Related Experiment Video
Updated: Jun 17, 2026
Efficient and Consistent Generation of Retinal Pigment Epithelium/Choroid Flatmounts from Human Eyes for Histological Analysis
Published on: October 28, 2022
Does the presence of an epiretinal membrane alter the cleavage plane during internal limiting membrane peeling?
Nihal Kenawy1, David Wong, Theodore Stappler
1St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom. nkenawy@nhs.net
Purpose:
To determine whether the presence of a clinically and/or microscopically detectable epiretinal membrane (ERM) alters the cleavage plane during internal limiting membrane (ILM) peeling.
Design:
Retrospective, observational, immunohistochemical study of ILM specimens using archival formalin-fixed, paraffin-embedded tissue.
Participants:
Fifty-one patients who had had ILM excision.
Methods:
Fifty-one ILM specimens peeled during vitrectomy for various etiologies were examined by light microscopy. The removal of ILM was assisted using Trypan blue (n = 30), indocyanine green (n = 7), or brilliant blue G (n = 14). Monoclonal antibodies to glial fibrillary acidic protein and to neurofilament protein were used to detect glial or neuronal cells respectively on the vitreous or retinal surfaces of the ILM. Specimens were divided into 2 groups: ILM peeled for full-thickness macular hole (MH; n = 31) and ILM peeled after removal of clinically detectable ERM (n = 20).
Main Outcome Measures:
Primary outcome measure was the localization of immunohistochemical markers to neuronal or glial cells on the vitreous or retinal surfaces of ILM. The secondary outcome measure was the correlation of the results of the primary measure with the dyes used to facilitate ILM peeling.
Results:
Glial and/or neuronal cells were detected on the retinal surface of the ILM in 10 of 31 (32%) of the MH ILM specimens and in 13 of 20 (65%) of the ILM peeled after ERM excision; the difference was significant (P = 0.02). There was no association between the presence of neuronal and glial cells with the type of dye used (P = 0.2). Of the 23 ILM specimens with cells attached to the retinal surface, 21 (91%) were associated with clinical and/or histologic evidence of ERM and 2 (9%) were not. The correlation between the presence of cells on the vitreous and the retinal surfaces of ILM was high (P<0.0001).
Conclusions:
The findings suggest that ERM may be associated with sub-ILM changes that alter the plane of separation during ILM peeling. This study does not confirm any influence of dyes on the cleavage plane during surgery.
Insights
Epiretinal membrane (ERM) presence may alter the internal limiting membrane (ILM) peeling plane, with glial/neuronal cells found more often on ILM specimens removed after ERM excision. Dyes used in surgery did not influence the cleavage plane.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Histopathology
Background:
- Internal limiting membrane (ILM) peeling is a crucial step in treating macular holes and other retinal pathologies.
- Epiretinal membranes (ERMs) are often present during ILM peeling, but their effect on the surgical plane is not fully understood.
Purpose of the Study:
- To investigate whether the presence of an epiretinal membrane (ERM) influences the cleavage plane during internal limiting membrane (ILM) peeling.
- To determine if glial or neuronal cells are present on ILM specimens and if their presence correlates with ERM or surgical dyes.
Main Methods:
- Retrospective, observational immunohistochemical study of 51 ILM specimens obtained during vitrectomy.
- ILM specimens were analyzed using light microscopy and immunohistochemistry for glial fibrillary acidic protein and neurofilament protein.
- Specimens were categorized based on whether ILM peeling was for macular hole or after ERM removal; dyes used (Trypan blue, indocyanine green, brilliant blue G) were noted.
Main Results:
- Glial and/or neuronal cells were detected on the retinal surface of ILM specimens in 32% of macular hole cases versus 65% of cases with prior ERM removal (P = 0.02).
- Cells attached to the retinal surface were associated with ERM in 91% of cases.
- No significant association was found between the presence of cells and the type of dye used for ILM peeling (P = 0.2).
Conclusions:
- Epiretinal membranes (ERMs) may be associated with sub-ILM changes that modify the cleavage plane during ILM peeling.
- The study did not find evidence that surgical dyes influence the cleavage plane during ILM peeling.
More Related Videos
Related Concept Videos
01:16Cell Motility through Blebbing
Blebbing Through the Matrix
In multicellular...
01:28Types of Membrane Protrusions
The microvilli, an example of stable protrusions, are finger-like projections with a...
02:13Determining the Plane of Cell Division
Animal cells
In animal cells, the cleavage furrow forms along the plane of cell division starting...