Macular pucker removal with and without internal limiting membrane peeling: pilot study

OBJECTIVE: To investigate results of macular pucker surgery with and without internal limiting membrane (ILM) peeling. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Forty-four consecutive patients underwent pars plana vitrectomy to remove an idiopathic macular pucker by two surgeons from June 1999 to July 2000. INTERVENTION: During the vitrectomy, one surgeon removed only the macular epiretinal membrane (24 patients), whereas the other surgeon removed the macular epiretinal membrane and then performed an additional ILM peeling (20 patients). MAIN OUTCOME MEASURES: Visual acuity and recurrence of macular pucker. RESULTS: Twenty-four (55%) patients underwent pars plana vitrectomy without ILM peeling, and 20 patients (45%) underwent pars plana vitrectomy with ILM peeling. Visual acuity improved or was unchanged in 79% of operated eyes without ILM peeling and 100% of operated eyes with ILM peeling (P = 0.01). Visual acuity improved 5 or more lines in 25% of operated eyes without ILM peeling and 30% of operated eyes with ILM peeling. At the final visit, 21% of eyes without ILM peeling at the initial surgery showed postoperative recurrent macular pucker or persistent contraction to the ILM, whereas none of the eyes with ILM peeling had evidence of this. CONCLUSIONS: This pilot study provides evidence that peeling of the ILM during macular pucker surgery may not have deleterious effects.