Internal limiting membrane removal during macular hole surgery: results of a multicenter retrospective study.
OBJECTIVE
To evaluate the effect of internal limiting membrane (ILM) peeling and other variables in hole closure and functional success rate after idiopathic macular hole surgery.


METHODS
Retrospective, multicenter, observational study.


METHODS
The records of 1627 patients operated on for idiopathic macular hole were collected retrospectively from 28 surgeons. All patients underwent a single pars plana vitrectomy and were divided into 2 groups: with and without ILM peeling. Preoperative, intraoperative, and postoperative variables were evaluated.


RESULTS
The overall rate of macular hole closure was 94.1% in the ILM peeling group and 89.0% in the no ILM peeling group (P<0.001). The probability of achieving hole closure after surgery is 2.59 times higher if the ILM is peeled (95% confidence interval [CI], 1.71-3.92; P<0.001), 3.12 times higher for holes lasting less than 6 months (95% CI, 1.70-5.71; P<0.001), 4.94 (95% CI, 2.39-10.20) for stage 2 holes, and 2.34 (95% CI, 1.55-3.53) for stage 3 holes than that of patients with a stage 4 hole (P<0.001).


CONCLUSIONS
Internal limiting membrane peeling seems to improve hole closure for stage 3 and 4 holes and for long-lasting holes. Higher-stage macular holes and longer duration of symptoms are risk factors for surgical failure. In patients obtaining hole closure, there is no difference in functional results between pseudophakic peeled and not peeled patients, whereas in phakic patients, a better functional result in not peeled patients was seen.
Tognetto
Daniele
D
Eye Clinic, University of Trieste, Trieste, Italy. tognetto@univ.trieste.it
Grandin
Rosita
R
Sanguinetti
Giorgia
G
Minutola
Daniela
D
Di Nicola
Marta
M
Di Mascio
Rocco
R
Ravalico
Giuseppe
G
D000368:Aged; D019773:Epiretinal Membrane / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects; D011379:Prognosis; D012167:Retinal Perforations / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects