Comparison of Vitrectomy with and without Internal Limiting Membrane Peeling for Idiopathic Epiretinal Membrane: A Meta-Analysis
DOI:
https://doi.org/10.11594/jk-risk.05.2.2Keywords:
Epiretinal membrane, Internal limiting membrane, VitrectomyAbstract
Background: Epiretinal Membranes (ERMs), also widely mentioned as macular puckers, are fibrocellular membranes which avascular and semi-translucent that cover the retinal surface. Complaints caused by ERM include visual impairments such as micropsia, macropsia, metamorphosis, monocular diplopia, and even blindness. Internal limiting membrane (ILM) peeling recently introduced as acceptable option for treating ERM, but the effectiveness of the procedure is still debatable.
Aim: To compare the clinical outcomes of vitrectomy procedure with ILM peeling or without it for idiopathic ERM treatment.
Methods: Study recorded relevant prospective or retrospective studies published in 2014-2024 by searching PubMed, Cochrane, Scopus, and ScienceDirect database. The mean change in BCVA and CMT was analyzed as a continuous variable, reported using Weighted Mean Difference (WMD) with 95% CI and heterogeneity was assessed using the chi-square test and I2 statistics.
Result: There were 4 relevant studies with adequate data published in the last 10 years. 163 eyes consisted of 82 eyes in the No-ILM peeling group and 81 eyes in the ILM peeling group. Postoperative BCVA did not differ significantly between the two groups (MD -0,01; 95% CI: -0,07 to 0,06; P = 0,85) and no significant difference was found between the two groups in postoperative CMT (MD 7.70; 95% CI: -20.11 to 35.52; P = 0.59).
Conclusion: There was no significant difference in BCVA and CMT between vitrectomy with and without ILM peeling in patients with idiopathic epiretinal membrane.
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References
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9. Aydin T, Kerci SG, Karti O, Zengin MO, Kusbeci T. Effect of Internal Limiting Membrane Peeling on Macular Structure and Metamorphopsia Scores in Idiopathic Epiretinal Membrane Surgery. Open Ophthalmol J. 2020 Mar 28;14(1):1–8.
10. Amouyal F, Shah SU, Pan CK, Schwartz SD, Hubschman JP. MORPHOLOGIC FEATURES AND EVOLUTION OF INNER RETINAL DIMPLES ON OPTICAL COHERENCE TOMOGRAPHY AFTER INTERNAL LIMITING MEMBRANE PEELING. Vol. 34, RETINA. 2014.
11. Lai TY, Kwok FRCS AK, Lai MRCS TY, Yuen MRCS KS. Epiretinal membrane surgery with or without internal limiting membrane peeling A BSTRACT. Vol. 33, Clinical and Experimental Ophthalmology. 2005.
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13. Schadlu R, Tehrani S, Shah GK, Prasad AG. LONG-TERM FOLLOW-UP RESULTS OF ILM PEELING DURING VITRECTOMY SURGERY FOR PREMACULAR FIBROSIS. Vol. 28, RETINA. 2008.
14. Lim JW, Cho JH, Kim HK. Assessment of macular function by multifocal electroretinography following epiretinal membrane surgery with internal limiting membrane peeling. Clinical Ophthalmology. 2010;4(1):689–94.
15. Lee JW, Kim IT. Outcomes of idiopathic macular epiretinal membrane removal with and without internal limiting membrane peeling: A comparative study. Jpn J Ophthalmol. 2010 Mar;54(2):129–34.
16. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses. Department of Epidemiology and Commuunity Medicine, University of Ottawa. 2011;
17. Falkenstein IA, Cochran DE, Azen SP, Dustin L, Tammewar AM, Kozak I, et al. Comparison of Visual Acuity in Macular Degeneration Patients Measured with Snellen and Early Treatment Diabetic Retinopathy Study Charts. Ophthalmology. 2008 Feb;115(2):319–23.
18. Zhang B, Dong X, Sun Y. Effect of internal limiting membrane peeling for idiopathic epiretinal membrane. Heliyon. 2023 Mar 1;9(3).
