• Hyperreflective foci
• Idiopathic epiretinal membrane
• OCT-angiography
• Optical coherence tomography

• Humans
• Tomography, Optical Coherence/methods
• Epiretinal Membrane/diagnosis
• Epiretinal Membrane/diagnostic imaging
• Male
• Female
• Fluorescein Angiography/methods
• Aged
• Middle Aged
• Retrospective Studies
• Visual Acuity
• Fundus Oculi
• Retinal Vessels/pathology
• Retinal Vessels/diagnostic imaging
• Macula Lutea/diagnostic imaging
• Macula Lutea/pathology
• Macula Lutea/blood supply
• Aged, 80 and over

• Proliferative vitreoretinopathy
• Rhegmatogenous retinal detachment
• Silicone oil

• Humans
• Retinal Detachment/surgery
• Retrospective Studies
• Female
• Silicone Oils/adverse effects
• Male
• Risk Factors
• Middle Aged
• Endotamponade/adverse effects
• Vitrectomy/adverse effects
• Recurrence
• Adult
• Visual Acuity
• Aged
• Postoperative Complications
• Drainage

• Epiretinal membrane
• anatomy/biochemistry/physiology.
• pars plana vitrectomy
• retinal pathology / research
• techniques of retinal examination

• Humans
• Epiretinal Membrane/physiopathology
• Epiretinal Membrane/surgery
• Female
• Male
• Prospective Studies
• Visual Acuity/physiology
• Tomography, Optical Coherence
• Retinal Vessels/physiopathology
• Retinal Vessels/diagnostic imaging
• Aged
• Vitrectomy
• Middle Aged
• Visual Field Tests
• Retina/physiopathology
• Retina/diagnostic imaging
• Visual Fields/physiology
• Regional Blood Flow/physiology

• Epiretinal membrane
• Internal limiting membrane peeling
• Metamorphopsia
• Pars plana vitrectomy
• Vitreomacular interface

• Humans
• Epiretinal Membrane/surgery
• Epiretinal Membrane/diagnosis
• Epiretinal Membrane/pathology
• Vitrectomy/methods
• Tomography, Optical Coherence
• Vision Disorders/etiology
• Vision Disorders/surgery
• Vision Disorders/diagnosis
• Visual Acuity/physiology

• optical coherence tomography
• ganglion cell
• nerve fiber layer
• macrophage-like cell

• Humans
• Multiple Sclerosis/complications
• Pilot Projects
• Tomography, Optical Coherence/methods
• Retina/pathology
• Retinal Ganglion Cells/pathology
• Optic Neuritis/diagnosis
• Optic Neuritis/pathology

• Humans
• Vitrectomy/methods
• Epiretinal Membrane/surgery
• Basement Membrane/surgery
• Eye
• Postoperative Complications/surgery
• Retrospective Studies
• Tomography, Optical Coherence

• epiretinal membrane
• internal limiting membrane
• macular peeling
• proliferative vitreoretinopathy
• recurrent retinal detachment
• retinal detachment
• vitrectomy
• vitreoretinal surgery complications

• Central macular thickness
• Idiopathic epiretinal membrane
• Internal limiting membrane
• Recurrence
• Visual acuity

To identify the predictive parameter among preoperative measurements that best predicts postoperative visual outcome in the epiretinal membrane (ERM).

Thirty-three consecutive patients with idiopathic unilateral ERM patients between 2015 and 2018 were enrolled. Nineteen healthy normal eyes were selected as an independent age-matched group. Based on preoperative optical coherence tomography (OCT), we further divided the patients with ERM into two groups: type 1, loosely attached ERM, and type 2, tight adherent ERM. We documented the vision and thickness of various retinal layers: nerve fiber layer, ganglion cell layer, inner plexiform layer (GCL + IPL), inner nuclear layer (INL), outer retinal layer (ORL), and retinal pigment epithelium/Bruch complex layer before and after the surgery. The association between postoperative visual acuity and these variables was analyzed using multiple linear regression analysis.

