Clinical Outcomes of Vitrectomy and Internal Limiting Membrane Peeling with Air Tamponade for the Treatment of Idiopathic Macular Hole

Abstract

Objective: To evaluate the effect of vitrectomy and internal limiting membrane peeling with air tamponade for the treatment of idiopathic macular hole (MH). Methods: A retrospective study was performed on 32 eyes of 32 patients with idiopathic macular hole in our hospital from January 2017 to January 2018. There were 9 males (9 eyes) and 23 females (23 eyes), with amean age of 60.7±12.2 years (range from 47~78 years). Pars plana vitrectomy with internal limiting membrane peeling was performed, followed by fluid-air exchange. According to the results of OCT scanning in the first postoperative follow-up, all patients were divided into two groups: MH closed ornot closed. The preoperative and postoperative best corrected visual acuity (BCVA) and diameter of the MH were compared between the two groups, using a Wilcoxon test and independent sample t test. The MH closure rate, the continuity of the external limiting membranes and photoreceptors were compared using a chi square test. Results: At the last follow-up, the LogMAR BCVA was 0.40 (0.30, 0.73), which was significantly higher than the preoperative BCVA 0.80 (0.70, 1.00) (Z=-3.439, P<0.001). Early postoperative OCT scansshowed that 24 macular holeswere closed, while the macular holes in the other 8 eyes were not closed sofluid-air exchange was performed again. The macular holeswereclosed in all 8 patients one month after the second treatment or the last follow-up. Sixteen patients hadcontinuous external limiting membrane (ELM) but none with a continuous external zone (EZ) in the OCT scansone month after the operation. However, 18 patients showed continuous ELM and 6 showed continuous EZ at the last follow-up. According to whether MH was closed or not at the first postoperative OCT scanning, all patients were divided into two groups. The mean pre-surgical diameter of the MH of the unclosed group was 532±104 um, which was significantly larger than that of the closed group (352±180 μm) (t=-2.656, P=0.013). The continuity of the ELM of the MH closed group was higher than the unclosed group at one month after the operation and at the last follow-up (P<0.05). The patients with continuous EZ at the last follow-up were all in the closed group, while the EZs in the unclosed group were discontinuous. There was a statistically significant difference between the two groups (χ2=3.89, P=0.048). Conclusions: The results of this study indicate that vitrectomy combined with ILM peeling and air tamponade for the treatment of idiopathic macular hole has a good result. However, for those macular holes with more than a 400 um diameter, a second fluid-air exchange is needed. Early closure of the MH suggests a better prognosis after surgery. Key words: macular hole; air tamponade; vitrectomy