Internal Limiting Membrane Peeling in Macular Hole Surgery; Why, When, and How?

Chatziralli, Irini; Theodossiadis, Panagiotis; Steel, David

doi:10.1097/iae.0000000000001959

Cited by 81 publications

(70 citation statements)

References 115 publications

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“…[71][72][73] In general, it is thought that large, chronic, and myopic macular holes may benefit from ILM peeling, while small, recent macular holes may not need ILM peeling in all cases. 74 A cost-effectiveness analysis was also performed alongside a RCT and concluded that ILM peeling is a cost-effective treatment for FTMH compared to no-peeling technique over a 6-month period and was based on the higher number of reoperations required in the no-peel arm of the trial. 75 Indocyanine green (ICG), trypan blue (TP), brilliant blue (BB), and other dyes, as well as triamcinolone acetonide (TA), have been reported to optimize visualization of the ILM during surgery.…”

Section: P189mentioning

confidence: 99%

Idiopathic Macular Hole Preferred Practice Pattern®

et al. 2020

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Section: P189mentioning

confidence: 99%

Idiopathic Macular Hole Preferred Practice Pattern®

et al. 2020

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“…VA improvement largely depends on pre-operative VA, MH size, and symptoms duration. [1,16,18] In 2001, the American Academy of Ophthalmology published an ophthalmic technology assessment report investigating and reporting the accumulated knowledge regarding the treatment of MHs. [7] This report was based on a broad literature review that included three multicentered randomized controlled trials (RCTs) comparing surgery versus observation for MHs.…”

Section: Treatment Modalities For Mhs Vitrectomymentioning

confidence: 99%

“…Being a relatively rigid membrane, removal of the ILM aids hole closure by improving retinal compliance. [16] ILM peeling further helps healing by removing vitreous cortex residues which can exert traction after surgery, eliminating the bed for fibrocellular proliferation surrounding the hole, and promoting glial cell proliferation which was found to improve hole contraction [16,18,22]…”

Section: Rationalementioning

confidence: 99%

“…[23] ILM peeling is challenging and carries additional risks including increased surgery time, use of intraocular dyes, retinal toxicity, increased retinal inflammation and edema, and mechanical retinal damage. [18,23] Vital dyes are used to enhance the ILM visualization and improve safety during surgery. In addition to increasing ILM visibility, vital dyes may make the ILM more rigid and fragile.…”

Section: Ilm Dyeingmentioning

confidence: 99%

“…In addition to increasing ILM visibility, vital dyes may make the ILM more rigid and fragile. [18] The first dye in use was indocyanine green (ICG). [18] It allows good visualization of the ILM but shortly after its introduction, it became clear that ICG causes dose-dependent retinal toxicity.…”

Section: Ilm Dyeingmentioning

confidence: 99%

See 2 more Smart Citations

Idiopathic macular holes – A review of current management strategies

Sela¹,

Hadayer²,

Zahavi³

2019

cleverjournal

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Description of the Condition Macular holes (MHs) are retinal defects which involve the center of the anatomical fovea. [1,2] Severity may range from asymptomatic incidentally discovered MHs, to advanced vision-threatening ones. [2,3] MHs are often described according to the extent of retinal layers involvement. Full-thickness MHs (FTMHs) encompass all the layers of the retina from the internal limiting membrane (ILM) to the retinal pigmented epithelium (RPE) [Figure 1]. [2] Partialthickness MHs, also termed lamellar holes, involve only the inner retinal layers, while the photoreceptors layer may remain intact [Figure 2]. [2,3] Although the majority of cases are idiopathic (>85%), MHs may also be secondary to various conditions, among the most common of which are high myopia and ocular trauma. [2,4,5] Kumawat et al. described in detail other infrequent causes of secondary MHs. [5] Epidemiology The reported prevalence of idiopathic MHs (IMHs) in the general population ranges between 0.02% and 0.33%. [1,4] IMHs are more common in women (approximately 70% of cases) and usually appear in the 6 th and 7 th decades of life. [1,4,6] For patients with an idiopathic FTMH in one eye, the risk for developing an MH in the fellow eye is 10-20%. [1,7] Pathophysiology IMHs are the sequelae of vitreomacular adhesion (VMA) and traction (VMT). [2] The vitreous is a clear gel-like structure enveloped by a hyaloid membrane (the vitreous cortex), the posterior part of which is attached to the ILM of the retina. With aging, the vitreous body liquefies, shrinks, and gradually detaches from the retina, starting at the posterior pole. Physiologically, the vitreous will continue to detach from the retina and eventually remain firmly attached to the retina only at the vitreous base, straddling the ora serrata. In most cases, this process results in no retinal damage. [2,8,9] However, incomplete or abnormal detachment may result in pathologic VMA and VMT, which can distort the foveal contour and result in MH formation [Figure 3]. [8] The traction forces affect the foveola and might impair central vision, causing distorted vision or decreased visual acuity (VA). [2,5,10]

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