Journal d'ophtalmologie clinique et expérimentale
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Histopathology of Internal Limiting Membrane Peeling In Traction Induced Maculopathies

Schumann RG, Yang Y, Haritoglou C, Schaumberger MM, Eibl KH, Kampik A and Gandorfer A

Purpose: To compare the presence of cell fragments and entire cell bodies on the retinal side of the internal limiting membrane (ILM) after removal with and without dye assistance in traction maculopathies.
Methods: En-bloc removal of the ILM and epimacular tissue was performed during vitrectomy in 75 eyes without dye-assistance and in 45 eyes with assistance of either Brilliant Blue G (BBG) or Trypan Blue (TB). We included 79 eyes with macular holes (MH) and 41 eyes with other traction maculopathies. All ILM specimens were processed by serial sectioning preparation for light microscopy. Exclusively, if cellular elements of more than 2 μm in diameter were found on the retinal side of the ILM by light microscopy, specimens were prepared for transmission electron microscopy.
Results: 23 (19%) specimens of this series demonstrated such cell fragments and entire cell bodies on the retinal side of the ILM. Specimens removed from MH eyes demonstrated less frequently retinal cell debris than specimens removed from other traction maculopathies. If epiretinal cell proliferation was seen, cellular debris on the ILM was significantly more frequent, irrespective of BBG or TB assistance.
Conclusions: Removal of cellular structures on the retinal side of the ILM during ILM peeling appears to be associated with epiretinal cell proliferation. The presence of cell fragments and entire cell bodies on the retinal side of the ILM seems unrelated to the use of BBG and TB. Epiretinal membranes with wrinkling and folding of the ILM may contribute to structural changes that facilitate pulling off parts of cells or entire cell bodies during ILM peeling.