Is removal of internal limiting membrane always necessary during stage 3 idiopathic macular hole surgery?
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.
Kimura
Tetsushi
T
Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University,Kyoto, Japan.
Takahashi
Masayo
M
Takagi
Hitoshi
H
Kiryu
Junichi
J
Nishiwaki
Hirokazu
H
Tanabe
Teruyo
T
Suzuma
Kiyoshi
K
Oh
Hideyasu
H
Honda
Yoshihito
Y
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