A Novel Standardized Reproducible Method to Calculate the Area of Internal Limiting Membrane Peeled Peroperatively in Macular Hole Surgery by Using a Video Overlay - Boral’s Ring

Abstract

The challenges in macular hole surgery1-7 include the following:1. Till date no study described the standardized logical reproducible method of calculating area of ILM peeled(AIP) in macular hole surgery and 2. The area of Internal Limiting Membrane (ILM) that has to be peeled to ensure post-operative macular hole closure without any foveal neurosensory retinal defect is not well defined. Our aim was to highlight the way to calculate the Area of Internal Limiting Membrane Peeled (AIP) and its relation with hole closure pattern on OCT in idiopathic FTMH cases. We conducted a prospective single blind study taking 105 eyes/105 patients with symptomatic Idiopathic FTMH< 6months duration. We included idiopathic full thickness macular holes, excluding cases of secondary macular holes, old macular holes with symptoms more than six months duration and eyes with small & large optic discs. All cases were operated by four VR surgeons in our hospitals, where triamcinolone assisted vitrectomy, PVD induction, BBG dye assisted ILM peeling done followed by fluid air exchange and injection of C3F8 gas in non expansile conc . All surgeries were video recorded. Three parameters were evaluated – pre Techniques