Surgical outcomes of pars plana vitrectomy with and without internal limiting membrane peeling for symptomatic vitreomacular traction
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PURPOSE: To study the long-term anatomic and visual outcomes after pars plana vitrectomy (PPV) with and without internal limiting membrane (ILM) peeling in patients with symptomatic vitreomacular traction (VMT). This study assesses the frequency of complications, changes in visual acuity, and changes in anatomical central macular thickness after macular surgery. METHODS: This retrospective, single-site, single-surgeon study reviewed 40 medical records (45 eyes) of patients at the Beth Israel Deaconess Medical Center requiring PPV with ILM peeling (n=27) or without ILM peeling (n=18) for VMT between the years of 2003 and 2016. Successful surgery was defined as the relief of anatomical traction, and the absence of a second surgery, or any post-operative complications (n=42). Visual acuity was documented for each eye prior to surgery and post surgery. RESULTS: All 27 (100%) eyes that had ILM peeling had successfully resolved macular traction following a single surgery, and 15 of the 18 (83.3%) eyes without ILM peel were successful. None of 27 (0%) eyes that had ILM peeling required a second surgery, nor did they have complications. 3 of the 18 (16.7%) eyes without ILM peeling required a second surgery. Best corrected visual acuity (BCVA, logMAR) improved significantly in both groups: BCVA improved from 0.59 ± 0.29 preoperatively to 0.37 ± 0.25 postoperatively in eyes receiving ILM peeling and from 0.77 ± 0.37 to 0.53 ± 0.37 in eyes with PPV only. Mean change in CMT pre-operatively to post-operatively was found to be greater in eyes with PPV alone, but this difference was not statistically significant. CONCLUSIONS: Our case series shows that PPV with ILM peeling for VMT relieved macular traction better than PPV alone, although there was no significant difference in visual acuity outcomes or central macular thickness between the two groups. Further research is required to validate these findings.