Internal limiting membrane peeling in macular hole surgery.

Area of Science:

• Ophthalmology
• Retinal Surgery

Background:

• Macular hole surgery has advanced significantly, becoming highly successful.
• Internal limiting membrane (ILM) peeling is a key step, established due to ILM's role in macular hole pathogenesis.

Purpose of the Study:

• To review the role of ILM in macular hole pathogenesis.
• To discuss the benefits and adverse effects of ILM peeling.
• To explore modifications and alternatives to ILM peeling.

Main Methods:

• Review of literature on ILM peeling in macular hole surgery.
• Analysis of spectral domain optical coherence tomography and microperimetry data.
• Discussion of surgical technique evolution and alternative treatments.

Main Results:

• ILM peeling, while essential, has short- and long-term adverse effects on macular structure and function.
• Surgical techniques have evolved from total peeling to modified approaches like inverted or temporal flaps.
• Emerging alternatives like ILM abrasion and Ocriplasmin show promise but have limitations.

Conclusions:

• ILM peeling remains a cornerstone of macular hole surgery, but its adverse effects necessitate technique modifications.
• Ongoing research focuses on refining ILM peeling or developing alternative strategies to optimize surgical outcomes and preserve macular function.