title: Long-term follow-up after macular hole surgery with internal limiting membrane peeling.
abstract: OBJECTIVE
  To report long-term anatomical and functional results after pars plana vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular hole.
  
  
  METHODS
  Prospective, nonrandomized, consecutive series.
  
  
  METHODS
  Ninety-nine patients with a follow-up of at least 12 months were included. The surgical technique consisted of a standard pars plana vitrectomy, removal of the ILM, and an intraocular gas tamponade (15% hexafluoroethane [C(2)F(6)] gas mixture) followed by head-down positioning for at least 5 days. Follow-up examinations included a clinical examination, Goldmann perimetry, optical coherence tomography, and static microperimetry using a Rodenstock scanning laser ophthalmoscope (SLO-105). Stimulus size was 0.2 degrees (Goldmann II), intensities employed were 0 and 12 dB. Twenty-degree fields were used for all tests.
  
  
  RESULTS
  Mean period of review was 32 months (median 34). Anatomic closure was achieved in 86 (87%) of 99 patients by one surgical procedure. Nine patients underwent a successful second operation with an improvement of visual acuity in 7 patients. The closure rate after two surgical interventions was 96%. Best-corrected visual acuity improved from a median of 20/100 preoperatively to a median of 20/40 postoperatively (P <.001). An improvement of visual acuity was achieved in 94% of patients. In 13 of 99 patients (13%) a combined vitrectomy and cataract surgery with intraocular lens implant was performed; 72 patients (73%) underwent cataract surgery later. Ninety of 99 patients (91%) were pseudophakic on last presentation. Paracentral scotomata did not change in size, density, or shape over time. Its incidence was not correlated with the stage of the macular hole. No postoperative epiretinal membrane formation or late reopening of the macular hole was observed. One patient presented with a peripheral visual field defect after vitrectomy.
  
  
  CONCLUSIONS
  Macular hole surgery with peeling of the ILM without the use of adjuvants or ILM staining leads to good functional long-term results. Paracentral scotomata remained subclinical in most cases and may be due to a mechanical trauma of the nerve fiber layer.
authors.affiliation: Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. christos.haritoglou@ak-i.med.uni-muenchen.de
authors.forename: Christos
authors.initials: C
authors.lastname: Haritoglou
authors.forename: Carolin A
authors.initials: CA
authors.lastname: Gass
authors.forename: Markus
authors.initials: M
authors.lastname: Schaumberger
authors.forename: Arnd
authors.initials: A
authors.lastname: Gandorfer
authors.forename: Michael W
authors.initials: MW
authors.lastname: Ulbig
authors.forename: Anselm
authors.initials: A
authors.lastname: Kampik
mesh_terms: D000368:Aged; D019773:Epiretinal Membrane / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005466:Fluorocarbons / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D016684:Prone Position; D011446:Prospective Studies; D012167:Retinal Perforations / Q000503:physiopathology / Q000601:surgery*; D014054:Tomography; D016896:Treatment Outcome; D014792:Visual Acuity; D058609:Visual Field Tests; D014794:Visual Fields; D014821:Vitrectomy
chemical_list: D005466:Fluorocarbons; C048381:perfluoroethane