Abstract
Purpose: To compare the presence of cell fragments and entire cell bodies on the retinal side of the internal limiting membrane (ILM) after removal with and without dye assistance in traction maculopathies. Methods: En-bloc removal of the ILM and epimacular tissue was performed during vitrectomy in 75 eyes without dye-assistance and in 45 eyes with assistance of either Brilliant Blue G (BBG) or Trypan Blue (TB). We included 79 eyes with macular holes (MH) and 41 eyes with other traction maculopathies. All ILM specimens were processed by serial sectioning preparation for light microscopy. Exclusively, if cellular elements of more than 2 μm in diameter were found on the retinal side of the ILM by light microscopy, specimens were prepared for transmission electron microscopy. Results: 23 (19%) specimens of this series demonstrated such cell fragments and entire cell bodies on the retinal side of the ILM. Specimens removed from MH eyes demonstrated less frequently retinal cell debris than specimens removed from other traction maculopathies. If epiretinal cell proliferation was seen, cellular debris on the ILM was significantly more frequent, irrespective of BBG or TB assistance. Conclusions: Removal of cellular structures on the retinal side of the ILM during ILM peeling appears to be associated with epiretinal cell proliferation. The presence of cell fragments and entire cell bodies on the retinal side of the ILM seems unrelated to the use of BBG and TB. Epiretinal membranes with wrinkling and folding of the ILM may contribute to structural changes that facilitate pulling off parts of cells or entire cell bodies during ILM peeling.
Highlights
Internal limiting membrane (ILM) peeling is widely accepted as an essentially safe surgical technique, removal of the internal limiting membrane (ILM) during macular surgery may sometimes lead to the presence of cell fragments or entire cell bodies on the retinal side of the peeled ILM
Specimens were included according to (1) diagnosis (macular holes (MH), macular pucker (MP), vitreomacular traction syndrome (VMTS), proliferative vitreoretinopathy (PVR), and diabetic macular edema (DME) associated with traction), (2) surgical technique of ILM peeling, (3) specimen preparation method, and (4) presence of the ILM within the specimen as demonstrated by light microscopy
In the group without dye assistance, retinal cell debris was found in 17 specimens composed of 7 specimens removed from eyes with MH, 4 specimens from MP, 2 specimens from VMTS, 3 specimens from traction diabetic macular edema and 1 specimen from PVR
Summary
Internal limiting membrane (ILM) peeling is widely accepted as an essentially safe surgical technique, removal of the ILM during macular surgery may sometimes lead to the presence of cell fragments or entire cell bodies on the retinal side of the peeled ILM. Microscopic and immunohistochemical studies occasionally demonstrated retinal cell debris on the ILM which was assigned to glial cells and neuronal debris, such as Müller cell endfeet and cell fragments of the retinal nerve fiber layer [1,2,3,4,5,6]. It is still under debate how frequent these findings are and whether these morphological observations have an impact on functional results after surgery. Lim and colleagues [14] correlated the presence of retinal cell debris of larger size with macular dysfunction on multifocal electroretinogram suggesting that major cellular fragments on the ILM are related to Müller cell damage with alterations of retinal function
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