Functional and Structural Measurements for the Assessment of Internal Limiting Membrane Peeling in Idiopathic Macular Pucker

In Brief Objective: To investigate the role of structural and functional measurements in the assessment of internal limiting membrane (ILM) peeling for the treatment of eyes with macular pucker. Methods: Ten patients with macular pucker who underwent pars plana vitrectomy with ILM peeling were studied prospectively. Visual acuity measurement, standard automated achromatic perimetry, multifocal electroretinography (mfERG), and optical coherence tomography (OCT) were performed before and 3 months after surgery. Four surgical samples obtained from similar patients were analyzed with electron microscopy. Results: Three months after surgery, mean visual acuity ± SD was significantly improved from 0.4 ± 0.11 logMAR to 0.19 ± 0.13 logMAR (P ≤ 0.002), and mean central retinal thickness ± SD was significantly decreased 428 ± 73 μm to 326 ± 34 μm (P ≤ 0.002). The mfERG response amplitudes were slightly decreased in eight patients, and five of these patients also had asymptomatic decreases in visual field sensitivity. The electron micrographs revealed segments of Müller cell footplates on the retinal side of the ILM in all four specimens. Conclusion: In this study, the use of mfERG, OCT, and standard automated achromatic perimetry showed changes in macular function and structure postoperatively. These measures of visual function and structure allow for better evaluation of the surgical outcome and understanding of the changes that may occur after ILM peeling. In this prospective study of 10 patients undergoing vitrectomy with internal limiting membrane peeling for the treatment of macular pucker, there was evident improvement in visual acuity, sensitivity, and morphology after surgery; however, there was a mild decrease in multifocal electroretinography response amplitudes in the peeled areas.