A randomised controlled trial evaluating internal limiting membrane peeling forceps in macular hole surgery

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 261; no. 6; pp. 1553 - 1562
• Main Authors: Ferrara, Mariantonia, Rivera-Real, Antonio, Hillier, Roxane J., Habib, Maged, Kadhim, Mustafa R., Sandinha, Maria T., Curran, Katie, Muldrew, Alyson, Steel, David H. W.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2023; Springer Nature B.V
• Subjects: Acuity; Archives & records; Basement Membrane - pathology; Basement Membrane - surgery; Epiretinal Membrane - surgery; Eye; Humans; Iatrogenesis; Lasers; Macular Holes; Medicine; Medicine & Public Health; Ophthalmology; Optic nerve; Retina; Retina - pathology; Retinal Disorders; Retinal Perforations - diagnosis; Retinal Perforations - surgery; Retrospective Studies; Statistical analysis; Surgeons; Surgery; Tomography, Optical Coherence; Visual field; Vitrectomy; Internal limiting membrane forceps; Full-thickness macular hole; Swelling of arcuate nerve fibre layer lesion; Internal limiting membrane; Proof of concept randomised controlled trial; Inner retina defects; Dissociated optic nerve fibre layer lesions
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-022-05932-y

Purpose To assess study design and a range of anatomical and functional changes after internal limiting membrane (ILM) peeling using forceps developed for atraumatic ILM pick-up compared to standard forceps. Methods We conducted a masked proof-of concept randomised controlled trial (RCT) on 65 patients who underwent ILM peeling for idiopathic full-thickness macular hole (FTMH) using etched-tip forceps (etched-tip group, 33 eyes) compared to standard ILM forceps (smooth-tip group, 32 eyes). Patients were assessed preoperatively, 3 weeks, 3 and 6 months postoperatively. Results The primary closure rate was 95.4%. There was no statistically significant difference between the groups in terms of final visual acuity (66.9 vs 70.9 ETDRS letters, p  = 0.13), difference of visual field mean deviation (1.32 vs 1.14 decibels), and number of eyes with pick-up-related retinal haemorrhages (16% vs 16%, p  = 0.96), swelling of arcuate nerve fibre layer lesions (63% vs 55%, p  = 0.54), number of dissociated optic nerve fibre layer lesions (31.4 vs 41.0, p  = 0.16), nor inner retina defects (37% vs 22%, p  = 0.17). Similar changes in inner retinal volumes were detected in all 9 sectors of an ETDRS grid except for a trend ( p  = 0.06) towards a lower reduction in the inferior inner sector in the etched-tip group. Conclusions The study was successfully completed with masking maintained and a low risk of bias. Multiple endpoints relating to ILM peeling were assessed, and estimates were provided that can be used for future studies. Although the study was not powered to assess any specific endpoint, the anatomical and functional outcomes assessed did not significantly differ.