EC Ophthalmology

Purpose: This review explored whether adding internal limiting membrane (ILM) peeling to pars plana vitrectomy (PPV) influences postoperative outcomes in eyes with tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR).

Methods: A narrative literature review was conducted including comparative studies evaluating pars plana vitrectomy with and without ILM peeling for TRD secondary to advanced PDR. Eligible studies included randomized controlled trials, prospective interventional studies, and retrospective comparative cohort studies. Among postoperative outcomes, best-corrected visual acuity (BCVA) and epiretinal membrane (ERM) formation were the most prominently reported parameters.

Results: Across all included studies, retinal reattachment rates were generally high and comparable between ILM peeling and non-peeling groups. Postoperative ERM formation was consistently lower in eyes undergoing ILM peeling, with some studies reporting substantially reduced ERM incidence compared with non-peeling techniques. Findings regarding central macular thickness were variable across studies. Visual outcomes showed overall improvement following surgery in both groups; however, differences in final BCVA between ILM peeling and non-peeling groups were inconsistent. Rates of postoperative complications, including vitreous hemorrhage, recurrent retinal detachment, and neovascular glaucoma, were generally comparable between surgical approaches.

Conclusion: Despite inconsistent evidence regarding postoperative visual improvement, ILM peeling during diabetic vitrectomy was associated with potential anatomical advantages, including lower rates of postoperative ERM formation and reduced need for reoperation, without a clear increase in major complications. Therefore, ILM peeling may be beneficial in selected cases.

Keywords: Internal Limiting Membrane Peeling; Pars Plana Vitrectomy; Tractional Retinal Detachment; Proliferative Diabetic Retinopathy; Epiretinal Membrane

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