Klaus Lucke, Silvia Bopp Bremen, Germany

Peeling of the internal limiting membrane of the retina has become technically easy by the introduction of intraoperative staining with ICG and is being performed routinely by most vitreoretinal surgeons in macular hole surgery. This technique is furthermore under investigation for the treatment of macular edema in diabetic maculopathy and cystoid macular edema secondary to uveitis and other conditions.
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, also most likely caused by a contraction of the ILM.
We have therefore considered the possibility that removal of the ILM might be useful in relaxing retinal structures and that this might allow a smoother and easier reattachment.
We found that removing the ILM in the macular area in PVR very satisfactorily relaxed the macular structures indeed. It was particularly easy to remove the ILM if the central retina was stabilized by a PFCL bubble. In some eyes needing revision surgery some weeks later we could furthermore demonstrate that no PVR membranes had developed in the previously delaminated areas and that furthermore ILM had not reformed in those areas.
Staining the ILM in the peripheral retina proved to be extremely helpful in identifying residual PVR membranes and removing any contractile elements.
Video sequences will be shown demonstrating the surgical technique and illustrating the above findings.