Macular hole surgery with and without internal limiting membrane peeling.

Area of Science:

• Ophthalmology
• Retinal Surgery

Background:

• Idiopathic macular holes are a significant cause of vision loss.
• Surgical repair is the primary treatment for macular holes.
• The role of internal limiting membrane (ILM) peeling in improving surgical outcomes is debated.

Purpose of the Study:

• To compare the efficacy of macular hole surgery with and without internal limiting membrane (ILM) peeling.
• To evaluate the impact of ILM peeling on closure rates, visual acuity, and complications.
• To assess outcomes in recent, chronic, and reopened macular holes.

Main Methods:

• Retrospective, nonrandomized comparative trial.
• Analysis of 44 eyes without ILM peeling vs. 116 eyes with ILM peeling (hole duration ≤ 6 months).
• Inclusion of a third group of 65 eyes with ILM peeling (hole duration > 6 months).
• All eyes underwent pars plana vitrectomy with or without ILM peeling.

Main Results:

• ILM peeling significantly improved primary closure rates (100% vs. 82%) and eliminated reopening in holes > 300 microm.
• Visual acuity outcomes were comparable between groups with successful closure.
• Eyes with ILM peeling and longer duration (> 6 months) showed high closure rates (97%) and visual improvement (65%).

Conclusions:

• ILM peeling is crucial for achieving high visual and anatomic success in macular hole surgery.
• It is beneficial across all stages of macular holes, including chronic and reopened cases.
• ILM peeling effectively prevents reopening, particularly for larger holes (> 300 microm).