Macular Edema Management with Multiple IVTs Required: There is No Reason Why ILM Peeling Should Not Be Considered at One Time



A discussion why ILM peeling should be proposed to every patient with a recurrent or chronic Macula Edema.


All kinds of RVO, BRVO, or DR could be associated to a recurrent or chronic ME. EVRS ME study teached us possibility of very good results with ILM peeling, and efficiency didn’t depend to the etiology. With time, studies and experience, we understood too that results of IVTs for ME were similar for both vitrectomized or non-vitrectomized eyes. A lot of patients treated by ILM surgery for ME didn’t have had ME recurrence and didn’t have had more treatments needed. For patients with ME recurrence after ILM peeling, IVTs or a lot of different treaments (combined or not) are still possible, and can improve VA if decreased. With a very few rate of complications associated with such surgery, clearly quite similar to multiple IVTs rate of complications, ILM peeling is a very safe surgery. Cost of ME treatment obviously increased concomitantly with the number of IVTs: whatever a safe treatment is possible with huge reduce of the cost, it should be considered, and this treatment for ME is ILM peeling.


Regarding our current knowledge, there is no evidence of superiority of achieving results with IVTs compared to ILM peeling with or without IVTs after surgery if needed. In addition, when taking the very high cost of multiple IVTs into consideration, there is no reason why ILM peeling should not be considered at one time for all recurrent or chronic ME.



Frédéric Hamon, Rita Soyeur
St Jean de Luz & Biarritz, France