The Effect of Internal Limiting Membrane Cleaning on Epiretinal Membrane Formation after Vitrectomy for Proliferative Diabetic Retinopathy

Abstract

<b><i>Purpose:</i></b> We hypothesised that cleaning the internal limiting membrane (ILM) with a flexible nitinol loop following diabetic vitrectomy without peeling may reduce the common occurrence of postoperative epiretinal membrane (ERM) formation. <b><i>Methods:</i></b> Consecutive patients undergoing vitrectomy for proliferative diabetic retinopathy by one surgeon from 2015 to 2019 were studied and divided into 2 cohorts: the control group underwent standard surgery, and the ILM clean group underwent additional cleaning of the macular retina using a flexible nitinol loop after vitrectomy. Masked comparison of ERM on optical coherence tomography was performed at 3 months, and visual acuity (VA) was measured until 12 months postoperatively. <b><i>Results:</i></b> Baseline demographics, clinical features, and protein levels were similar between cohorts. The ILM clean group (<i>n</i> = 56) had fewer clinically significant ERM than the control group (<i>n</i> = 50; 4 vs. 20%; <i>p</i> = 0.01), and a significantly lower proportion of the ILM clean group required revision surgery (2 vs. 14%; <i>p</i> = 0.02). VA in the ILM clean group was significantly better than in the control group at 3 months (0.35 vs. 0.50 logMAR; <i>p</i> = 0.02) but not at 12 months (0.34 vs. 0.43 logMAR; <i>p</i> = 0.17). <b><i>Conclusion:</i></b> ILM cleaning with a flexible nitinol loop following diabetic vitrectomy resulted in significant reduction in ERM formation and reduced necessity for revision surgery. There was significant improvement in VA at 3 months but not over a longer follow-up.