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Peel and peel again
S K Gibran1, B Flemming, T Stappler
1St Paul's Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK. syedgibran@yahoo.com
Aim:
To determine if the internal limiting membrane (ILM) was present in the epiretinal membrane (ERM) when we deliberately tried to perform a "double peel" for macular pucker.
Methods:
Pars-plana vitrectomy and a "double peel" were carried out. The ERM and ILM were stained with Trypan Blue and peeled separately over the same area. The amount of ERM present in ILM specimens and the amount of ILM present in ERM specimens were evaluated by histological examination.
Results:
Seventeen eyes in 17 patients were included. It was possible to double peel in all cases. Five of 17 ERM specimens (29%) contained ILM fragments. When ILM was present on the ERM, it represented less than 50% of the sample. One ILM specimen was lost as result of an administrative error; of the remaining 16 specimens, residual ERM was found in six, and cellular remnants were observed on the vitreous surface in a further six of the ILMs. Clinically, no recurrence of ERM was found.
Conclusion:
ILM was present in some ERM specimens seemingly over the same area that an intact ILM was subsequently peel. We speculate that the ILM in the ERM represent a secondary basement membrane and that the surgical plane of dissection for most ERM peel is between the ERM and the native ILM, making it feasible to double peel routinely.
Insights
Internal limiting membrane (ILM) fragments were found in epiretinal membrane (ERM) specimens during macular pucker surgery. This suggests a secondary basement membrane may be present, making routine "double peeling" feasible.
Area of Science:
- Ophthalmology
- Retinal Surgery
Background:
- Epiretinal membrane (ERM) peeling is a common surgical procedure for macular pucker.
- The internal limiting membrane (ILM) is often removed with the ERM, but its consistent presence within ERM specimens is debated.
Purpose of the Study:
- To investigate the presence of ILM within ERM specimens obtained during a deliberate "double peel" technique for macular pucker.
- To assess the feasibility and implications of separating ERM and ILM during surgery.
Main Methods:
- Pars-plana vitrectomy with a "double peel" technique was performed on 17 eyes.
- Epiretinal membranes (ERMs) and internal limiting membranes (ILMs) were stained with Trypan Blue and peeled separately.
- Histological examination evaluated the presence of ILM in ERM specimens and ERM in ILM specimens.
Main Results:
- A "double peel" was successful in all 17 cases.
- Internal limiting membrane (ILM) fragments were identified in 29% (5/17) of epiretinal membrane (ERM) specimens.
- Residual ERM or cellular remnants were found in some ILM specimens, with no observed clinical recurrence of ERM.
Conclusions:
- The internal limiting membrane (ILM) can be present within epiretinal membrane (ERM) specimens, even when seemingly peeled separately.
- This suggests the ILM in ERM may be a secondary basement membrane.
- The surgical plane between the ERM and native ILM allows for routine "double peeling" in macular pucker surgery.
