Epiretinal Membrane Peeling with Foveal Sparing of the Internai Limiting Membrane: A Pilot Study

Purpose: To compare the long-term efficacy of surgery for epiretinal membrane {ERM) with complete peeling ofthe internai limiting membrane {ILM) versus foveal sparing of the ILM. Methods :A prospective study was performed involving 52 patients scheduled to undergo vitrectomy for idiopathic ERM by a single surgeon (F.M.). Patients were randomized to complete fovea l peeling ofthe ILM (FP group) orto foveal sparing {FS group), in which the ILM was peeled around the fovea but leaved untouched upon it (o ne disc diameter). The surgeries were performed using 25-gauge transconjunctival system and microperimetry was performed at baseline and 1, 3, and 6-month after surgery. Results : Both groups had significant BCVA improvements, and no differences were found between FP and FS groups (0.18 ± 0.05 LogMAR an d 0.15 ± 0.05 LogMAR, respectively). After 6 months, in the FS group was more likely to fin d recurrent ERM in the macula postoperatively (11 %) compared to FP group (0%), but less likely to fin d foveal decrease in retina l sensitivity and microscotomas. Compared to basellne, at 6-month follow-up mean centrai retinal sensitivity decreased in FP group {-0.8 d B) and increased (+1.8 dB) in the FP group (P< 0.001). Conclusions: Fovea l sparing ofthe ILM in ERM surgery is a less traumatic procedure for the centrai fovea that allows fora greater increase in retinallight sensitivity in the centrai 5 degrees. Conversely, a complete peeling ofthe ILM results in greater likelihood of decreased retinal sensitivity and para centrai scotomas, but permits a more complete and permanent re m ovai of ERM.