19. Iuliano L, Fogliato G, Gorgoni F, Corbelli E, Bandello F, Codenotti M. Idiopathic epiretinal membrane surgery: Safety, efficacy and patient related outcomes. Vol. 13, Clinical Ophthalmology. Dove Medical Press Ltd; 2019. p. 1253–65.
20. Ducloyer JB, Ivan J, Poinas A, Lebreton O, Bonissent A, Fossum P, et al. Does internal limiting membrane peeling during epiretinal membrane surgery induce microscotomas on microperimetry? Study protocol for PEELING, a randomized controlled clinical trial. Trials. 2020 Jun 8;21(1).
21. Obata S, Fujikawa M, Iwasaki K, Kakinoki M, Sawada O, Saishin Y, et al. Changes in Retinal Thickness after Vitrectomy for Epiretinal Membrane with and without Internal Limiting Membrane Peeling. Ophthalmic Res. 2017 Feb 1;57(2):135–40.
22. De Novelli FJ, Goldbaum M, Monteiro MLR, Aggio FB, Takahashi WY. SURGICAL REMOVAL OF EPIRETINAL MEMBRANE WITH AND WITHOUT REMOVAL OF INTERNAL LIMITING MEMBRANE Comparative Study of Visual Acuity, Features of Optical Coherence Tomography, and Recurrence Rate.
23. Chang S, Gregory-Roberts EM, Park S, Laud K, Smith SD, Quan ;, et al. Double Peeling During Vitrectomy for Macular Pucker The Charles L. Schepens Lecture [Internet]. Vol. 131, JAMA Ophthalmol. 2013. Available from: www.asrs.org]
24. Sultan H, Wykoff CC, Shah AR. Five-year outcomes of surgically treated symptomatic epiretinal membranes with and without internal limiting membrane peeling. Ophthalmic Surg Lasers Imaging Retina. 2018 May 1;49(5):296–302.
25. Lee HJ, Kim MS, Jo YJ, Kim JY. Thickness of the macula, retinal nerve fiber layer, and ganglion cell layer in the epiretinal membrane: The repeatability study of optical coherence tomography. Invest Ophthalmol Vis Sci. 2015;56(8):4554–9.
26. Huang Q, Li J. With or without internal limiting membrane peeling during idiopathic epiretinal membrane surgery: A meta-analysis. PLoS One. 2021 Jan 1;16(1 January).
27. Azuma K, Ueta T, Eguchi S, Aihara M. EFFECTS OF INTERNAL LIMITING MEMBRANE PEELING COMBINED WITH REMOVAL OF IDIOPATHIC EPIRETINAL MEMBRANE A Systematic Review of Literature and Meta-Analysis [Internet]. Vol. 37, RETINA. 2017. Available from: http://links.lww.
28. Ducloyer JB, Eude Y, Volteau C, Lebreton O, Bonissent A, Fossum P, et al. Pros and cons of internal limiting membrane peeling during epiretinal membrane surgery: A randomised clinical trial with microperimetry (PEELING). British Journal of Ophthalmology. 2024 Dec 17;
29. Wu L. Case report illustrates potential for complication with peeling. Costa Rica; 2017.
30. Abdelkader E, Lois N. Internal Limiting Membrane Peeling in Vitreo-retinal Surgery. Surv Ophthalmol. 2008 Jul;53(4):368–96.
31. Guber Ioana Pereni Hendrik N Scholl Ivo Guber Richard J Haynes JP. Outcomes after Epiretinal Membrane Surgery with or Without Internal Limiting Membrane Peeling. Ophthalmol Ther [Internet]. 2019; Available from: https://doi.org/10.6084/
32. Cubuk MO, Unsal E. Anatomic and functional results of idiopathic macular epiretinal membrane surgery. Int J Ophthalmol. 2020;13(4):614–9.
2. Fang XL, Tong Y, Zhou YL, Zhao PQ, Wang ZY. Internal limiting membrane peeling or not: A systematic review and meta-analysis of idiopathic macular pucker surgery. British Journal of Ophthalmology. 2017 Nov 1;101(11):1535–41.
