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B. Schwent, H. Grossniklaus, G. B. Hubbard, III; Electron Microscopic Appearance of Internal Limiting Membrane Specimens Obtained During Macular Hole Surgery. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3280.
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Previously published reports state that staining the internal limiting membrane (ILM) with indocyanine green (ICG) prior to membrane peeling during macular hole surgery results in increased amounts of cellular debris along the retinal surface of ILM specimens compared to control. These results support the hypothesis that increased retinal damage may occur during ICG assisted ILM peeling due to a deeper cleavage plane somehow induced by the ICG. This study was performed to reevaluate these previous results and to determine whether using triamcinolone to visualize the internal limiting membrane (ILM) during macular hole surgery had similar affects on the electron microscopic appearance of ILM specimens obtained during ILM peeling.
All ILM specimens obtained during idiopathic macular hole surgery and submitted to the LF Montgomery Ocular Pathology Laboratory between 2/06 and 5/07 were examined using transmission electron microscopy. 42 specimens (19 using ICG, 12 using triamcinolone, 11 using nothing to aid visualization) were submitted by 5 different surgeons. 31 specimens (12, 11, and 8 respectively) had identifiable tissue for examination. Specimens were then examined by a reviewer who was masked to any information regarding surgical technique used to obtain the ILM. These specimens were examined to determine qualitatively the amount of cellular elements on the retinal surface of the ILM and compared to a set of 4 standard photographs representing no, minimal, moderate, and maximal cellular elements.
There was a large variation in the amounts of cellular debris attached to the retinal surface of ILM specimens within each of the three groups (ICG, triamcinolone, and no stain). No identifiable qualitative difference was detected between each of the three groups. In addition, no difference was detected between specimens obtained by the various surgeons.
In contrast to previously published reports, we do not find a difference between the electron microscopic appearance of ILM specimens obtained with and without ICG staining at the time of macular hole surgery. In addition, the use of triamcinolone does not appear to affect the amount of cellular elements attached to ILM specimens obtained during macular hole surgery. These results go against the hypothesis that using ICG (or triamcinolone) to better visualize the ILM during macular hole surgery results in a deeper cleavage plane and possible increased retinal damage during ILM peeling.
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