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INTERNAL LIMITING MEMBRANE PEELING IN MACULAR HOLE SURGERY; WHY, WHEN, AND HOW?
Irini P Chatziralli1, Panagiotis G Theodossiadis1, David H W Steel2,3
1Second Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece.
Retina (Philadelphia, Pa.)
|December 7, 2017
Summary
Internal limiting membrane (ILM) peeling in macular hole (MH) surgery improves closure rates but has functional consequences. Evidence is reviewed for why, when, and how to perform ILM peeling, with evolving alternatives discussed.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Macular Diseases
Background:
- Macular holes (MH) are a common cause of visual impairment.
- Pars plana vitrectomy is a standard surgical treatment for idiopathic MH.
Purpose of the Study:
- To review the rationale for internal limiting membrane (ILM) peeling in MH surgery.
- To discuss the evidence for the indications, timing, and techniques of ILM peeling.
Main Methods:
- Comprehensive review of existing scientific literature on ILM peeling in MH surgery.
Main Results:
- ILM peeling enhances MH closure rates and prevents reopening post-surgery.
- Concerns exist regarding ILM peeling's impact on retinal structure and function.
- Optimal extent and techniques for ILM peeling remain debated, with variations like ILM flaps and scraping described.
Conclusions:
- While ILM peeling improves MH closure, it can affect retinal structure and function.
- Factors like hole size influence the necessity and extent of peeling.
- Novel peeling alternatives require further investigation for improved outcomes.
