Surgery: Removal of Epiretinal Membrane and ILM

This video demonstrates the removal of epiretinal membrane and then the removal of the Internal Limiting Membrane after staining it with brilliant blue. An air fluid exchange was done at the end of the surgery.

Surgeon: Dr. Manish Nagpal, Retina Foundation & Eye Research Centre, Ahmedabad, India


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Dr. Manish Nagpal: This is a case of epiretinal membrane. Vitrectomy is being done so remove the vein thrombosis tree use. The core vitrectomy is done, and then after that it is removed. Now, you can get a good view of the retinal membrane which is distorting the retinal vessels and an alternative mix of the macular is seen.
The forceps is taken to start peeling the epiretinal membrane. We follow the pinch and peel technique in which we pinch with the forceps to get an edge of the epiretinal membrane. You can see at the moment there’s a small edge which has lifted. And then we go back and pick up the edge and start to peel in a circumferential manner.
So, gradually the retinal membrane comes off. One has to be careful that one doesn’t pull interiorly, because otherwise it can cause breaks in the retina if the adhesion is too strong. So, one has to gradually peel circumferentially just like one does with a capsulorhexis in a phaco surgery.
Peripheral edge is picked up so as to remove some of the peripheral part of the retinal membrane which is spanning between the macula and the disk. After this brilliant blue dye is injected so as to stain the ILM. The internal limiting membrane.
When we remove the epiretinal membrane, some of the membrane comes off with bits and pieces of the internal limiting membrane. So, with the stain we can know what part of the internal limiting membrane is left behind and then can peel it off. The residual dye is aspirated. And now you can see the parts of the internal limiting membrane which are stained very well. And then in a similar fashion to how we removed the epiretinal membrane, the same circumferential manner we try to gradually remove the internal limiting membrane.
The removal of the internal limiting membrane reduces the risk of reoccurrence of the epiretinal membrane in the future. Now, both the epiretinal and the internal limiting have been peeled. We are doing air exchange at this stage. The fluid is replaced by the air by aspirating at the disk.
We crossly look at the periphery and then just trim some of the remaining skirt off. Which is as can be seen much better under air now. And also look for any androgenic breaks if any are in the periphery. Some retinal fluid is aspirated at the end of the surgery.


January 31, 2018

Last Updated: October 31, 2022

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