Macula, Vitreous and Retina Associated of Costa Rica, San José, Costa Rica.
Retina. 2018 Sep;38 Suppl 1:S5-S11. doi: 10.1097/IAE.0000000000001906.
Epiretinal membranes (ERMs) have been described for more than 150 years. Currently, they are a common indication for vitreoretinal surgery. Recently, there has been an increasing trend to peel the internal limiting membrane (ILM). Although ILM peeling has generally been accepted as a fundamental step in macular hole repair, its current role in ERM remains controversial.
Literature review.
Proponents of ILM peeling argue that peeling of the ILM reduces the recurrence rate and facilitates a greater resolution of retinal folds. Opponents of ILM peeling show that the visual outcomes between eyes that undergo ILM peeling and those that do not have their ILM peeled are the same. Stripping of the ILM removes the Müller cell footplates, so it is reasonable to expect some Müller cell dysfunction. Adverse events such as eccentric paracentral macular holes, macular microscotomata, and retinal dimpling have been associated with ILM peeling.
Internal limiting membrane peeling does not improve the functional outcomes after ERM surgery. Internal limiting membrane peeling reduces ERM recurrences, but many recurrences are not clinically significant. It remains unclear what the long-term effects of ILM peeling are. We should err on the side of caution and avoid routine ILM peeling in primary idiopathic ERM cases and should reserve it for recurrent and high risk of recurrence cases.
内界膜（ILM）已被描述了 150 多年。目前，它是玻璃体视网膜手术的常见适应证。最近，剥离内界膜（ILM）的趋势有所增加。尽管 ILM 剥离通常被认为是黄斑裂孔修复的基本步骤，但它在 ERM 中的作用目前仍存在争议。
文献回顾。
ILM 剥离的支持者认为，剥离 ILM 可降低复发率，并更有利于视网膜皱褶的解决。反对 ILM 剥离的人则表明，接受 ILM 剥离和不进行 ILM 剥离的眼睛的视力结果是相同的。ILM 的剥离会去除 Müller 细胞足板，因此可以预期会出现一些 Müller 细胞功能障碍。与 ILM 剥离相关的不良事件包括偏心旁中心黄斑裂孔、黄斑微切迹和视网膜下陷等。
ILM 剥离并不能改善 ERM 手术后的功能结果。ILM 剥离可减少 ERM 的复发，但许多复发并不具有临床意义。ILM 剥离的长期影响仍不清楚。我们应该谨慎行事，避免在原发性特发性 ERM 病例中常规进行 ILM 剥离，并将其保留用于复发性和高复发风险的病例。
