Finesse™ Sharkskin™ ILM Forceps ILM Peeling Internal Limiting Membrane (ILM) peeling is one of the most common surgical procedures and is carried out in the majority of vitreoretinal cases. Yet it is a challenging surgical step with potentially significant complications to the patient. The following are indications for ILM peeling:
• Macular Hole • Epiretinal Membrane • Vitreomacular Traction Syndrome • Vitreomacular Schisis and Myopic Foveoschisis
• Proliferative Vitreoretinopathy
p Figure 1: ILM denoted as “a”
What makes ILM peeling so challenging? The ILM is a 3 μm transparent thick membrane overlying the retinal nerve fiber layer, and representing the basement membrane of the retinal Muller cells. The ILM is intrinsically related to the nerve fiber layer and has a convoluted margin on its retinal side. During surgery its removal may be made more challenging by respiratory and other inadvertent patient movements. Given its transparent nature a variety of surgical stains have been used to enhance the visualization of the ILM. Therefore, successful peeling of the ILM is dependent on a combination of surgical skills and instrumentation (Fig. 2). Later in the document Dr. Steve Charles1 shares some of the surgical pearls he found helpful in his practice to increase likelihood of successful outcomes.
p Figure 2: Surgical view of ILM peeling with Brilliant Blue staining
ILM peeling has several potential advantagesi: • Reduces recurrence rates of epiretinal membrane by removing the scaffold for recurrent ERM formation
• Increased likelihood of macula hole closure and decreases reopening rates • Increases likelihood of complete removal of epiretinal membrane and/or residual posterior vitreous cortex
1
Dr. Steve Charles is a paid consultant to Alcon
David Steel et.al. “INTERNAL LIMITING MEMBRANE PEELING IN MACULAR HOLE SURGERY; WHY, WHEN, AND HOW?”, RETINA 0:1–13, 2017
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