Internal limiting membrane (ILM) peeling on blood flow in diabetic macula
Reviewed by Kurt Spiteri Cornish

This is a retrospective review of notes for diabetic patients with epiretinal membrane (ERM) who underwent surgery by the same surgeon. Nineteen had ERM peeling only, while the remaining 18 had both ERM and internal limiting membrane (ILM) peeling. The postoperative best corrected visual acuity (BCVA) improved in both groups (p=0.516) with an improvement in central macular thickness (CMT, p=0.122). No recurrence of ERM was found during the six-month follow-up. In the superficial capillary plexus (SCP), there was no difference in vessel density (VD) or vessel length density (VLD) between the two groups. The VD of both groups was higher than the preoperative level, and the VLD decreased. In the deep capillary plexus (DCP), the VD was lower in the ILM peel group than that in the ERM peeling group and remained lower than the preoperative level. In the ERM only group, the VD gradually increased by month six to a level higher than before surgery. VLD decreased in both groups and then gradually increased, but this was delayed in the ILM group. At month six, the VLD was higher than before surgery in the ERM only group compared to the ILM group, where it remained lower. The authors conclude that, even though anatomical and functional outcomes were similar in both groups, intraoperative peeling of the ILM in patients with diabetic ERM can have an inhibitory effect on deep retinal vascular recovery. Further studies into the mechanism of Muller cells regulating microcirculation changes after ILM peeling are warranted.

Effect of internal limiting membrane peeling or not on blood flow signal in macular area of diabetic patients with preretinal membrane.
Li B, Du Y, Gou W, et al.
CURRENT EYE RESEARCH
2023;48(6):584-90.