Garweg J. G., Messerli-Gerhardts D., Körner U., Körner F.

Dept. Ophthalmology, University of Berne, 3010 Bern

Background: The structural and functional role of the inner limiting membrane (ILM) has not completely been uncovered. Therefore it is also still unknown, which effects a complete removal of ILM might harbour. The present study targets the morphologic and functional outcome after macula surgery with complete controlled removal of the ILM using intraoperative vital staining with indocyanine green (ICG).
Patients and Methods: 62 patients operated on with intraoperative vital staining of the ILM using indocyanine green (ICG) for macular hole (MH) or vitreomacular traction syndrome (VMT) were followed prospectively over 6 months postoperatively to record their visual acuity, macular visual field (Octopus M2) and morphological results.
Results: The anatomic success may be improved in MH as well as in VMT regarding closure of macula foramen and residual vitreoretinal traction by vital staining of the ILM six months postoperatively. Visual acuity however remained stable at 0.2 in MH, but improved from 0.3 to 0.45 in VMT. No change in reading vision (MH 0.1, VMT 0.22) was observed nor were diffuse or systematic visual field defects uncovered.
Conclusion: After complete removal of the ILM, an improved anatomic success rate without any obvious morphological disadvantage may be achieved. This was not accompanied by a functional improvement which may be due to long standing symptoms and thus reduced functional reserve. Possible additional mechanisms include a mechanical damage of the fovea due to the stripping off of ILM and a not recognized metabolic or structural function of the removed ILM for which we found no evidence.

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