Internal Limiting Membrane Peeling During Idiopathic Epiretinal Membrane Removal

Abstract

Idiopathic epiretinal membrane (ERM) is characterized by the growth of fibrocellular tissue on the internal limiting membrane (ILM). An ERM can range from a subtle cellophane-like film that does not cause any visual disturbance to a significant, multilayered, contractile membrane with folds in the underlying and adjacent retina, causing metamorphopsia and a decline in visual acuity. Although the exact pathogenesis of ERM formation is unclear, it is known to be associated with posterior vitreous detachment 1 leading to hypertrophy of glial (Muller) cell processes and the accumulation of extracellular matrix components on the ILM. The ILM is the basement membrane of the Muller cells. 2,3 ' ERM Surgery Pars Plana VitrectomyAlthough there are rare cases in which an ERM spontanously separates from the retina and induces regression of the macular distortion, 4,5 in the great majority of cases it remains stable or progresses slowly. Progression of an ERM often results in underlying retinal changes with thickening and/or folds that can lead to a decline in visual acuity. Standard pars plana vitrectomy to remove the vitreous gel and ERM has traditionally been the standard of therapy for visually significant ERM and usually results in significant regression of the retinal thickening and/or folds. However, reports show that the

Internal limiting membrane peeling or not: a systematic review and meta-analysis of idiopathic macular pucker surgery

“…Visual acuity findings in our meta-analysis are likely explained by the fact that additional ILM peeling provided no improvement in functional outcomes, these findings were in consistent with the previous review,39 but contrast to a recent meta-analysis,40 which revealed that ILM peeling group had better BCVA after surgery within 12 months, but worse BCVA in the 18th month.…”

Long-term Safety and Efficacy of Sutureless Vitrectomy for Combined Epiretinal and Internal Limiting Membrane Removal

“…However, it should be noted that the majority (11/12, 91.7%) of eyes with recurrent ERMs in our study were not visually significant, which is in agreement with prior work indicating that most recurrent ERMs are not clinically significant. 15 One possible explanation for the deviation in our results relative to prior studies is the significant presence of risk factors predisposing to ERM formation in our patient cohort, as described previously and seen in Table 1. Regardless, given the results of prior work regarding combined ERM and ILM removal and the clinical insignificance of recurrent ERMs noted herein, we are still of the opinion that removal of both ERM and ILM is still beneficial for patients choosing to undergo vitrectomy.…”

Long Term Outcomes after Pars Plana Vitrectomy for the Treatment of Epiretinal Membranes

“…The cause of its existence is not yet clear. However, it has been attributed mostly to posterior vitreous detachment (PVD) [1], which provokes glial cells (Muller) and extracellular components to accumulate and migrate on the ILM [2]. The prevalence of ERM ranges from 1.02% to 18.5% [3].…”

“…ERM is removed by the aid of a special substance which dyes the membrane on the ILM. Triamcinolone, indocyanine green and triphenylmethane (brilliant blue) are dyes which can be used during the operation [2]. The rate of recurrence of ERM formation is 10%-16.3% [1].…”

“…Furthermore, ILM peeling helps residual's ERM removal and provides lower risk of ERM's recurrence [5]. However, the ILM peel is still an issue, because it may cause damage on the inner retinal layers and on the optic nerve fiber layer [2]. In addition, the staining dyes may have a toxic effect on the retinal tissue, especially the triamcinolone, indocyanine green.…”