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Probe-assisted ILM-Rhexis: A Novel Peeling Technique
Ramin Nourinia1,2, Seyed-Hossein Abtahi1,2, Hosein Nouri1,3
1Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract:
This study describes a novel technique for removing the internal limiting membrane (ILM) using a 25-G vitrectomy probe during the epiretinal membrane (ERM)/ILM double peeling procedure. After standard 3-port 25-gauge pars plana vitrectomy, ERM is removed using membrane forceps and appropriate staining. An incidental ILM flap may occur while washing out the ILM-specific dye with the vitrectomy probe. To prevent this, we suggest not withdrawing the vitrectomy probe, but instead applying proximal and tangential aspiration force over the ILM flap, which may be extended and peeled off by gentle probe maneuvers along the retinal surface. The technique is described in three cases, with details, and shown in a video. This approach has several advantages. It may reduce the number of entries into the posterior segment during pars plana vitrectomy, preventing inadvertent retinal breaks. Furthermore, in cases with fragile ILMs that are hard to elongate with forceps, the active aspiration force of the vitrectomy probe might rapidly extend and form large flaps. We suggest applying this technique in scenarios involving ERM/ILM double peeling and double staining, where an incidental ILM flap is found after washing out the ILM-specific dye.
Insights
This study presents a new method for internal limiting membrane (ILM) removal during epiretinal membrane (ERM) surgery using a vitrectomy probe. The technique utilizes aspiration force to manage ILM flaps, potentially reducing retinal breaks.
Area of Science:
- Ophthalmology
- Surgical Techniques
- Retinal Surgery
Background:
- Epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling are crucial in treating various retinal pathologies.
- Incidental ILM flaps can occur during ILM dye washout, posing challenges.
- Current techniques may require additional instrumentation or maneuvers.
Purpose of the Study:
- To describe a novel technique for managing incidental internal limiting membrane (ILM) flaps during epiretinal membrane (ERM)/ILM double peeling.
- To demonstrate the utility of a 25-gauge vitrectomy probe for ILM flap removal.
Main Methods:
- A modified technique using a 25-gauge vitrectomy probe for aspiration and gentle peeling of ILM flaps.
- Application of proximal and tangential aspiration force over the ILM flap.
- Procedure demonstrated in three cases with video documentation.
Main Results:
- Successful management of incidental ILM flaps in all three described cases.
- The technique potentially reduces the need for additional posterior segment entries.
- Facilitates ILM peeling in cases with fragile membranes.
Conclusions:
- The described vitrectomy probe-assisted technique offers a safe and effective method for managing ILM flaps during ERM/ILM peeling.
- This approach may minimize complications such as inadvertent retinal breaks.
- It provides an alternative for handling fragile ILMs that are difficult to grasp with forceps.
