Klaus Lucke*, Silvia Bopp, Tagesklinik Universit├Ątsallee, Bremen, Germany

Purpose:

Peeling of the internal limiting membrane (ILM) of the retina has become technically easy by the introduction of intraoperative staining with ICG and is being performed routinely in macular hole surgery by most vitreoretinal surgeons. In retinal detachment the ILM frequently seems to contract as demonstrated by the sand dune phenomenon. In PVR detachments folding of the retina both in the macular area and more peripherally occurs, and often persists after removal of the typical opaque PVR membranes. We therefore investigated the assumption that removal of the ILM might facilitate the mobilization of stiffened retina.

Methods:

In all eyes with PVR operated on since January 2001 the stained ILM was removed in the macular area and as far as possible beyond the major vessel arcades.

Results:

Intra-operatively we found that removing the ILM in the macular area very satisfactorily re-laxed the macular structures. A PFCL bubble was helpful in stabilizing the mobile retina to facilitate ILM removal. ICG-staining furthermore helped greatly in identifying edges of residual membranes. In some eyes needing revision surgery some weeks later we found that ILM had not reformed in the previously delaminated areas and that surprisingly recurrent PVR membranes never developed there. Postoperatively the macular areas were always smooth, no case of recurrent puckers was observed. ILM-peeling did not seem to affect visual function negatively, visual results were in keeping with the underlying disease. A few eyes, however, with a short history of detachment but with a preoperatively clearly distorted and detached macula regained surprisingly good visual function with unusual speed (e.g. 0.3 – 0.4 after 2 weeks).Staining the ILM in the peripheral retina proved to be extremely helpful in identifying residual PVR membranes and removing any contractile elements. In some eyes removal of the ILM seemed to facilitate very good visual recovery. ILM-removal seems to protect against recurrent membrane forma-tion in the delaminated areas.

Conclusions:

ICG staining of the ILM has proven to be a fantastic new tool in PVR facilitating more thorough membrane removal, protecting against recurrent membrane formation and relieving macular contraction resulting in relatively good visual results in may cases.