0000000000000193

11. Tadayoni R, Paques M, Massin P, et al. Dissociated optic nerve fiber layer appearance of the fundus after idiopathic epiretinal membrane removal. Ophthalmology. 2001; 108: 2279–83. doi: 10.1016/s0161-6420(01)00856-9

12. Pournaras CJ, Emarah A, Petropoulos IK. Idiopathic macular epiretinal membrane surgery and ILM peeling: anatomical and functional outcomes. Semin Ophthalmol. 2011 Mar; 26 (2): 42–6. doi: 10.3109/08820538.2010.544237

13. Jia Y, Tan O, Tokayer J, et al. Split-spectrum amplitude-decorrelation angiography with optical coherence tomography. Opt Express. 2012; 20: 4710–25. doi: 10.1364/OE.20.004710

14. Wang X, Jia Y, Spain R, et al. Optical coherence tomography angiography of optic nerve head and parafovea in multiple sclerosis. Br J Ophthalmol. 2014; 98: 1368–73. doi: 10.1136/bjophthalmol-2013-304547

15. Lumbroso B, Huang D, Jia Y, Fujimoto JA, Rispoli M. Clinical guide to angioOCT: Noninvasive, dyeless OCT angiography. New Delhi: Jaypee Brothers Medical Pub.; 2015. doi: 10.5005/jp/books/12389

16. Lumbroso B, Huang D, Chen CJ, et al. Clinical OCT angiography atlas. 1st edition. New Delhi, India: Jaypee Brothers Medical Publishers, Ltd; 2012. https://www.amazon.in/Clinical-Angiography-Atlas-Lumbroso-Brunoebook/dp/B01G3Q2TXK#

17. Lyskin P.V., Volodin P.L., Makarenko I.R. Study of the retina macular region microvascular bed parameters in healthy people of the older age group according to optical coherence tomography with angiography function. Kazan medical journal. 2024; 105 (3): 387–95 (In Russ.). https://doi.org/10.17816/KMJ112545

18. Gandorfer A, Haritoglou C, Scheler R, et al. Residual cellular proliferation on the internal limiting membrane in macular pucker surgery. Retina. 2012; 32: 477–85. doi: 10.1097/IAE.0b013e3182246e2a

19. Coscas F, Sellam A, Glacet-Bernard A, et al. Normative data for vascular density in superficial and deep capillary plexuses of healthy adults assessed by optical coherence tomography angiography. Invest Ophthalmol Vis Sci. 2016; 57: 211–23. doi: 10.1167/iovs.15-18793

20. Lyskin P.V., Makarenko I.R., Chukanin O.A. An alternative approach to epiretinal fibrosis surgery. Russian ophthalmological journal. 2024; 17 (4): 29–33 (In Russ.). https://doi.org/10.21516/2072-0076-2024-17-4-29-33