Complications of Macular Peeling

Abstract

Macular peeling refers to the surgical technique for the removal of preretinal tissue or the internal limiting membrane (ILM) in the macula for several retinal disorders, ranging from epiretinal membranes (primary or secondary to diabetic retinopathy, retinal detachment…) to full-thickness macular holes, macular edema, foveal retinoschisis, and others. The technique has evolved in the last two decades, and the different instrumentations and adjuncts have progressively advanced turning into a safer, easier, and more useful tool for the vitreoretinal surgeon. Here, we describe the main milestones of macular peeling, drawing attention to its associated complications.

Effects of internal limiting membrane peeling during vitrectomy for macula-off primary rhegmatogenous retinal detachment

“…This displacement has been shown to occur secondary to alterations in axonal transport and contractility in the retinal nerve fiber layer caused by apoptotic and atrophic degeneration in the peripapillary region. 37 Finally, no patient in our study exhibited edema or macular hole at the end of the followup period. Collectively, these findings support the safety of ILM peeling.…”

Eccentric Macular Hole Formation Following Successful Macular Hole Surgery

“…Regarding further intervention, it is necessary to consider the BCD-VA, the location of the MH, and its evolution in terms of size (3). In rare cases, an eccentric MH may enlarge and lead to central MH re-opening (2,4). In our case, no further intervention was recommended since the BCDVA and fundus findings remained stable.…”

“…The presence of an eccentric MH is a rare finding in patients after ILM peeling, reported in less than 0.6% of cases (2,3). Several theories have been proposed concerning the pathogenesis implicated, including induced surgical trauma, the use of intraocular dyes during the peeling, removal of the ILM layer itself inducing a weakening of retinal glial structures, and the contraction of the residual ILM (3,4).…”

“…Surgical treatment options for MH include: pars plana vitrectomy and intravitreal ocriplasmin application (1). Vitrectomy, with internal limiting membrane (ILM) peeling and gas tamponade has become a routine technique for MH surgery, with a postoperative closure rate of 90% (1,2). However, macular ILM peeling has been associated with complications, including trauma to the retina, macular phototoxicity, focal retinal hemorrhages, macular edema, postoperative swelling of the arcuate retinal nerve fiber layer (SANFL) followed by dissociated optic nerve fiber layer (DONFL), foveal displacement and, in extremely rare cases, iatrogenic eccentric full-thickness retinal breaks (2).…”

Analysis of Retinal Architectural Changes Using Intraoperative OCT Following Surgical Manipulations With Membrane Flex Loop in the DISCOVER Study

“…9 Various surgical techniques have been described, including “pinch-and-peel” techniques and membrane engagement with a diamond-dusted membrane scraper. Retinal architectural alterations and tissue trauma have been reported as intraoperative complications related to ILM peeling.…”