LAUSR

The internal limiting membrane (ILM) peeling is a recognised technique for management of various vitreoretinal disorders like macular holes, myopic foveoschisis, epiretinal membranes, vitreomacular traction, recalcitrant diabetic macular edema, retinal detachment, etc.[1] A Cochrane review in 2013 has concluded favourable role of ILM peeling in management of stages 2, 3 and 4 idiopathic macular holes.[2] ILM peeling causes reduction of tangential traction at fovea, increased retinal compliance and stimulation of retinal glial cells secondary to trauma to Muller cell end feet[2] as well as thickening of outer and middle inner retinal inner layers at macula. Papillofoveal distance is also shortened.[3,4] These changes are postulated to help in realignment of the external limiting membrane and photoreceptor restoration leading to macular hole closure and visual recovery. There is also thinning of retinal nerve fibre layer (RNFL), ganglion cell layer and inner plexiform layer, which is more marked in temporal side of the fovea than nasal. It could be attributed to instrument trauma or Brilliant Blue G (BBG) dye exposure.[3]