Probe-assisted ILM-Rhexis: A Novel Peeling Technique

This study describes a novel technique for removing the internal limiting membrane (ILM) using a 25-G vitrectomy probe during the epiretinal membrane (ERM)/ILM double peeling procedure. After standard 3-port 25-gauge pars plana vitrectomy, ERM is removed using membrane forceps and appropriate staining. An incidental ILM flap may occur while washing out the ILM-specific dye with the vitrectomy probe. To prevent this, we suggest not withdrawing 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. The technique is described in three cases, with details, and shown in a video. This approach has several advantages. It may reduce the number of entries into the posterior segment during pars plana vitrectomy, preventing inadvertent retinal breaks. Furthermore, in cases with fragile ILMs that are hard to elongate with forceps, the active aspiration force of the vitrectomy probe might rapidly extend and form large flaps. We suggest applying this technique in scenarios involving ERM/ILM double peeling and double staining, where an incidental ILM flap is found after washing out the ILM-specific dye.