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Experimental principles and indications of internal limiting membrane peeling
Author(s) -
CREUZOT CP
Publication year - 2008
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2008.5211.x
Subject(s) - macular hole , epiretinal membrane , medicine , inner limiting membrane , internal limiting membrane , macular edema , limiting , ophthalmology , surgery , visual acuity , retinal , vitrectomy , mechanical engineering , engineering
Purpose The removal of the internal limiting membrane (ILM) has become a widely accepted option in macular surgery. We will present the fundamental and clinical features to assess the influence of this technique in the management of surgical macular diseases. Methods The internal limiting membrane peeling is considered as an option to the commonly accepted treatment of macular hole surgery but its place remains under debate. Different studies were performed to assess the influence of ILM peeling on the outcome of macular hole, epiretinal membrane or macular edema. However they frequently combined different factors as well as different surgical techniques. Results The ILM should constitute a scaffold for glial cell proliferation if not removed. It should increase the rate of success and decrease the rate of late opening of macular hole but it remains speculative and controversial at the moment. About all the studies assessing the efficacy of ILM peeling in macular hole surgery are retrospective. All the studies about ILM peeling in macular edema or epiretinal membrane are non randomized study. The peeling of ILM is possible without any staining. However, the difficulty to peel it without trauma of the retina and even more the putative toxic risk of the different dyes to facilitate its removal are of concern. Conclusion The ILM peeling represents an interesting option in the treatment of macular hole surgery but its place needs to be defined more clearly. In the future, we have to define “individual” treatment considering all influencing factors (size, onset, stage of macular hole) to choose a “tailored” treatment.