Efficiency and Safety of Internal Limiting Membrane Peeling with Different Forceps for Macular Disease

Abstract

Purpose To compare the efficiency and safety of internal limiting membrane (ILM) peeling between the Sharkskin forceps and End-grasping forceps in various macular diseases. Methods It is a prospective cohort block-randomized study conducted in a tertiary medical center. Seventy subjects with macular hole, epiretinal membrane, vitreomacular traction syndrome or myopic foveoschisis, receiving pars plana vitrectomy and ILM peeling surgery were equally divided into Sharkskin forceps group and End-grasping forceps group. The duration of ILM peeling, the number of attempts to initiate peeling and peeling-related retinal damage were evaluated by recorded video and optical coherence tomography. Results In the Sharkskin group, we demonstrated significantly fewer attempts to initiate ILM peeling compared with End-grasping group, with an average of 1.9 and 3.1 attempts (p=0.0001); and a lower incidence of retinal microstructural damage (20% versus 45%, p<0.0001). Moreover, the mean depth of inner retinal injury at the initiating site exhibited distinct difference post-operatively at 3 months between the Sharkskin group then the End-grasping group (4.3um versus 30.0um, p=0.001). Conclusions Sharkskin forceps provide better efficiency and outcome in ILM peeling in patients with various vitreomacular interface diseases, including reduced risk of retinal injury and fewer attempts to initiate ILM flap.