Internal limiting membrane removal in the management of full-thickness macular holes.
OBJECTIVE
To determine the effectiveness of removal of the internal limiting membrane in the treatment of full-thickness macular holes.


METHODS
Data were reviewed from a prospective study on 47 consecutive eyes with full-thickness macular holes undergoing vitrectomy, internal limiting membrane maculorhexis, and fluid-gas exchange. No eye underwent repeat macular hole surgery. A meta-analysis was performed to compare the outcomes of different surgical techniques in the treatment of full-thickness macular holes.


RESULTS
The outcome measures were disappearance of the submacular fluid and the change in best-corrected visual acuity. The surgery was anatomically successful in 44 of the 46 eyes (96%) and 39 of the eyes (85%) showed an improvement of at least two Snellen lines. Best-corrected final vision was 20/40 in 18 (39%) eyes. No permanent complications specifically caused by the removal of the macular internal limiting membrane were detected; the minor hemorrhages and retinal edema seen in most eyes resolved spontaneously. Retinal detachment developed and was successfully treated in three eyes (7%). A meta-analysis on 1,654 eyes from published reports showed that internal limiting membrane maculorhexis appears to significantly (P <.0001) increase the anatomical and functional success rates in macular hole surgery.


CONCLUSIONS
Internal limiting membrane removal is an important development in the evolving field of macular hole surgery. A randomized, prospective, multicenter clinical trial should be performed to determine which surgical technique is the most beneficial in patients with full-thickness macular holes.
Mester
V
V
Department of Ophthalmology, University of Pécs, Pécs, Hungary.
Kuhn
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D019773:Epiretinal Membrane / Q000473:pathology / Q000601:surgery*; D005122:Exudates and Transudates; D005260:Female; D005654:Fundus Oculi; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D011446:Prospective Studies; D012167:Retinal Perforations / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy