Working with Membranes

This chapter discusses the technical issues of dealing with different types of membranes inside the vitreous cavity.1 Additional details2 about these membranes are discussed either here or in various chapters in Part V.

32.1ILM3

32.1.1 Instrumentation and Infrastructure

The most delicate surgical maneuver (see Sect. 15.2) performed on the human body is ILM removal.

•The microscope must have excellent resolution (see Sect. 12.2).

•The surgeon must sit comfortably with his wrist firmly supported (see Sect. 16.2). While ILM peeling can be performed without wrist support (only the surgeon’s fingers resting on the patient’s forehead), this is far from ideal.4

•All equipment and instruments must be in working condition5 and the materials prepared in advance and readily available.

–The forceps (see also Sect. 13.2.1) must be a dedicated ILM forceps to allow grabbing the ILM whose thickness is less than 2 μ.

1The “what” and “how” questions (see Sect. 3.4).

2The “when” and “why” questions (see Sect. 3.4).

3Table 32.1 provides a summary of the indications for ILM peeling.

4“I’m able to peel the ILM without wrist support” – such boasting is irresponsible, rather than a tribute to the surgeon’s exceptional dexterity.

5The ILM forceps is an extremely delicate tool; whether reusable or disposable, it should not be automatically assumed that its operating mechanism actually works or the jaws perfectly close.

F. Kuhn, Vitreoretinal Surgery: Strategies and Tactics,

DOI 10.1007/978-3-319-19479-0_32