Vitrectomy

[chalula]

I hjave seen 2 retinal specialists regarding my macular pucker. One of them says he does not remove the ILM the internal limiting membrane but some may come off on its own. The other says he would remove it as he feels this the better way to go as the pucker will have less chance of growing back. This surgeon also does the sutureless which I have read alot about on this site. I have not been able to find much info on whether it is a good idea to remove the ILM.
Would appreciate your comments

[kgw1117]

i also was told by the second retina specialist that time and light is very important regarding toxicity from ICG use. But it only takes a drop and it also remains for months. i visited my retinal specialist yesterday where the scans show remaining and this has been since Jan. 2009, he said he had never seen it to remain for over 8 months. the thing that concerns me is there is a blue dye which is FDA approved, the ICG is NOT FDA approved to use this way and there is not dosing instructions. you sound like you are doing your homework and will make an informed decision.

[JodieJ]

If you are having your surgery with an experienced, board-certified retinal specialist, I predict that you will be pleased with the results.  This is not painful surgery, and the newer "sutureless" equipment substantially decreases the time needed for visual recovery.  (There are no sutures in the eye to distort vision with astigmatism.)   I believe that dyes are frequently used without negative effects.

[John C Hagan III, MD, FACS, FAAO]

You two seem to have worked this out quite nicely on your own. Well done and thanks Jodie J

JCH III MD

[chalula]

The specialist I spoke to explained that he first tries to remove as much as he can without the dye ( which is the indocyanine green that he says he dilutes) He then says it is a matter of the time spent and the light needed for the procedure that contributes to toxicity. He says that most studies are done by students who work slowly and are not as adept.  After the surgery is completed, he says you can see light toxicity on the angiogram and he has never had a problem show up. I think I will be using him and hope I don't have buyer's remorse. It seems as though it has more pros than cons. Would like your thoughts.

[chalula]

The specialist I spoke to explained that he first tries to remove as much as he can without the dye ( which is the indocyanine green that he says he dilutes) He then says it is a matter of the time spent and the light needed for the procedure that contributes to toxicity. He says that most studies are done by students who work slowly and are not as adept.  After the surgery is completed, he says you can see light toxicity on the angiogram and he has never had a problem show up. I think I will be using him and hope I don't have buyer's remorse. It seems as though it has more pros than cons. Would like your thoughts.

[JodieJ]

My own ERM surgery left me with excellent acuity (20/20+) but a larger image size in my affected eye.  Through personal correspondence with a respected retinal surgeon, it was suggested that a second procedure involving ILM peeling might eliminate my image size problem.  Through online research, I learned that ILM peeling does seem to be associated with less central vision distortion post-surgery.  Unfortunately, in my case I was advised that the risks of a second procedure would outweigh the benefits.  But if I had to do it over,  I'd want to include it.  (Image size problems post ERM surgery have been described in the medical literature as being a "not uncommon" problem.)

[chalula]

I'm awaiting a call from the specialist who does remove the ILM and I will ask him about the dyes and their possible toxic effects. You seem very knowledgeable about eye problems. . I will post what he says and go friom there. Would appreciate your  further comment when I get this info.

[JodieJ]

I have strong feelings about the highly technical  (and controversial) question you've raised based on my personal research.  ILM peeling tends to require the use of dyes that may have toxic effects.  It is my impression that it is not generally done during ERM surgery (at least in the US) unless a macular hole is present.  However,  there is preliminary evidence that peeling the ILM significantly reduces post-surgery distortion in central vision, including an alteration in image size in the affected eye.  I'd definitely opt for including this procedure in my surgery.