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P Szurman, S Grisanti, U Schraermeyer, U Bartz-Schmidt; Morphological Retinal Changes After Peeling of the Internal Limiting Membrane . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2489.
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Purpose: Vital staining by indocyanine green (ICG) facilitated the visualization of the internal limiting membrane (ILM) and increased the significance of ILM peeling in vitreoretinal surgery. The morphological biocompatibility of this method remains controversial, as it was evaluated indirectly by microscopy of excised membranes. To investigate possible damage of the inner retinal layer after ILM peeling, we examined the ultrastructure of the retina in cadaver eyes after such a peeling procedure. Method: Human and porcine cadaver eyes underwent a three port pars plana vitrectomy with forced separation of the posterior vitreous within twelve hours post mortem. Fluid/Air exchange and application of 5 mg/ml ICG-solution disclosed a delicately stained ILM which could be removed under visual control. Vitrectomy without staining or peeling served as control to distinguish post mortem tissue alteration. Excised membranes and specimen of the inner retina were examined by light, scanning and transmission electron microscopy. Results: By transmission electron microscopy the removed membrane could be identified as ILM without adherent cellular debris. Scanning electron microscopy of the inner retina disclosed a smooth, slightly undulated surface without ILM residues. The transition zone of the peeled area to normal ILM-covered retina showed a sharp delimitation. Moderate post mortem changes of the entire retina could be seen with no difference to the control group. Conclusion: Vital staining of the ILM seems to allow a controlled peeling without significant mechanical damage to the inner retinal layer. Separation occurs strictly between the ILM and the Muller cell end feet. The latter create a homogenous vitreoretinal surface without severe alteration apart from regular post mortem changes.
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