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Case report: Injury in ILM peeling may trigger proliferative response

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Experience in two patients suggests that the injury associated with internal limiting membrane peeling in macular hole surgery may stimulate a proliferative response, researchers said.

Riyo Uemoto and colleagues at Toho University Sakura Hospital in Chiba, Japan, reported on two patients with idiopathic macular holes who underwent pars plana vitrectomy with ILM peeling. Optical coherence tomography (OCT) was performed pre- and postoperatively.

In one case, at 2 months postop a thin epiretinal membrane developed over the nasal macula area where the ILM had been peeled. Visual acuity had improved, but the patient complained of metamorphopsia. After 18 months, her VA was 1.0 and the thin epiretinal membrane around the nasal fovea remained.

In a second case, surgery sealed the macular hole and VA had improved to 1.0 at 3 months. An indistinct epiretinal membrane developed in the macular region where the ILM had been peeled. Two years postop, the patient’s VA remained unchanged.

“We suggest that the injury associated with the ILM peeling may have stimulated glial proliferation,” the authors said in their report, published in the February issue of Graefe’s Archive for Clinical and Experimental Ophthalmology.