Retinal Damage Induced by Internal Limiting Membrane Removal

Abstract

The internal limiting membrane (ILM), the basement membrane of the Müller cells, serves as the interface between the vitreous body and the retinal nerve fiber layer. It has a fundamental role in the development, structure, and function of the retina, although it also is a pathologic component in the various vitreoretinal disorders, most notably in macular holes. It was not until understanding of the evolution of idiopathic macular holes and the advent of idiopathic macular hole surgery that the idea of adjuvant ILM peeling in the treatment of tractional maculopathies was explored. Today intentional ILM peeling is a commonly applied surgical technique among vitreoretinal surgeons as it has been found to increase the rate of successful macular hole closure and improve surgical outcomes in other vitreoretinal diseases. Though ILM peeling has refined surgery for tractional maculopathies, like all surgical procedures it is not immune to perioperative risk. The essential role of the ILM to the integrity of the retina and risk of trauma to retinal tissue spurs suspicion with regard to its routine removal. Several authors have investigated the retinal damage induced by ILM peeling and these complications have been manifested across many different diagnostic studies.

Effect of internal limiting membrane peeling on normal retinal function evaluated by microperimetry-3

“…Controversy focused on the potential side effects of ILM-peeling. Major side effects of ILM peeling have been reported as potential mechanical or functional damage to retina [2][3][4][5][6][7][8][9][10]. Previous studies about retinal functional changes that caused by ILM peeling are conflicting: some studies reported no changes after peeling [11,12], whereas others showed decrease of retinal sensitivity [13,14].…”

Non-inverted pedicle internal limiting membrane transposition for large macular holes

“…Instead, the pedicle of the ILM attached to the retina allows us to cover the MH in a noninverted way, which would be more physiological. Gelman et al [13] have reviewed some retinal damage induced by ILM removal including damage to müller cell, dissociated optic nerve fiber layer, and phototoxic damage. A number of studies have also investigated the histopathological characteristic of ILM [14,15].…”

Effect of internal limiting membrane peeling on normal retinal function evaluated by microperimetry-3

“…Controversy focused on the potential side effects of ILM-peeling. Major side effects of ILM peeling have been reported as potential mechanical or functional damage to retina [2][3][4][5][6][7][8][9][10] . Previous studies about retinal functional changes that caused by ILM peeling are conflicting: some studies reported no changes after peeling [11,12] , whereas others showed decrease of retinal sensitivity [13,14] .…”