Abstract

Purpose
We hypothesised that cleaning the internal limiting membrane (ILM) with a flexible nitinol loop
following diabetic vitrectomy without peeling may reduce the common occurrence of postoperative
epiretinal membrane (ERM) formation.
Methods
Consecutive patients undergoing vitrectomy for proliferative diabetic retinopathy by one surgeon
from 2015-2019 were studied and divided into two cohorts: the control group underwent standard
surgery; the ILM-Clean group underwent additional cleaning of the macular retina using a flexible
nitinol loop post-vitrectomy. Masked comparison of ERM on optical coherence tomography was
performed at 3 months and visual acuity (VA) was measured until 12 months postoperatively.
Results
Baseline demographics, clinical features and protein levels were similar between cohorts. The ILMClean
group (n=56) had fewer clinically significant ERM compared to the control group (n=50)
(4%vs.20%;p=0.01) and a significantly lower proportion of the ILM-Clean group required revision
surgery (2%vs.14%;p=0.02). VA in the ILM-Clean group was significantly better than the control group
at 3 months (0.35vs.0.50logMAR;p=0.02) but not at 12 months (0.34vs.0.43logMAR;p=0.17).
Conclusion
ILM cleaning with a flexible nitinol loop following diabetic vitrectomy resulted in significant reduction
in ERM formation and reduced necessity for revision surgery. There was significant improvement in
VA at 3 months but not over longer follow-up.