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The following is a summary of “Pros and cons of internal limiting membrane peeling during epiretinal membrane surgery: a randomised clinical trial with microperimetry (PEELING),” published in the June 2024 issue of Ophthalmology by Ducloyer et al.

It’s unclear whether removing the internal limiting membrane (ILM) is also beneficial after removing the idiopathic epiretinal membrane (iERM).

Researchers conducted a prospective study assessing if actively peeling the ILM after iERM removal could cause microscotomas (small blind spots). 

They reviewed the PEELING study, a national RCT, to determine whether the ILM didn’t peel spontaneously after idiopathic epiretinal membrane removal and whether patients were randomly assigned to ILM peeling. The groups were compared at months 1, 6, and 12 visits using microperimetry, visual acuity, and optical coherence tomography. 

The results showed that of the 213 patients, 101 had spontaneous ILM peeling, and 100 were randomized to ILM peeling (n=51) or no peeling (n=49). At month 1, the ILM peeling group had 3.9 more microscotomas (P=0.0155), but by month 6, it reduced to 2.1 (P=0.1155). Only the no ILM peeling group showed decreased microscotomas and improved retinal sensitivity. The ERM recurred in 19.6% of the no-peeling group vs. none in the peeling group (P=0.0008). Also, 2 required additional surgery. At month 12, BCVA and microperimetry did not differ between recurrence groups. 

Investigators concluded that spontaneous ILM peeling was expected, while active ILM peeling prevented ERM from returning, which might cause retinal issues and slow visual improvement.

Source: bjo.bmj.com/content/early/2024/06/19/bjo-2023-324990