Abstract
The inner limiting membrane (ILM) is the basement membrane of the Müller cells and can act as a scaffold for cellular proliferation in the pathophysiology of disorders affecting the vitreomacular interface. The atraumatic removal of the macular ILM has been proposed for treating various forms of tractional maculopathy in particular for macular pucker. In the last decade, the removal of ILM has become a routine practice in the surgery of the epiretinal membranes (ERMs), with good anatomical results. However many recent studies showed that ILM peeling is a procedure that can cause immediate traumatic effects and progressive modification on the underlying inner retinal layers. Moreover, it is unclear whether ILM peeling is helpful to improve vision after surgery for ERM. In this review, we describe the current understanding about ILM peeling and highlight the beneficial and adverse effects associated with this surgical procedure.
Highlights
Macular distortion and macular edema with the resultant macular dysfunction are the sequelae of epimacular proliferation.Such proliferation of surface cells is associated with the distortion of both the inner limiting membrane (ILM) and sometimes the outer retinal layers.The ILM is the basement membrane of Muller cells and is stiffer than the underlying neuroretina that is bent or changed in shape.The ILM provides a support surface to contractile cells acting as a rigid scaffold that transmits the distortion on the underlying retina
The second pattern of epiretinal membranes (ERMs), termed type I ERM, is characterized by a layer of collagen between the ILM and the proliferating cells. This pattern seems to underlie a second possibility for ERM formation: a subtle layer of vitreous remains attached to the retina after Posterior vitreous detachment (PVD) and this remnant provides a medium for the proliferation of glial cells and hyalocytes [40]
It has been suggested that a primary mechanism that leads to ERM enlargement is phagocytosis of blood-borne substances and cell debris, which adhere to the vitreal surface of the retina by Muller cell processes that extend through holes in the basement membrane of the ILM [19]
Summary
Macular distortion and macular edema with the resultant macular dysfunction are the sequelae of epimacular proliferation Such proliferation of surface cells is associated with the distortion of both the inner limiting membrane (ILM) and sometimes the outer retinal layers. The ILM is the basement membrane between the neuroretina and the vitreous and can act as a scaffold for cellular proliferation in the pathophysiology of disorders affecting the vitreomacular interface. When ILM is spontaneously separated from the retina in Terson’s syndrome, the macula displays no significant reparative fibrosis and maintains excellent visual function during long-term follow-up [2, 3]. The appearance of a transient reduction of the retinal differential light threshold is more marked in cases of ILM removal than in cases in which the ILM is left in place It is not known whether these morphological and functional changes reflect potentially progressive retinal damage. In this review are analyzed the pathogenesis and the treatment of ERM focusing primarily on positive and negative consequences related to ILM peeling
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