title: Epimacular proliferative response following internal limiting membrane peeling for idiopathic macular holes.
abstract: OBJECTIVE
  To present two patients who underwent surgery for an idiopathic macular hole (IMH) with internal limiting membrane (ILM) peeling and developed an epimacular proliferative response.
  
  
  METHODS
  Observational case report. Two patients with an IMH underwent pars plana vitrectomy with ILM peeling. Ophthalmic examination including optical coherence tomography (OCT) was performed pre- and postoperatively. In both cases, scanning laser ophthalmoscopy (SLO) was performed postoperatively.
  
  
  RESULTS
  In the first case, the closure of the macular hole (MH) was confirmed ophthalmoscopically and by OCT following the surgery. At 2 months postoperatively, a thin epiretinal membrane (ERM) developed over the nasal macula area where the ILM had been peeled. The patient's visual acuity had recovered to 1.0 but she complained of metamorphopsia. At 18 months postoperatively, the thin ERM around the nasal fovea remained and her visual acuity was still 1.0. In the second case, the MH was sealed after the surgery, and the patient's visual acuity had improved to 1.0 at 3 months, but an indistinct ERM developed in the macular region where the ILM had been peeled. Two years after the operation, her VA was still 1.0. One and two years postoperatively, a thin epimacular proliferation remained unchanged; in addition, the OCT and SLO images remained stable.
  
  
  CONCLUSIONS
  Two patients who underwent IMH surgery with ILM peeling developed an epimacular proliferative response postoperatively. We suggest that the injury associated with the ILM peeling may have stimulated glial proliferation.
authors.affiliation: Department of Ophthalmology, Toho University Sakura Hospital, 564-1 Shimoshizu, 285-8741, Sakura, Chiba , Japan. ruemoto@sakura.med.toho-u.ac.jp.
authors.forename: Riyo
authors.initials: R
authors.lastname: Uemoto
authors.affiliation: Department of Ophthalmology and Visual Science, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Yamamoto
authors.affiliation: Department of Ophthalmology, Toho University Sakura Hospital, 564-1 Shimoshizu, 285-8741, Sakura, Chiba , Japan.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Takeuchi
mesh_terms: D000328:Adult; D000368:Aged; D001485:Basement Membrane / Q000601:surgery*; D019773:Epiretinal Membrane / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005911:Gliosis / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D009457:Neuroglia / Q000473:pathology*; D009887:Ophthalmoscopy; D011183:Postoperative Complications; D012167:Retinal Perforations / Q000601:surgery*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014821:Vitrectomy