Bohdana Kalvodova, MD (Prague, Czech Republic), Jaroslava Duskova, MD, PhD (Prague, Czech Republic), Tarek Aboutable, MD, PhD (Prague, Czech Republic), Martin Janek, MD (Prague, Czech Republic), Evantia Omoscharkas, MD (Prague, Czech Republic)

PURPOSE:

Removal of the posterior hyaloid and ILM during microsurgery appears to have a positive influence on the resolution of diabetic macular edema (DME) and idiopathic macular hole (IMH). Morphological identification of the peeled material as ILM and subsequent morphometry evaluation provides very effective information about the role of ILM in the pathogenesis of these diseases.

METHODS:

Complete release of tractional forces seems to be prudent in the eyes with tractional maculopathy and may lead to inhibition of reproliferation of fibrous astrocytes. Removal of the ILM contributes to the resolution of DME and closure of IMH and consequently to the improvement of the visual acuity. The peeled ILM from operated eyes was fixed in 2,5% glutaraldehyde, processed according to a standardized protocol and evaluated by the LUCIA G5 (Laboratory Universal Computer Image Analysis, Laboratory Imaging, Prague).

RESULTS:

The extracted ILM of 18 from 20 patients were analysed in the framwork of long-term research project MSM 0021620807 of the 1st Medical Faculty, Charles University in Prague. This obtained material was supplied for qualitative and quantitative evaluation was identified as ILM and measured. Mostly a substantial thickening of the ILM was found in all eyes, especially in patients with DME (12 patients). It reached the thickness from 1,68 to 4,69 μm, while normal value is 0,5 μm). Some cellular elements (mostly resembling macrophages) were observed on the vitreous side of the peeled ILM in both groups.

CONCLUSION:

USM analysis of the ILM provides objective tool to the assessment of the vitreomacular interface. The thickening of ILM and cell presence on its vitreous surface might play a significant role in the pathogenesis of the DME and IMH. Evaluation of peeled ILM and the clinical correlations are to be important basis for further study of the pathogenetic mechanisms in the traction maculopathy diseases. See images on next page. OCT image of cystoid macular edema and serous macular detachment before vitrectomy. ILM removed from patient with CME. ILM thickness is 4,11 μm.