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Removing the internal limiting membrane (ILM) can be very challenging because of the difficulty in its visualization and consequent risk of incomplete peeling or retinal damage. Although the use of indocyanine green makes visualization and removal of the ILM easier, concerns have been expressed regarding its toxicity. This report describes the authors’ use of triamcinolone acetonide to improve the safety and efficiency of ILM peeling without involvement of adjuvant ILM staining.
Various surgical techniques and adjuvant therapies have been proposed to increase rates of macular hole closure and to improve visual results. It has been described that the removal of the internal limiting membrane (ILM) is an effective approach to idiopathic macular hole surgery, leading to an improved closure rate. 1 ILM peeling may also be useful in patients with chronic cystoid macular edema 2 and epiretinal membrane. Removal of the ILM is technically challenging because of its inherently transparent structure. Even in the hands of experienced surgeons, it is difficult to confirm the complete removal of the macular ILM. Concern has been expressed that retinal damage could occur if areas that have been peeled are manipulated again because of poor visualization. 3 Agents used to stain the ILM, such as indocyanine green, greatly facilitate its removal, 3 but concerns have been expressed regarding the safety of this method of dye-assisted surgery. We describe a technique of triamcinolone acetonide–assisted ILM peeling that combines improved membrane visualization with an excellent adjuvant safety profile.
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