Peel and peel again.
OBJECTIVE
To determine if the internal limiting membrane (ILM) was present in the epiretinal membrane (ERM) when we deliberately tried to perform a "double peel" for macular pucker.


METHODS
Pars-plana vitrectomy and a "double peel" were carried out. The ERM and ILM were stained with Trypan Blue and peeled separately over the same area. The amount of ERM present in ILM specimens and the amount of ILM present in ERM specimens were evaluated by histological examination.


RESULTS
Seventeen eyes in 17 patients were included. It was possible to double peel in all cases. Five of 17 ERM specimens (29%) contained ILM fragments. When ILM was present on the ERM, it represented less than 50% of the sample. One ILM specimen was lost as result of an administrative error; of the remaining 16 specimens, residual ERM was found in six, and cellular remnants were observed on the vitreous surface in a further six of the ILMs. Clinically, no recurrence of ERM was found.


CONCLUSIONS
ILM was present in some ERM specimens seemingly over the same area that an intact ILM was subsequently peel. We speculate that the ILM in the ERM represent a secondary basement membrane and that the surgical plane of dissection for most ERM peel is between the ERM and the native ILM, making it feasible to double peel routinely.
St Paul's Eye Unit, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK. syedgibran@yahoo.com
S K
SK
Gibran
B
B
Flemming
T
T
Stappler
I
I
Pearce
C
C
Groenewald
H
H
Heimann
P
P
Hiscott
D
D
Wong
D000328:Adult; D000368:Aged; D001485:Basement Membrane / Q000473:pathology; D004396:Coloring Agents; D019773:Epiretinal Membrane / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D014343:Trypan Blue; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods
D004396:Coloring Agents; D014343:Trypan Blue