Surgical removal of the internal limiting membrane for the treatment of a macular hole.
BACKGROUND
To evaluate the efficacy of internal limiting membrane (ILM) peeling in the treatment of a macular hole.


METHODS
The ocular evaluation included Snellen visual acuity, a slit-lamp examination, indirect ophthalmoscopy, and contact lens biomicroscopy. The macular holes were confirmed using a Watzke-Allen slit beam test. Surgery consisted of a standard 3-port vitrectomy under local anesthesia. The vitreous was removed, and the macular ILM was peeled by creating a small opening and a tear in the ILM with a bent 22-gauge needle around the inner margin of the vascular arcade. The ILM flap was then grasped with end-gripping forceps, and a circular capsulorrhesis maneuver was initiated. Next, gas-fluid exchange and internal tamponade with 10% C3F8 were performed, followed by postoperative face-down positioning.


RESULTS
Thirty-six eyes in 36 patients with idiopathic macular holes from stages 2 to 4 were included. The average follow-up time was 8.9 months. The holes were completely closed in 33 eyes (92%), and visual acuity was improved in 26 eyes (72%). Ten eyes were pseudophakic, 24 of the 26 phakic eyes had an increased density of the cataract after surgery, which was not detected in 2 cases. One of the patients had vitreous hemorrhage and hyphema; no retinal detachment or retinal tear was found in this study.


CONCLUSIONS
Surgery for macular holes using ILM peeling has a high anatomical and functional success rate.
Lai
Chi-Chun
CC
Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC. ccl404@cgmh.org.tw
Chuang
Lan-Hsing
LH
Ku
Wan-Chen
WC
Wu
Wei-Chi
WC
Yang
Ko-Jen
KJ
Tsao
Yeo-Ping
YP
Chen
Tun-Lu
TL
D000328:Adult; D000368:Aged; D001485:Basement Membrane / Q000601:surgery; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D006801:Humans; D008266:Macula Lutea / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012167:Retinal Perforations / Q000601:surgery*; D014821:Vitrectomy / Q000379:methods*