3. Fung AT, Galvin J, Tran T. Epiretinal membrane: A review. Vol. 49, Clinical and Experimental Ophthalmology. John Wiley and Sons Inc; 2021. p. 289–308.
4. Chen L, Liu M, Xie AM, Liu Y. Original Article A study on change of macular retinal thickness and its relationship with vision before and after operation to idiopathic macular epiretinal membranes [Internet]. Vol. 8, Int J Clin Exp Med. 2015. Available from: www.ijcem.com/
5. Duan XR, Liang YB, Friedman DS, Sun LP, Wong TY, Tao QS, et al. Normal macular thickness measurements using optical coherence tomography in healthy eyes of adult Chinese persons: The Handan Eye Study. Ophthalmology. 2010;117(8):1585–94.
6. Haves A. 451-1107-2-PB. Ashan, Haves (2020) Karakteristik Ketebalan Makula Sentral Sebelum dan Sesudah Injeksi IntravitrealBevacizumab di RSKM Padang Eye Center Periode Januari 2018 – Januari 2019 Health & Medical Journal 2 01-07 1033854/heme.v2i2451. 2020;
7. Chan A, Duker JS, Ko TH, Fujimoto JG, Schuman JS. Normal Macular Thickness Measurements in Healthy Eyes Using Stratus Optical Coherence Tomography. Vol. 124, Arch Ophthalmol. 2006.
8. Schechet SA, Devience E, Thompson JT. THE EFFECT OF INTERNAL LIMITING MEMBRANE PEELING ON IDIOPATHIC EPIRETINAL MEMBRANE SURGERY, WITH A REVIEW OF THE LITERATURE.
9. Aydin T, Kerci SG, Karti O, Zengin MO, Kusbeci T. Effect of Internal Limiting Membrane Peeling on Macular Structure and Metamorphopsia Scores in Idiopathic Epiretinal Membrane Surgery. Open Ophthalmol J. 2020 Mar 28;14(1):1–8.
10. Amouyal F, Shah SU, Pan CK, Schwartz SD, Hubschman JP. MORPHOLOGIC FEATURES AND EVOLUTION OF INNER RETINAL DIMPLES ON OPTICAL COHERENCE TOMOGRAPHY AFTER INTERNAL LIMITING MEMBRANE PEELING. Vol. 34, RETINA. 2014.
11. Lai TY, Kwok FRCS AK, Lai MRCS TY, Yuen MRCS KS. Epiretinal membrane surgery with or without internal limiting membrane peeling A BSTRACT. Vol. 33, Clinical and Experimental Ophthalmology. 2005.
12. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement [Internet]. Canada; 2009 Aug. Available from: www.annals.org
13. Schadlu R, Tehrani S, Shah GK, Prasad AG. LONG-TERM FOLLOW-UP RESULTS OF ILM PEELING DURING VITRECTOMY SURGERY FOR PREMACULAR FIBROSIS. Vol. 28, RETINA. 2008.
14. Lim JW, Cho JH, Kim HK. Assessment of macular function by multifocal electroretinography following epiretinal membrane surgery with internal limiting membrane peeling. Clinical Ophthalmology. 2010;4(1):689–94.
15. Lee JW, Kim IT. Outcomes of idiopathic macular epiretinal membrane removal with and without internal limiting membrane peeling: A comparative study. Jpn J Ophthalmol. 2010 Mar;54(2):129–34.
16. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomised Studies in Meta-Analyses. Department of Epidemiology and Commuunity Medicine, University of Ottawa. 2011;
17. Falkenstein IA, Cochran DE, Azen SP, Dustin L, Tammewar AM, Kozak I, et al. Comparison of Visual Acuity in Macular Degeneration Patients Measured with Snellen and Early Treatment Diabetic Retinopathy Study Charts. Ophthalmology. 2008 Feb;115(2):319–23.
18. Zhang B, Dong X, Sun Y. Effect of internal limiting membrane peeling for idiopathic epiretinal membrane. Heliyon. 2023 Mar 1;9(3).