All retinal layers of ERM eyes were thicker than the normal eyes (P < 0.05). Among ERMs, we identified 11 eyes with type 1 adhesions and 22 eyes with type 2 adhesions. The preoperative GCL + IPL layers were significantly thicker in type 2 patients than in type 1 patients (93.67 ± 33.03 um vs 167.71 ± 13.77 um; P = 0.023). Greater GCL + IPL thickness was correlated with a worse postoperative visual acuity and multiple linear regression analysis showed that GCL + IPL thickness was an independent predictor of postoperative visual acuity (VA) (beta value = 0.689; P = 0.012). A greater thickness of GCL + IPL layers of type 2 patients had worse postoperative best-corrected visual acuity (BCVA) (P = 0.028). Ectopic inner foveal layers with disappearance of fovea pit were persistently presented in OCT profiles of both groups.

Idiopathic ERM demonstrated significantly thicker inner retinal layers (GCL + IPL and INL). However, the ORL thickness was similar between the normal eyes and ERM eyes. The preoperative GCL + IPL layers were significantly thicker in patients with type 2 ERM than that in patients with type 1 ERM. The increase in GCL + IPL thickness was significantly correlated with worse postoperative visual outcomes.

• ERM
• Ectopic inner retinal layer
• Inner retinal layer
• Outer retinal layer

We investigated the postoperative visual outcomes and morphological changes of the internal limiting membrane (ILM) flap, in patients who underwent the temporal inverted ILM flap technique for macular hole (MH). Between August 2018 and February 2020, 22 eyes of 22 patients with idiopathic or myopic MH who underwent vitrectomy with ILM flap were included in this study and followed-up for more than 6 months. Postoperative MH status, comparison of best-corrected visual acuity (BCVA) before and 6 months after surgery, changes in the ILM flap area at 1 and 6 months postoperatively, and the factors related to changes in ILM flap size, were analyzed. MH closure was achieved in all of the patients. The BCVA at 6 months postoperatively (0.18 ± 0.15) was significantly better than the preoperative BCVA of 0.63 ± 0.37 (P < 0.001, paired t test). The area of the ILM flap decreased significantly from 3.25 ± 1.27 mm² at 1 month to 3.13 ± 1.23 mm² at 6 months (P = 0.024, Wilcoxon signed-rank test). Two eyes showed an ILM flap contraction of more than 20%, and one eye required reoperation due to an increase in metamorphopsia and decreased visual acuity. Among age, sex, ILM flap area at 1 month, preoperative BCVA, and axial length, ILM flap contraction was correlated with patient age and ILM flap area. Although vitrectomy with the inverted ILM flap technique confers a good visual outcome, the ILM flap may contract in younger patients.

• 25G pars plana vitrectomy
• Cataract surgery
• Combined operation
• Lens opacity
• Retina

This study aims to evaluate the morphology of ganglion cell complex (GCC) along with functional outcomes in patients undergoing vitrectomy with ILM peeling and macular abrasion with Tano diamond dusted membrane scrapers (DDMS) for three different stages of the idiopathic macular hole (IMH).

This retrospective study was conducted between April 2019 and December 2019. 33 patients with IMH were included and divided into three groups: stage I, stage II, and stage IV. All patients were subjected to vitrectomy with ILM peeling. Gentle and vigorous macular abrasion was additionally performed for stage II and stage IV patients, respectively. The best-corrected visual acuity (BCVA), GCC thickness (measured by spectral domain-optical coherence tomography (SD-OCT)), and photopic contrast sensitivity (Rodenstock CV 900 Chart Panel) were determined before surgery and at 1- and 3-month follow-ups.

Closure of MH was achieved in all the patients. The difference between the preoperative and one- and three-month postoperative values of BCVA was statistically significant in the three groups (P < 0.01). Contrast sensitivity progressively improved in all patients and was statistically significant (P < 0.01). The reduction in GCC thickness during follow-up was 34%–42% of the preoperative measurements. On comparing the mean GCC thickness of the operated and healthy eyes, it was not statistically significant in stage I patients. However, the same when done in stage II and IV was statistically significant with P value < 0.05 and P < 0.01, respectively.

