Vitreous surgery with and without internal limiting membrane peeling for macular hole repair.
OBJECTIVE
To compare surgical results for idiopathic macular holes with and without internal limiting membrane (ILM) peeling in a series of consecutive patients during an 8-year period.


METHODS
A retrospective, nonrandomized, comparative trial. Four hundred seventeen eyes with macular holes without ILM peeling were compared with 175 eyes with ILM peeling. All eyes underwent pars plana vitrectomy with intravitreous gas, followed by head-down positioning. No adjunctive therapies were used. Comparison of closure and reopening rates and visual acuity with and without ILM peeling was analyzed.


RESULTS
Initial success rate significantly improved from 81% to 92% with ILM peeling. ILM peeling significantly improved the initial success rates in all categories of preoperative features. Reopening rates significantly decreased from 7% to 0.6% with ILM peeling. Among successful cases, line improvement was 6.0 in ILM-reserved eyes and 5.8 in ILM-peeled eyes. Among all cases, line improvement was 5.4 in ILM-reserved eyes and 5.7 in ILM-peeled eyes. Initial success rate of holes measuring more than 400 microm was significantly less than that of holes measuring less than 400 microm with or without ILM peeling. Initial success rate of holes older than 6 months old was significantly less than that for holes less than 6 months old without ILM peeling.


CONCLUSIONS
Internal limiting membrane peeling shows high closure and low reopening rates in macular hole surgery. ILM peeling is beneficial in older holes but is limited in larger holes. ILM peeling does not significantly improve visual acuity.
Kumagai
Kazuyuki
K
Shinjo Ophthalmologic Institute, Miyazaki, Japan. kumagai3@f8.dion.ne.jp
Furukawa
Mariko
M
Ogino
Nobuchika
N
Uemura
Akinori
A
Demizu
Seiji
S
Larson
Eric
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000601:surgery; D004396:Coloring Agents; D003452:Cryosurgery; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D016684:Prone Position; D012167:Retinal Perforations / Q000601:surgery*; D012189:Retrospective Studies; D013459:Sulfur Hexafluoride / Q000008:administration & dosage; D014821:Vitrectomy / Q000379:methods*; D014822:Vitreous Body / Q000601:surgery*
D004396:Coloring Agents; D007208:Indocyanine Green; D013459:Sulfur Hexafluoride