Internal limiting membrane peeling is routinely performed during vitrectomy for a full-thickness idiopathic macular hole. What is the primary rationale for removing the ILM?

• A It restores the physiological pumping function of the retinal pigment epithelium
• B It removes the source of vascular endothelial growth factor driving chronic edema
• C It eliminates residual tangential traction on the hole edges and stimulates gliotic bridging ✓
• D It prevents postoperative cystoid macular edema by sealing perifoveal capillaries

Explanation

The ILM acts as a scaffold for contractile cellular proliferation on the hole margins. Peeling it removes tangential centripetal forces, allows the edges to approximate, and creates a substrate for glial tissue to bridge and close the hole. It has no direct action on RPE pumps or VEGF production, which excludes options A and B. Staining with dyes such as brilliant blue improves visualization of this thin membrane.

Reference: Ryan's Retina, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.