MACULAR PUCKER To Peel or Not to Peel the Internal Limiting Membrane? A Microperimetric Response GUIDO RIPANDELLI, MD,* FABIO SCARINCI, MD,* PAOLO PIAGGI, PHD,†‡ GIANLUCA GUIDI, MD,§ MARCO PILERI, MD,¶ GAETANO CUPO, MD,* MARIA S. SARTINI, MD,§ VINCENZO PARISI, MD,* SARA BALDANZELLU, MD,¶ CRISTIANO GIUSTI, MD,** MARCO NARDI, MD,§ MARIO STIRPE, MD,* STEFANO LAZZERI, MD* Background: To compare functional and anatomical outcomes after idiopathic macular pucker removal between eyes that underwent internal limiting membrane (ILM) peeling and eyes that did not. Methods: In this multicentric, randomized clinical trial, 60 eyes of 60 patients affected with idiopathic macular pucker were enrolled. Thirty eyes underwent 23-gauge pars plana vitrectomy associated with ILM peeling (“ILM peeling group”), whereas 30 eyes did not undergo ILM peeling (“ILM not peeling group”). Retinal sensitivity, frequency of microsco- tomas, and all the other microperimetric parameters were tested by MP1 microperimetry. Best-corrected visual acuity was investigated with the Early Treatment Diabetic Retinopa- thy Study chart. Anatomical outcomes were analyzed with spectral domain optical coher- ence tomography. Results: After a 12-month follow-up, the mean retinal sensitivity in the 4° central area showed a greater and faster recovery in the ILM not peeling group than in the ILM peeling group (P = 0.041). The number of absolute microscotomas (0 dB) within the 12° central retinal area was significantly higher in the ILM peeling group than in the ILM not peeling group (P = 0.044). Conclusion: The ILM not peeling group seems to show better outcomes than the ILM peeling group as measured by mean retinal sensitivity and number of microscotomas after a 12-month follow-up. RETINA 35:498–507, 2015 I diopathic epiretinal membrane (ERM) is a common disease affecting 2% of individuals younger than 60 years of age and 12% in those older than 70 years. 1 The pathogenesis of ERMs is not well known. Some authors hypothesize that ERM could develop as a result of microbreaks in the retina after posterior vitreous detachment, allowing for the migration of fibroblasts, glial cells, and astrocytes from the retina to the internal limiting membrane (ILM), where they proliferate. 2 However, the most recent hypothesis states that col- lapse of the liquefied vitreous body without sufficient dehiscence at the vitreoretinal interface can induce a split within the posterior vitreous cortex (vitreoschi- sis), leaving the outermost layer of the posterior vitre- ous cortex attached to the macula. 3 Visual disturbance resulting from decreased best- corrected visual acuity (BCVA) with or without metamorphopsia because of retinal wrinkling and distortion is the main indication for ERM surgery. 4 Epiretinal membrane symptoms also include microp- sia, macropsia, and monocular diplopia. 5 Surgery for ERMs has been a common vitreoretinal procedure for many years. 6 Indeed, previous works have reported good results in patients with symptomatic From the *Scientific Institute of Admission and Care, “G. B. Bietti” Foundation, IRCCS, Rome, Italy; Departments of †Endocri- nology and Metabolism, ‡Energy and Systems Engineering, and §Surgical, Medical and Molecular Pathology, and Critical Area, University of Pisa, Pisa, Italy; ¶Department of Ophthalmology, Ospedale San Giovanni Addolorata, Rome, Italy; and **Department of Ophthalmology, University “Campus Bio-Medico,” Rome, Italy. None of the authors have any financial/conflicting interests to disclose. Reprint requests: Stefano Lazzeri, MD, Ophthalmology Unit, Department of Surgical, Medical, and Molecular Pathology, and Critical Area, University of Pisa, Via Paradisa, 2, Building 30/A, Oculistica Universitaria, 56100 Pisa, Italy; e-mail: stefano_lazzeri@ hotmail.it 498