Document Detail


Removal of the internal limiting membrane in macular holes. Clinical and morphological findings
MedLine Citation:
PMID:  9376691     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The recommended treatment for full-thickness macular holes is removal of the posterior hyaloid and sometimes the epiretinal membrane from the retina during vitrectomy in order to release the assumed intravitreous traction. We have employed a technique involving the additional removal of the membrana limitans interna (MLI) from the retina in the vicinity of the macular hole. We report on our clinical results and ultrastructural findings. MATERIALS AND METHODS: Between December 1995 and July 1996, we performed vitrectomies on 39 eyes of 37 patients with full-thickness macular hole. After removal of the attached posterior hyaloid, a specially developed forceps was used to remove a circular area of the MLI approximately three to four disc diameters in size. At the conclusion of the operation, 20% C3F8 gas was injected and the patient instructed to stay in a prone position for 8 days. RESULTS: Intraoperatively, "rhexis" of the MLI only rarely produced bleeding or recognizable retinal edema. Complete closure of the hole was observed postoperatively in 36 of the 39 eyes (92%). A visual improvement of at least two lines was achieved in 77% of eyes with successful closure. Pigment irregularities or edematous changes could not be detected either clinically or by fluorescein angiography in any of the 39 eyes. Electron microscopy was performed on 23 of the membranes. The salient feature was the MLI. Canals leading from the inner to the outer surface of the MLI contained Müller cell processes with clear signs of necrosis or degeneration. On the vitreous side, the MLI usually exhibited myofibroblasts. CONCLUSIONS: The MLI was successfully removed in all 39 eyes with a full-thickness macular hole. This procedure led to very good anatomic and functional results. It remains for future studies to determine the pathogenic significance of the necrotic processes detected by electron microscopy in the MLI canals.
Authors:
C Eckardt; U Eckardt; S Groos; L Luciano; E Reale
Publication Detail:
Type:  English Abstract; Journal Article    
Journal Detail:
Title:  Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft     Volume:  94     ISSN:  0941-293X     ISO Abbreviation:  Ophthalmologe     Publication Date:  1997 Aug 
Date Detail:
Created Date:  1997-11-21     Completed Date:  1997-11-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9206148     Medline TA:  Ophthalmologe     Country:  GERMANY    
Other Details:
Languages:  ger     Pagination:  545-51     Citation Subset:  IM    
Affiliation:
Augenklinik, Städtische Kliniken Frankfurt/Main-Höchst.
Vernacular Title:
Entfernung der Membrana limitans interna bei Makulalöchern. Klinische und morphologische Befunde.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Epiretinal Membrane / pathology,  surgery*
Female
Humans
Hyalin* / ultrastructure
Macula Lutea / pathology,  surgery
Male
Microscopy, Electron
Middle Aged
Retinal Perforations / pathology,  surgery*
Treatment Outcome
Vitrectomy / methods*

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