title: DETRIMENTAL EFFECTS OF ACTIVE INTERNAL LIMITING MEMBRANE PEELING DURING EPIRETINAL MEMBRANE SURGERY: Microperimetric Analysis.
abstract: BACKGROUND
  The aim of the study was to assess the microperimetric consequences of active internal limiting membrane (ILM) peeling during idiopathic epimacular membrane (IEMM) surgery.
  
  
  METHODS
  This retrospective monocentric study included 32 eyes of 31 consecutive patients who underwent IEMM surgery. Internal limiting membrane integrity was assessed by ILM Blue staining after IEMM removal: peeling was spontaneous (Group S) or active (Group A). Preprocedure and postprocedure (1 and 6 months) examinations were performed using visual acuity determination, spectral domain optical coherence tomography and microperimetry.
  
  
  RESULTS
  Twenty-two eyes had an "active ILM peeling" and 10 a "spontaneous ILM peeling." Both groups had comparable and significant improvements in visual acuity 6 months after surgery (+1.82 lines [+9 letters] [Group A] and +1.51 lines [+8 letters] [Group S], P < 0.01) associated with a significant reduction in optical coherence tomography central thickness (-99.9 μm [Group A], P < 0.01 and -62.2 μm [Group S], P = 0.05). Six months after surgery, the microperimetry showed more numerous and deeper microscotomas in the Group A than in the Group S (change in the number of microscotomas: 2.09 vs. -0.10, P = 0.06; change in deficit severity score: 13.18 dB vs. -2 dB, P < 0.01 for Group A and S, respectively). The number of microscotomas and also severity were increased in 63.6% of Group A patients and in only 20% of Group S patients. Microscotomas were most frequently located in IEMM and/or ILM areas.
  
  
  CONCLUSIONS
  Internal limiting membrane peeling has progressively become generalized in IEMM surgery to reduce recurrences. This additional procedure does not change the postoperative visual acuity but increases the development of deeper microscotomas. The real impact on the quality of vision remains unclear.
  
  
  CONCLUSIONS
  Active ILM peeling in IEMM surgery may be responsible for visual impairment related to its microtraumatic effects.
authors.affiliation: *Service d'ophtalmologie, Centre hospitalier universitaire de Nantes, Nantes, France; and †Ophthalmology Service, Centre hospitalier du Mans, Le Mans, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Deltour
authors.forename: Pierre
authors.initials: P
authors.lastname: Grimbert
authors.forename: Helene
authors.initials: H
authors.lastname: Masse
authors.forename: Olivier
authors.initials: O
authors.lastname: Lebreton
authors.forename: Michel
authors.initials: M
authors.lastname: Weber
mesh_terms: D000368:Aged; D001485:Basement Membrane / Q000601:surgery*; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012607:Scotoma / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields; D014821:Vitrectomy