Probe-Assisted ILM-Rhexis: A Novel Peeling Technique

Abstract Background and Objective: To describe a novel surgical technique of removing internal limiting membrane (ILM) using a 25 G vitrectomy probe amid epiretinal membrane (ERM)/ILM double peeling operation. Materials and Methods After standard 3-port 25-gauge pars plana vitrectomy, ERM is removed using membrane forceps and appropriate staining. When washing out the ILM-specific dye by the vitrectomy probe an incidental ILM flap may be noticed. We suggest not drawing out the vitrectomy probe but instead applying proximal and tangential aspiration force over the ILM flap, which may be extended and peeled off by gentle probe maneuvers along the retinal surface. Results The technique is described in three opertaed cases. Details of probe maneuvers are displayed in a video. Conclusion We suggest applying this technique amid surgical scenarios involving ERM/ILM double peeling and double staining where an incidental ILM flap is found after washing out of the ILM-specific dye. Advantages over using conventional forcerps include the reduced number of entries into the posterior segment, lower risk of inadvertent retinal breaks, better safety profile, and easier-to-perform elongation of ILM flaps.