Combining ILM peeling with macular abrasion in advanced stages of MH may facilitate its closure without significantly affecting the functional outcome.

To evaluate epiretinal membrane (ERM) removal utilizing internal limiting membrane (ILM) forceps and visualization with triamcinolone acetonide (TA).

Retrospective interventional case series of eyes undergoing ERM removal with TA visualization with follow-up of up to five years. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and incidence of complications were reviewed.

A total of 132 eyes were included with 54 and 16 eyes completing 3- and 5-year follow-up, respectively. Mean BCVA and CMT improved significantly at all postoperative evaluations compared to baseline (p<0.001). Pre-operative presence of PVD did not affect outcome measures. No intraoperative complications were reported. Immediate post-operative complications included one case of sterile endophthalmitis and one case of vitreous and perimacular hemorrhage. At one year, complications included progression of cataract in phakic eyes (65.4%), steroid-induced glaucoma (2.2%), retinal tear (0.8%), recurrent ERM (4.5%), and recurrent macular edema (11.3%). No further complications were reported at three- and five-year follow-up.

Combination ILM forceps and TA visualization offers an affordable and safe option for ERM removal with comparable or better outcomes than traditional methods of ERM surgery.

• chromovitrectomy
• epiretinal membrane
• triamcinolone acetonide

• Internal limiting membrane
• Pars plana vitrectomy
• Pediatric
• Rhegmatogenous retinal detachment

The epiretinal membrane (ERM) is a degenerative condition associated with age, which can cause loss of vision and/or metamorphopsia. The treatment of symptomatic ERM involves surgical removal including a vitrectomy followed by peeling of the ERM using a microforceps. As the internal limiting membrane (ILM) is adherent to the ERM, it is sometimes removed with it (spontaneous peeling). If ILM remains in place, it can be removed to reduce ERM recurrence. However, it is important to clarify the safety of ILM peeling, while it increases surgical risks and cause histological disorganization of the retina that can lead to microscotomas, may be responsible for definitive visual discomfort.

PEELING is a prospective, randomized, controlled, single-blind, and multicentered trial with two parallel arms. This study investigates the benefit/risk ratio of active ILM peeling among individuals undergoing ERM surgery without spontaneous ILM peeling. Randomization is done in the operating room after ERM removal if ILM remains in place. After randomization, the two groups—“active peeling of the ILM” and “no peeling of the ILM”—are compared during a total of three follow-up visits scheduled at month 1, month 6, and month 12. Primary endpoint is the difference in microscotomas before surgery and 6 months after surgery. Patients with spontaneous peeling are not randomized and are included in the ancillary study with the same follow-up visits and the same examinations as the principal study.

Relevant inclusion criteria involve individuals aged > 18 years living with idiopathic symptomatic ERM, including pseudophakic patients with transparent posterior capsule or open capsule or lensed patients with age-related cataracts. The calculated sample size corresponds to 53 randomized eyes (one eye/patient) per arm that means 106 randomized eyes (106 randomized patients) in total and a maximum of 222 included patients (116 spontaneous peeling).

ILM peeling is often practiced in ERM surgery to reduce ERM recurrence. It does not impair postoperative visual acuity, but it increases the surgical risks and causes anatomical damages. If active ILM peeling is significantly associated with more microscotomas, it may contraindicate the ILM peeling during primitive idiopathic ERM surgery.

ClinicalTrials.gov, NCT02146144. Registered on 22 May 2014. Recruitment is still ongoing.

• Idiopathic epiretinal membrane
• Internal limiting membrane
• Microscotomas
• Peeling

• Full-thickness macular hole
• immunocytochemistry
• internal limiting membrane
• neurotrophic factors
• premacular cells
• transmission electron microscopy

• Aged
• Basement Membrane/surgery
• Endotamponade/methods
• Female
• Follow-Up Studies
• Humans
• Macula Lutea/pathology
• Macula Lutea/surgery
• Male
• Middle Aged
• Retinal Detachment/complications
• Retinal Detachment/diagnosis
• Retinal Detachment/surgery
• Retrospective Studies
• Tomography, Optical Coherence
• Treatment Outcome
• Visual Acuity
• Vitrectomy/methods
• Vitreoretinopathy, Proliferative/diagnosis
• Vitreoretinopathy, Proliferative/etiology
• Vitreoretinopathy, Proliferative/surgery

We aimed to report our experiences and outcomes of vitreoretinal surgery in idiopathic epiretinal membrane.

