Abstract
Purpose This study aimed to show the impact of different extents of internal limiting membrane (ILM) peeling on visual and anatomical outcomes following idiopathic full-thickness macular hole (FTMH) surgery. Methods In this single-center prospective study, patients with idiopathic FTMH underwent standard pars plana vitrectomy with two different extents of ILM peeling: 2-disc diameters (DD) or 4 DD. The main outcome measures were the closure rate of the holes based on optical coherence tomography (OCT) findings at three months after surgery. Results Forty eyes from 39 patients were enrolled in the study. After three months, anatomical closure was achieved in 78% and 76% eyes in 2 DD peel and 4 DD peel groups, respectively. From 29 eyes with macular hole index (MHI) ≤ 0.5, type 1 closure was achieved in 42% eyes receiving a 2 DD ILM peel, compared to 66% eyes receiving a 4 DD peel (p=0.041). In comparison, this significant difference was not seen in the subgroup of MHI > 0.5 (p=061). In the subgroup of subjects with baseline MHI ≤ 0.5, visual improvement was significantly more in eyes with 4 DD ILM peeling (p=0.034), which was not seen in the MHI > 0.5 subgroup (p=0.61). Conclusion In patients with idiopathic full‐thickness macular hole (MHI ≤ 0.5), a larger ILM peel of 4 DD appears to yield better anatomical outcomes than a more limited 2 DD peel.
Highlights
An idiopathic full-thickness macular hole (FTMH) is a foveal defect, which is responsible for central vision loss [1]
E primary outcome was the proportion of eyes with complete closure of the holes based on optical coherence tomography (OCT) findings within each group at three months after operation. e secondary outcome measure consisted of the best-corrected visual acuity (BCVA) and anatomical outcomes difference between two groups, along with the difference between the BCVA and anatomical outcomes in c b a Macular hole index (MHI) = b/a subgroups when subjects were stratified by baseline macular hole minimum diameter and macular hole index (MHI)
After three months, based on Fisher’s exact test, from 29 eyes with MHI ≤ 0.5, type 1 closure was achieved in 6/14 eyes (42%) receiving a 2 disc diameters (DD) internal limiting membrane (ILM) peel, compared to 10/15 eyes (66%) receiving a 4 DD peel (23.8% difference; 95% CI : 17.3%–30.3%; p 0.041)
Summary
An idiopathic FTMH is a foveal defect, which is responsible for central vision loss [1]. It often leads to severe central vision loss to the levels of 20/200 or worse [2]. A surgical approach for the management of idiopathic macular hole (MH) is pars plana vitrectomy (PPV) and a combination of adjuvant techniques, including internal limiting membrane (ILM) peeling, gas tamponade, and postoperative prone posturing [5]. ILM peeling has been simplified by using different dyes such as brilliant blue-green (BBG) [9]. It has been shown that BBG assisted ILM peeling could contribute to better visual acuity outcomes than other dyes in patients with FTMH [8, 10]
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