J Korean Ophthalmol Soc.  2010 Jan;51(1):42-48.

Ultrastructure of the Internal Limiting Membrane Removed During Macular Hole and Diabetic Macular Edema Surgery

• Koo GH
• Lee JE
• Choi HY
• Oum BS

Abstract

PURPOSE
To evaluate retinal damage following internal limiting membrane (ILM) peeling in macular hole and diabetic macular edema (DME) surgeries.
METHODS
Forty-five eyes with macular holes and thirty-five eyes with DME underwent pars plana vitrectomy with ILM peeling. The structures of the ILM were investigated using transmission electron microscopy, and the grades of retinal tissue damage were analyzed. We additionally observed the clinicopathologic association of retinal damage with the development of retinal hemorrhage during ILM peeling and that seen with indocyanine green (ICG) staining.
RESULTS
In all specimens, cellular fragments were observed on the retinal side of the ILM in both macular hole and DME patients. The thickness of the ILM in DME significantly increased (3.13+/-1.12 micrometer compared with that in patients with macular holes (2.41+/-0.77 micrometer, p=0.002). The frequency of minute retinal bleeding during ILM peeling was higher in macular hole patients (46.7%) than in those with diabetic macular edema (22.9%m p=0.028). Twenty-two eyes of 45 macular hole patients (48.9%) and 16 eyes of 35 DME patients (45.7%) had relative retinal damage. Overall, ILM performed in eyes which had minute bleeding during the peeling had more retinal damage (62.1%) than did those without hemorrhage (39.2%, p=0.049). ICG staining did not appear to influence retinal damage (p=0.81).
CONCLUSIONS
ILM peeling can cause minor, but demonstrable, damage of the adjacent retina.

Keyword

Internal limiting membrane; Muller cell

MeSH Terms

Eye
Hemorrhage
Humans
Indocyanine Green
Macular Edema
Membranes
Microscopy, Electron, Transmission
Retina
Retinal Hemorrhage
Retinal Perforations
Retinaldehyde
Vitrectomy
Indocyanine Green
Retinaldehyde

Figure

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  Figure 1. Transmission electron microscopic findings of the internal limiting membrane (ILM) removed during macular hole surgery. Only a few very tiny cellular fragments (arrow) are observed on the retinal side (R) of the ILM. The vitreous side (V) shows a very smooth surface. (×3,000)

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  Figure. 2. Many cellular debris of Müller cells (arrow) are adherent to the retinal surface (R) of the internal limiting membrane (asterisk) in diabetic macular edema. A red blood cell is visible. (arrowhead). Collagen and cellular elements cover the vitreous side (V) of the internal limiting membrane (×3,000).

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  Figure 3. Stretching forces split adjacent retinal structures (arrow) during the peeling of ILM in diabetic macular edema. The plasma membrane of Müller cells and other undetermined large cellular fragments (arrowhead) are adherent to the retinal surface of the ILM (×5,000).

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  Figure 4. Partial tear of the internal limiting membrane (arrow) is seen in diabetic macular edema (×6,000).

Reference

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