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Remnant ILM after ERM surgery may serve as a nidus for continued ERM proliferation

Ophthalmology. 2009;116(7):1370-1376.

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Complete peeling of the internal limiting membrane facilitated by staining with double brilliant blue G may reduce recurrence of epiretinal membrane and reoperation.

In a series of 246 eyes, 104 underwent single epiretinal membrane (ERM) peeling with indocyanine green staining and 142 underwent ERM removal followed by peeling of residual internal limiting membrane (ILM) assisted by brilliant blue G. The 142 patients had their ERM peeled by one of three methods: with no staining in 46 eyes, with triamcinolone acetonide in 42 eyes and with brilliant blue G in 54 eyes.

In the 104 eyes operated with indocyanine green only, 17 eyes (16.3%) had a recurrence and six eyes (5.8%) were reoperated. By comparison, there were no recurrences or reoperations in the group of 142 eyes that underwent ERM peeling and stain-assisted ILM peeling.

However, the three ERM peeling methods differed in terms of residual ILM. Complete ILM removal was achieved in 20% of eyes without stain, in 36% of eyes when triamcinolone acetonide was used and in 61% of eyes when brilliant blue G was used.

Residual ILM may be significant, as histopathologic examination of the ERM recovered from the six eyes requiring reoperation "showed residual ILM to serve as a scaffold for cell proliferation," according to the study.