Title : Safety and efficacy of internal limiting membrane peeling in idiopathic epiretinal membrane surgery an umbrella review of visual functional and structural outcomes
Abstract:
Purpose: This umbrella review evaluates the efficacy, safety, functional, and anatomical outcomes of internal limiting membrane (ILM) peeling versus no peeling in idiopathic epiretinal membrane (iERM) surgery.
Methods: A systematic search of PubMed/MEDLINE, Scopus, Web of Science, ProQuest, and Cochrane Library (2010–2025) identified comparative studies. Twenty-five systematic reviews with meta-analyses were included, prioritizing randomized evidence. Outcomes included best-corrected visual acuity (BCVA), microperimetric sensitivity, metamorphopsia, central macular and retinal thickness, ERM recurrence, and adverse events. Methodological quality was assessed with AMSTAR and certainty with GRADE; primary-study overlap was considered.
Results: In iERM, meta-analyses of randomized controlled trials show no significant BCVA difference between ILM peeling and no peeling at 3–12 months. Microperimetry demonstrates a small subclinical sensitivity decrease after ILM peeling; effects on metamorphopsia are unclear. ILM peeling makes the central retina slightly thicker at 3–12 months, with partial improvement over time. Major complications are rare and similar. The main benefit is lower ERM recurrence and fewer reoperations. Review recommendations on safer practice favored the use of BBG/MB Dual dyes and gentle, limited peels.
Conclusions: For iERM, ILM peeling lowers recurrence and reoperation without sacrificing visual acuity; functional and structural trade-offs are small and typically subclinical. More randomized trials should compare different dyes and peel sizes, and use consistent measures of function (like microperimetry), to better identify which patients benefit most.