19. Iuliano L, Fogliato G, Gorgoni F, Corbelli E, Bandello F, Codenotti M. Idiopathic epiretinal membrane surgery: Safety, efficacy and patient related outcomes. Vol. 13, Clinical Ophthalmology. Dove Medical Press Ltd; 2019. p. 1253–65.
20. Ducloyer JB, Ivan J, Poinas A, Lebreton O, Bonissent A, Fossum P, et al. Does internal limiting membrane peeling during epiretinal membrane surgery induce microscotomas on microperimetry? Study protocol for PEELING, a randomized controlled clinical trial. Trials. 2020 Jun 8;21(1).
21. Obata S, Fujikawa M, Iwasaki K, Kakinoki M, Sawada O, Saishin Y, et al. Changes in Retinal Thickness after Vitrectomy for Epiretinal Membrane with and without Internal Limiting Membrane Peeling. Ophthalmic Res. 2017 Feb 1;57(2):135–40.
22. De Novelli FJ, Goldbaum M, Monteiro MLR, Aggio FB, Takahashi WY. SURGICAL REMOVAL OF EPIRETINAL MEMBRANE WITH AND WITHOUT REMOVAL OF INTERNAL LIMITING MEMBRANE Comparative Study of Visual Acuity, Features of Optical Coherence Tomography, and Recurrence Rate.
23. Chang S, Gregory-Roberts EM, Park S, Laud K, Smith SD, Quan ;, et al. Double Peeling During Vitrectomy for Macular Pucker The Charles L. Schepens Lecture [Internet]. Vol. 131, JAMA Ophthalmol. 2013. Available from: www.asrs.org]
24. Sultan H, Wykoff CC, Shah AR. Five-year outcomes of surgically treated symptomatic epiretinal membranes with and without internal limiting membrane peeling. Ophthalmic Surg Lasers Imaging Retina. 2018 May 1;49(5):296–302.
25. Lee HJ, Kim MS, Jo YJ, Kim JY. Thickness of the macula, retinal nerve fiber layer, and ganglion cell layer in the epiretinal membrane: The repeatability study of optical coherence tomography. Invest Ophthalmol Vis Sci. 2015;56(8):4554–9.
26. Huang Q, Li J. With or without internal limiting membrane peeling during idiopathic epiretinal membrane surgery: A meta-analysis. PLoS One. 2021 Jan 1;16(1 January).
27. Azuma K, Ueta T, Eguchi S, Aihara M. EFFECTS OF INTERNAL LIMITING MEMBRANE PEELING COMBINED WITH REMOVAL OF IDIOPATHIC EPIRETINAL MEMBRANE A Systematic Review of Literature and Meta-Analysis [Internet]. Vol. 37, RETINA. 2017. Available from: http://links.lww.
28. Ducloyer JB, Eude Y, Volteau C, Lebreton O, Bonissent A, Fossum P, et al. Pros and cons of internal limiting membrane peeling during epiretinal membrane surgery: A randomised clinical trial with microperimetry (PEELING). British Journal of Ophthalmology. 2024 Dec 17;
29. Wu L. Case report illustrates potential for complication with peeling. Costa Rica; 2017.
30. Abdelkader E, Lois N. Internal Limiting Membrane Peeling in Vitreo-retinal Surgery. Surv Ophthalmol. 2008 Jul;53(4):368–96.
31. Guber Ioana Pereni Hendrik N Scholl Ivo Guber Richard J Haynes JP. Outcomes after Epiretinal Membrane Surgery with or Without Internal Limiting Membrane Peeling. Ophthalmol Ther [Internet]. 2019; Available from: https://doi.org/10.6084/
32. Cubuk MO, Unsal E. Anatomic and functional results of idiopathic macular epiretinal membrane surgery. Int J Ophthalmol. 2020;13(4):614–9.
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2026-02-25
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How to Cite
Putri, D. P., Nabilah, Q. W., Wiraputra, B. M. S., & Telussa, A. E. (2026). Comparison of Vitrectomy with and without Internal Limiting Membrane Peeling for Idiopathic Epiretinal Membrane: A Meta-Analysis . Jurnal Klinik Dan Riset Kesehatan, 5(2), 101-111. https://doi.org/10.11594/jk-risk.05.2.2
