Large Internal Limiting Membrane Tears Often Accompany Epiretinal Membrane

Large internal limiting membrane (ILM) tears are often present in eyes with epiretinal membrane (ERM), and these tears can provide a convenient and safe “handle” for initiating membrane peeling during surgery, according to findings published in the American Journal of Ophthalmology.

Researchers at a single center conducted a retrospective interventional case series to describe the prevalence, clinical and imaging characteristics, and surgical utility of large ILM tears in eyes with ERM.

They collected demographic and clinical data from patients’ medical records. ERMs and large ILM tears had been identified and analyzed using multimodal imaging.

A total of 71 eyes of 70 consecutive patients underwent ERM peeling by a single vitreoretinal surgeon at the center between 2016 and 2019. The median follow-up duration was 385 days for those with large ILM tears (n=23; mean age, 65.7 years) and 336.5 days for those without large ILM tears (n=48; mean age, 67.5 years).

The researchers found large ILM tears (mean length, 5567±434 μm) in 32.4% of eyes with ERM that underwent surgical management. Among patients with ERM who did not undergo surgical management, the researchers found large ILM tears (those with a mean length of 4819±564 μm) in 8.0% of eyes. Of the eyes with large ILM tears (23/70), they found that 95.6% of the tears were identified preoperatively on multimodal imaging.

With further analysis, the team demonstrated that large ILM tears were commonly associated with other signs of ERM-induced retinal traction, including retinal nerve fiber layer schisis (87.0%), inner retinal dimpling (34.8%), and discrete paravascular red lesions (84.2%). In all eyes stained with Brilliant Blue G (BBG), they found that preoperative diagnosis of large ILM tear was confirmed and that the scrolled ILM edge was used successfully to initiate ILM peeling.

“The scrolled edge of a large ILM tear can readily be identified with BBG staining intraoperatively and provides a convenient and safe “handle” to initiate peeling of the ILM and overlying ERM,” the researchers explain. “Our findings suggest that large ILM tears are commonly present in eyes with surgical ERMs, that radial OCT scans and recognition of associated features may assist in their identification preoperatively, that ERM contraction is likely the predominant pathogenic mechanism in their development, and that the scrolled ILM edge provides a convenient and safe handle to initiate peeling of the ILM and overlying ERM.”

Limitations of the study included the retrospective design, lack of BBG staining in all cases, and use of a cohort of patients from a single vitreoretinal surgeon at a tertiary referral center. 

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.