A porous coral-like structure - A new insight into the morphology of the inner limiting membrane of the retina?

Abstract

To date, the internal limiting membrane (ILM), specifically, the side facing the retina, has never been studied by two parallel, mutually complementary methods. This is an attempt to explain favorable results of ILM peeling in various macular pathologies. Aim - by employing scanning (SEM) and transmission electron microscopy (TEM), to identify morphological features of epiretinal samples removed during vitrectomy in patients with lamellar macular hole (LMH) or epiretinal membrane (ERM). Material and methods. We studied 23 eyes of 23 patients divided into two groups. The first group (13 samples, 11 eyes) consisted of patients with LMH; the second (12 samples, 12 eyes) - with ERM. The surgeries yielded a total of 21 epiretinal samples peeled simultaneously with the ILM and 4 epiretinal samples (2 eyes) peeled in two parts, the second part containing the ILM. One half of the samples was studied by SEM without prior dehydratation, the other - by TEM. Results. The study revealed a high degree of ultrastructural similarity between the two groups of ILM samples. Judging from SEM findings, two sides of the membrane were clearly identified. Porous coral-like structures (PCS) were discovered on the side facing the retina. TEM in the area of PCS discovered parallel arrangement of multiple Muller cell (MC) bodies and processes separated by wide layers of the intercellular matrix. The vitreal side of all ILM samples was notable for numerous fibroblast-like cells. Many variously shaped petrified structures were found on both sides of the membrane. Conclusion. During the so called ILM peeling, the surgeon removes a layered structure that includes the basal membrane of MC, cells and fibers attached to its vitreal side, and one more layer comprised by PCS and rather readily torn off from the main massif. The functional significance of this previously unknown structure as well as the effect of its partial removal during surgical manipulations with neurosensory retina in the macular region is yet to be investigated.