The internal limiting membrane (ILM) is a thin, transparent, acellular membrane that forms the innermost boundary of the retina. ILM is the basal lamina of the inner retina, it is formed by the footplates of Müller cells and is composed of collagen fibers, glycosaminoglycans, laminin, and fibronectin. It has an important role in the early stages of retinal and optic nerve development, as a critical component of retinal histogenesis and optic axonal growth and navigation to the optic disc. However, in adults it’s function is not yet fully understood. ILM is the interface between the retina and vitreous and serves as a scaffold for cellular proliferation of myofibroblasts, fibrocytes, and retinal pigment epithelium cells, playing a role in the pathogenesis of vitreoretinal diseases. ILM peeling is a surgical technique commonly used today to treat various vitreoretinal disorders including vitreoretinal interface diseases (vitreomacular traction, macular holes, and epiretinal membranes), macular edema in diabetes and retinal vein occlusion, myopic macular retinoschisis and retinal detachment.

This video presents several clinical cases in which the peeling of the internal limiting membrane was important for the resolution of the clinical situation: macular holes, epiretinal membranes, vitreomacular tractions, diabetic macular edema, retinal vein occlusion with macular edema and retinal detachments. We share an unusual case in which multiple tiny bubbles were formed after the injection of perfluoro-n-octane during retinal detachment surgery. At the end of the surgery, when we performed fluid-air exchange, we realized that several bubbles of perfluoro-n-octane were on the macula (over?/under?) and it was impossible to remove them without damaging the retina with the flute needle. So, we decided to peel the internal limiting membrane and surprisingly, these bubbles, that were strongly attached to the ILM, came along. Despite this, nowadays, complete ILM peeling is not suitable for every type of macular surgery. The decision to peel the ILM should be individualized, based on the surgical situation.


David MARTINS, Pedro GOMES, Si­lvia DINIZ, Ines MATIAS, Pedro NEVES, Mario ORNELAS
Ophthalmology Department, Setubal Hospital Center
Setubal, Portugal
Email : drdavidmartins@hotmail.com
Cell Phone: +351964029156
Work Phone: +351964029156