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Abstract
1.Vitrectomy with ILM peeling minimizes or even eliminates the need for postoperative facedown (prone) positioning. ILM also relieves the tangential traction on the prefoveal vitreous and removes the scaffold for the proliferation of glial cells lead to improvement in anatomic and visual outcomes in cases of IMH but some ophthalmologists limit the value of ILM for macular hole >400 µm in diameter. Others reported that ILM peeling improves anatomic and not final visual outcome. Vitrectomy with ILM peeling promotes closure of the hole in cases of traumatic macular hole .ILM peeling is very useful in myopic macular hole surgery leading to a higher rate of anatomical closure with no direct influence on visual improvement.
2.ILM peeling reducing tangential traction which may play a role in the formation and progression of diffuse diabetic macular edema .ILM peeling accelerates the absorption of edema in more severe diabetic macular edema, but without any improvement of visual acuity .some ophthalmologists reported that vitrectomy in eyes with diabetic macular edema without ILM peeling was effective in reducing the retinal thickness and improving the visual acuity as eyes with ILM peeling.
3.Glial cells of retinal origin proliferated through defects in the internal limiting membrane responsible for producing epiretinal membranes. ILM peeling during macular ERM surgery may minimize the recurrence of ERM with improvement in visual acuity.
4.Vitreous traction may play a role in the pathogenesis of cystoid macular edema so vitrectomy with ILM peeling resulted in significant biomicroscopic and angiographic resolution of CME with a corresponding improvement in visual acuity. some ophthalmologist reported that ILM peeling was not found to improve visual acuity postoperatively
5.ILM peeling during PVR operation is consistent with two good anatomical outcomes: First, the removal of the ILM and overlying ERM may increase the flexibility of the detached retina, thus contribute to retinal reattachment. Second, as the ILM may be a scaffold for cellular proliferation, the removal of the ILM may prevent cellular reproliferation
6.Vitrectomy with ILM peeling is uncertain for patients with myopic foveoschisis some ophthalmologist support the other deny.
7.Several techniques have been described to remove the ILM: ILM maculorrhexis, peeling with Morris and Witherspoon ILM forceps, Pinch technique, FILMS technique, Ablation of inner retinal layers was achieved by Er: YAG-laser in vitro but could not produce selective and reproducible ILM removal.