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      Does Internal Limiting Membrane Peeling Size Matter?

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      Journal of VitreoRetinal Diseases

      SAGE Publications

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          Most cited references 15

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          Decreased retinal sensitivity after internal limiting membrane peeling for macular hole surgery

          Aims To compare the retinal sensitivity and frequency of microscotomas found by spectral domain optical coherence tomography (SD-OCT) combined with scanning laser ophthalmoscopy (SLO) microperimetry after idiopathic macular hole closure, in eyes that underwent internal limiting membrane (ILM) peeling and eyes that did not. Methods This was a retrospective, non-randomised, comparative study. Combined SD-OCT and SLO microperimetry was performed in 16 consecutive eyes after closure of an idiopathic macular hole. A customised microperimetry pattern with 29 measurement points was used. The ILM was peeled in 8/16 eyes. The main outcome measure was mean retinal sensitivity. Results Mean retinal sensitivity (in dB) was lower after peeling: 9.80±2.35 dB with peeling versus 13.19±2.92 without (p=0.0209). Postoperative microscotomas were significantly more frequent after ILM peeling: 11.3±6.6 points with retinal sensitivity below 10 dB in eyes that underwent peeling versus 2.9±4.6 in those that did not (p=0.0093). Conclusions These results suggest that ILM peeling may reduce retinal sensitivity, and significantly increase the incidence of microscotomas. Until a prospective trial confirming or not these results, it seems justified to avoid peeling the ILM when its potential benefit seems minor or unproved, and when peeling is carried out, to limit the surface peeled to the bare minimum.
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            Macular pucker: to peel or not to peel the internal limiting membrane? A microperimetric response.

            To compare functional and anatomical outcomes after idiopathic macular pucker removal between eyes that underwent internal limiting membrane (ILM) peeling and eyes that did not.
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              Origin and turnover of ECM proteins from the inner limiting membrane and vitreous body.

              The inner limiting membrane (ILM) and the vitreous body (VB) are two major extracellular matrix (ECM) structures that are essential for early eye development. The ILM is considered to be the basement membrane of the retinal neuroepithelium, yet in situ hybridization and chick/quail transplant experiments in organ-cultured eyes showed that all components critical for ILM assembly, such as laminin or collagen IV, are not synthesized by the retina. Rather, ILM proteins, with the exception of agrin, originate from the lens or (and) ciliary body and are shed into the vitreous. The VB serves as a reservoir providing high concentrations of ILM proteins for the instant assembly of new ILM during rapid embryonic eye growth. The function of the retina in ILM assembly is to provide the cellular receptor proteins for the binding of the ILM proteins from the vitreous. The VB is a gelatinous ECM structure that fills the vitreous cavity of the eye. Its major structural proteins, collagen II and fibrillin, originate primarily from the ciliary body. Reverse transcription-PCR and western blotting show that the rate of synthesis of structural, monomeric ILM and VB proteins, such as laminin, collagen IV and II is very high during embryogenesis and very low in the adult. The downregulation of ILM and VB protein synthesis occurs during early postnatal life, and both ILM and VB are from then on maintained throughout life with minimum turnover. Our data explain why ILM and VB do not regenerate after vitrectomy and ILM peeling.
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                Author and article information

                Journal
                Journal of VitreoRetinal Diseases
                Journal of VitreoRetinal Diseases
                SAGE Publications
                2474-1264
                2474-1272
                January 26 2017
                January 26 2017
                : 1
                : 1
                : 27-33
                Article
                10.1177/2474126416681222
                © 2017

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