ILM peeling in uncomplicated RRD surgery – yay or nay !
Is it just a surgically satisfying manoeuvre?
Has been proposed to decrease the incidence of post-operative ERM formation and the incidence of RD recurrence.
However, it may be surgically challenging in a detached retina and cause more trauma (evidenced by greater DONFL appearance). Use of silicon oil tamponade post operatively might enhance the potential for a toxic effect due to increased oil/nerve fibre layer contact.
So choose wisely!
This video illustrates ILM peeling in a case of recurrent RRD…
#VRlearning #VRgrowing #retinasurgery #surgicalretina #retinaldetachment #ILMpeeling #case4 #RD
Learning points:
Tryphan blue can be used to check for residual pre-retinal membranes especially in recurrent RD.
Using the dye after fluid gas exchange helps to temporarily settle the retina, which makes initiation of peeling easier. Also, lesser amount of dye is required for a shorter time, thus limiting toxicity. It is easier to remove and there is minimal penetration into the retinal tissues or subretinally.
ILM peeling does have a role in RD with PVR, recurrent RD and cases with associated macular pucker.
Post operative macular edema has been reported following ILM peeling and usually resolves with conservative management.