title: Is removal of internal limiting membrane always necessary during stage 3 idiopathic macular hole surgery?
abstract: OBJECTIVE
  To determine the indications for internal limiting membrane (ILM) removal in stage 3 idiopathic macular holes (MHs).
  
  
  METHODS
  Focal posterior vitreous detachments (PVDs) at MH rims were examined preoperatively by optical coherence tomography and binocular slit-lamp fundus examination in 19 patients retrospectively. All eyes underwent pars plana vitrectomy and creation of a PVD, and some eyes underwent a second surgery to remove the ILM. Indications of ILM removal for MH closure were discussed.
  
  
  RESULTS
  Preoperatively, 9 eyes did not (non-PVD group) and 10 eyes did (PVD group) have complete focal PVDs. In all nine eyes in the non-PVD group, MHs were closed after the creation of a PVD without ILM peeling (P <0.05, chi test). In the PVD group, 5 eyes (50%) had MHs closed by making PVD complete without ILM removal, and 5 eyes (50%) required ILM removal in a second surgery. In the end, closure of MHs was achieved in all eyes.
  
  
  CONCLUSIONS
  Anatomic closure of stage 3 idiopathic MHs without a PVD at the rim of the hole may be achieved only by creating a PVD without ILM removal.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University,Kyoto, Japan.
authors.forename: Tetsushi
authors.initials: T
authors.lastname: Kimura
authors.forename: Masayo
authors.initials: M
authors.lastname: Takahashi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takagi
authors.forename: Junichi
authors.initials: J
authors.lastname: Kiryu
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Nishiwaki
authors.forename: Teruyo
authors.initials: T
authors.lastname: Tanabe
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Suzuma
authors.forename: Hideyasu
authors.initials: H
authors.lastname: Oh
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Honda
mesh_terms: D000328:Adult; D000368:Aged; D001485:Basement Membrane / Q000601:surgery; D003941:Diagnostic Techniques, Ophthalmological; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012167:Retinal Perforations / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014821:Vitrectomy; D014822:Vitreous Body / Q000601:surgery