The alternative approach to epiretinal fibrosis surgery

Purpose . To evaluate the possibility of removal of epiretinal fibrosis (ERF) with complete saving of the internal limiting membrane (ILM) to reduce the risk of iatrogenic intraoperative trauma associated with the procedure of ILM removing, and postoperative complications associated with retinal nerve fiber layer damage developing as a result of ILM removing. Material and methods . The study included 54 patients with ERF, whose average age was 69.5 years. In the course of surgical treatment, it was planned to remove the epiretinal membrane (ERM) with an attempt to completely ILM saving. In all cases, after removal of the vitreous, epiretinal structures were stained with MembranBlue Dual and ERM was removed, trying to completely ILM saving. The anatomical result was evaluated according to optical coherence tomography. The functional result was evaluated according to the indicators of best corrected visual acuity (BCVA). The maximum follow-up period was 12 months. Results. It was possible to remove the ERM with complete ILM saving in 26 (48.14 %) patients, in 28 (51.86 %) the ERM was removed in a single unit with the ILM. In all cases, the postoperative period proceeded without peculiarities and complications. At a follow-up examination after 3 months, all 54 patients showed an increase of BCVA compared to preoperative value. There was no BCVA decrease in any case during this follow-up period. In cases of the ERM removal with the ILM saving in the long-term postoperative period (12 months), no recurrence of ERF was recorded, as in cases where the ILM was removed. Conclusions. It was possible to reduce intraoperative retinal injury due to the ILM saving during the ERM removal in 48.14 % of cases, using standard vitreoretinal instruments and techniques. According to the study, the ILM saving does not lead to a recurrence of ERF in the long-term postoperative period.