title: Controversies over the role of internal limiting membrane peeling during vitrectomy in macular hole surgery.
abstract: Surgical management of an idiopathic macular hole consists of vitrectomy to release vitreofoveal traction and intraocular tamponade to flatten and reappose the hole's edges. The intentional atraumatic removal of the internal limiting membrane has been proposed as cost-effective option in macular hole surgery. The internal limiting membrane contributes to tangential traction at the edges of the hole and acts as a platform on which glial cells proliferate. Removal of the internal limiting membrane increases the elasticity of the denuded macula and improves the anatomical success rate; however, the visual consequences of this surgical maneuver are still not fully known. We discuss the beneficial and adverse effects associated with internal limiting membrane peeling in macular hole surgery, highlighting the internal limiting membrane's role in macular hole etiology and pathogenesis and the anatomical and functional findings after its removal.
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic, University of Brescia, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Morescalchi
authors.affiliation: Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy; I.R.C.C.S. Neuromed, Pozzilli, Isernia, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Costagliola
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic, University of Brescia, Brescia, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Gambicorti
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic, University of Brescia, Brescia, Italy. Electronic address: sarah.duse@alice.it.
authors.forename: Sarah
authors.initials: S
authors.lastname: Duse
authors.affiliation: Department of Neuroscience, University Federico II, Naples, Italy.
authors.forename: Mario Rosario
authors.initials: MR
authors.lastname: Romano
authors.affiliation: Department of Medical and Surgical Specialties, Radiological Specialties and Public Health, Ophthalmology Clinic, University of Brescia, Brescia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Semeraro
mesh_terms: D006801:Humans; D008266:Macula Lutea / Q000000981:diagnostic imaging*; D012167:Retinal Perforations / Q000175:diagnosis / Q000601:surgery*; D041623:Tomography, Optical Coherence / Q000379:methods*; D014821:Vitrectomy / Q000379:methods*
keywords: Müller cells; internal limiting membrane removal; vital dye staining; vitreomacular diseases; vitreomacular surgery; vitreomacular traction