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Is removal of internal limiting membrane always necessary during stage 3 idiopathic macular hole surgery?
Tetsushi Kimura1, Masayo Takahashi, Hitoshi Takagi
1Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University,Kyoto, Japan.
Purpose:
To determine the indications for internal limiting membrane (ILM) removal in stage 3 idiopathic macular holes (MHs).
Methods:
Focal posterior vitreous detachments (PVDs) at MH rims were examined preoperatively by optical coherence tomography and binocular slit-lamp fundus examination in 19 patients retrospectively. All eyes underwent pars plana vitrectomy and creation of a PVD, and some eyes underwent a second surgery to remove the ILM. Indications of ILM removal for MH closure were discussed.
Results:
Preoperatively, 9 eyes did not (non-PVD group) and 10 eyes did (PVD group) have complete focal PVDs. In all nine eyes in the non-PVD group, MHs were closed after the creation of a PVD without ILM peeling (P <0.05, chi test). In the PVD group, 5 eyes (50%) had MHs closed by making PVD complete without ILM removal, and 5 eyes (50%) required ILM removal in a second surgery. In the end, closure of MHs was achieved in all eyes.
Conclusion:
Anatomic closure of stage 3 idiopathic MHs without a PVD at the rim of the hole may be achieved only by creating a PVD without ILM removal.
