Ultrastructural findings following ILM peeling

Arnd Gandorfer (München)


This is to report the ultrastructural findings following ILM-peeling in vivo, in human postmortem eyes, and in the cat model.
Retinal specimens from 91 patients with traction maculopathy (vitreomacular traction syndrome, macular hole, epimacular membrane, diffuse diabetic macular edema) were investigated for the presence or absence of retinal structures adherent to the retinal side of the ILM. Beside of tiny fragments of Müller cell membranes enclosed in folds of the ILM, no cellular or subcellular elements were found at the retinal side of the ILM.
In contrast, ILM-specimens which had been removed following ICG-staining of the ILM showed ruptured footplates of Müller cells and other undetermined retinal debris adherent to the retinal side of the ILM. In an experimental setting in human post-mortem eyes, application of ICG and illumination of the stained macula using a standard light device resulted in inner retinal damage. Such damage was neither seen following application of ICG alone nor after illumination of the posterior pole only. This may indicate that a photodynamic effect may occur at the vitreomacular interface during ICG-assisted ILM-peeling. These findings were confirmed in the cat model by using electron and confocal microscopy.

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