Peeling of the basal membrane in the human retina - Ultrastructural effects

Purpose: To study the effects of internal limiting membrane (ILM) peeling, usually performed in cases of macular hole formation, on the structural integrity of the human retina. Design: Experimental study. Material. Two human donor eyes. Methods: A human donor retina was subjected to ILM peeling shortly after enucleation, fixed, and studied by electron microscopy. Main Outcome Measures: Electron microscopic findings. Results: Within the peeled area, and even at its margins, a substantial number of Muller (glial) cell endfeet and vitreal Muller cell processes was severely damaged. However, many glial cells remained intact, and the cell bodies of the injured cells showed no signs of destruction. Conclusions: We have shown that ILM peeling results in minor, but demonstrable, damage of the adjacent retina. Clinical studies are required to demonstrate unequivocally that ILM peeling does not induce functional deficits rather than improvement of visual function. (C) 2004 by the American Academy of Ophthalmology.