title: Taut internal limiting membrane causing diffuse diabetic macular edema after vitrectomy: clinicopathological correlation.
abstract: OBJECTIVE
  To describe 2 cases of diffuse diabetic macular edema (DME) after diabetic vitrectomy caused by a taut internal limiting membrane (ILM), with clinicopathological correlation.
  
  
  METHODS
  Interventional case series with immunohistochemical analysis.
  
  
  RESULTS
  Two patients were referred for unresponsive diffuse DME after pars plana vitrectomy with removal of the posterior hyaloid. Clinically, a taut ILM was noted over the fovea, and its removal resulted in rapid and long-term resolution of the edema, confirmed by optical coherence tomography with visual acuity improvement. Histopathology with immunostaining revealed a segment of ILM with an inner monolayer of cytokeratin-positive (retinal pigment epithelial cells) and/or glial fibrillary acidic protein-positive cells with smooth muscle actin immunoreactivity.
  
  
  CONCLUSIONS
  A taut ILM can cause diffuse DME after vitrectomy, and its removal can restore the normal foveal contour and improve visual acuity. Tangential tractional forces from contractile cells propagated across the fovea via the ILM appear to be the etiology.
authors: Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY 10003, USA. rgentile@nyee.edu
authors: Ronald C
authors: RC
authors: Gentile
authors: Tatyana
authors: T
authors: Milman
authors: Dean
authors: D
authors: Eliott
authors: Juan M
authors: JM
authors: Romero
authors: Steven A
authors: SA
authors: McCormick