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

Koo, Gi Hong; Lee, Ji Eun; Choi, Hee Young; Oum, Boo Sup

doi:2010.51.1.42

J Korean Ophthalmol Soc > Volume 51(1); 2010 > Article

Original Article

Journal of the Korean Ophthalmological Society 2010;51(1):42-48.
DOI: https://doi.org/10.3341/jkos.2010.51.1.42 Published online January 15, 2010.

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

Gi Hong Koo, Ji Eun Lee, Hee Young Choi, Boo Sup Oum

¹Department of Ophthalmology, School of Medicine, Pusan National University, Busan, Korea. bsoum@pusan.ac.kr
²Medical Research Institute, Pusan National University, Busan, Korea.

황반원공과 당뇨황반부종에서 술 중 제거한 내경계막의 미세구조

구기홍¹ㆍ이지은^1,2ㆍ최희영^1,2ㆍ엄부섭^1,2

Department of Ophthalmology, School of Medicine, Pusan National University¹, Busan, Korea Medical Research Institute, Pusan National University², Busan, Korea

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.

Key Words: Internal limiting membrane;Muller cell