Purpose: To reevaluate the effect of internal limiting membrane peeling during vitrectomy on the Müller cell damage, we examined the ultrastructure of the internal limiting membrane by using focused ion beam/scanning electron microscopy (FIB/SEM).
Methods: A total of 12 internal limiting membranes obtained during surgery in both the macular hole and the idiopathic epiretinal membrane groups were processed for observation by FIB/SEM. Three-dimensional structures of the internal limiting membrane were analyzed.
Results: The number of cell fragments in the macular hole group was 5.07 ± 1.03 per unit area of internal limiting membrane (100 μm2). The total volume of cell fragments was 3.54 ± 1.24 μm3/100 μm2. In contrast, the number of cell fragments in the epiretinal membrane group was 12.85 ± 3.45/100 μm2, and the total volume of cell fragments was 10.45 ± 2.77 μm3/100 μm2. Data for both values were significantly higher than those observed in the macular hole group (P = 0.0024 and P = 0.0022, respectively, Mann-Whitney U test). No statistical difference was found for the mean volume of the cell fragment between the two groups.
Conclusions: All of the internal limiting membrane examined in this study showed cell fragments on the retinal surface of the internal limiting membrane. As compared with macular hole, epiretinal membrane exhibited a higher number and total volume of cell fragments, indicating that internal limiting membrane peeling for epiretinal membrane might have a higher risk of causing inner retinal damage.
Translational relevance: FIB/SEM was a useful tool for three-dimensional quantitative analysis of the internal limiting membrane.
Keywords: epiretinal membrane; focused ion beam/scanning electron microscopy; internal limiting membrane; macular hole; vitrectomy.