We retrospectively reviewed patients who underwent vitreoretinal surgery for idiopathic epiretinal membrane between January 2012 and 2014. The patients’ pre- and postoperative visual acuity, slit-lamp examination findings, and optical coherence tomography (OCT) images were evaluated.

Forty-five eyes of 45 patients (36% male, 64% female) were included (mean age, 69±8.2 years). Mean postoperative follow-up time was 7±4 (1-12) months. The mean preoperative logMAR best corrected visual acuity was 0.58±0.32 and postoperatively 0.40±0.31, 0.33±0.33, 0.28±0.34 respectively at 3, 6, and 12 months. All OCT parameters showed statistically significant anatomical improvement at 1, 3, 6, and 12 months. Correlation analysis showed that central macular thickness (r=0.69, p<0.05) and central macular volume (r=0.69, p<0.05) were the only parameters that had strong positive correlations with visual improvement.

Epiretinal membrane causes heterogeneous anatomical changes in the macula for every patient. Therefore, a correlation between visual gain and changes in central macular thickness could not yet be demonstrated. We believe that central macular volume may be a better parameter for following these patients.

• Epiretinal
• correlation
• internal limiting membrane
• volume

• Collagen
• Epiretinal membrane
• Gliosis
• Scanning electron microscopy

The inner limiting membrane (ILM) is the basement membrane of the Müller cells and can act as a scaffold for cellular proliferation in the pathophysiology of disorders affecting the vitreomacular interface. The atraumatic removal of the macular ILM has been proposed for treating various forms of tractional maculopathy in particular for macular pucker. In the last decade, the removal of ILM has become a routine practice in the surgery of the epiretinal membranes (ERMs), with good anatomical results. However many recent studies showed that ILM peeling is a procedure that can cause immediate traumatic effects and progressive modification on the underlying inner retinal layers. Moreover, it is unclear whether ILM peeling is helpful to improve vision after surgery for ERM. In this review, we describe the current understanding about ILM peeling and highlight the beneficial and adverse effects associated with this surgical procedure.

Persistent anomalous vitreo-macular adhesion (VMA) is a well-known factor, associated with a variety of sight threatening diseases - including macular hole, vitreo-macular traction syndrome, cystoid and diabetic macular edema, exudative age- related macular degeneration, myopic traction maculopathy and others. With the advent of optical coherence tomography our understanding of these pathologies and the ability of their early diagnosis has gone much far in the past two decades. The release of macular traction has been of exclusive surgical capability. Notwithstanding good results, vitrectomy is hampered by the inability of complete vitreo-retinal separation (i.e., smooth, bare internal limiting membrane), compulsory postoperative positioning in macular hole cases, surgical complications, and high costs. With aim to offer less invasive and safe treatment modality for anomalous VMA, investigators have made enormous progress in the past decade. Leading among the studied nonsurgical measures is the intravitreal application of pharmacologic agents for the induction of vitreo-retinal separation and vitreous liquefaction, a method termed pharmacologic vitreolysis. Several vitreolytic agents have been studied to date, the most potent among them proved to be plasmin. Recently, ocriplasmin (formerly known as microplasmin) - a more stable than plasmin recombinant product, proved to be safe and efficient in releasing VMA in large studies, and consequently received FDA approval. It’s role in clinical practice is now in the process of being determined. This paper aims to review and summarize the current knowledge and status of investigation on this new approach for the treatment of VMA.

• Pharmacologic vitreolysis
• Vitreo-macular adhesion
• Posterior vitreous detachment
• Macular hole
• Microplasmin