Didier Ducournau, Yvette Ducournau

56 ILM from ERM and MH were submitted, in 1988, to a histopathological study with a immunocytochemistry and scanning electron microscopy. A gliosis, GFAP positive, was found on each specimen. A systematic ILM removal was then performed in ERM and in MH since 1989. Over 12 000 cases were performed with a higher medium improvement compared to what is usually reported without ILM removal. In cases of CME, ILM removal has been performed since 2000, with the same functional improvements providing they were compared to the same preop visual acuity. In order to understand this similarity of results, wether a epiretinal membrane is visible or not, a study with anti GFAP staining and anti EGF-R staining has been performed in human eyes presenting ischemia and/or CME and/or RD. This study shows that a traumatic process as the RD, induces an over staining of EGF-R and a Müller cell gliosis, without any sign of CME even in the circumstances where a CME is expected. This study allows us to better understand the IML removal effect. More than removing a pathologic structure, ILM removal induces a cellular response which acts in favour of blood retinal barrier integrity, synaptogenesis, vasoconstriction, anti VEGF properties and anti apoptotic properties. We then better understand how damaging the Müller cells endfeet can be profitable.