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Papillomacular bundle sparing versus conventional internal limiting membrane peeling for idiopathic macular hole ≤400
Aman Kumar1, Bruttendu Moharana1, Deeksha Katoch1
1Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Purpose:
To compare the outcomes of papillomacular bundle (PMB) sparing internal limiting membrane (ILM) peeling (group LP) and conventional ILM peeling (group CP) for treatment of idiopathic macular hole (MH) of ≤400 μm.
Methods:
Fifteen eyes were included in each group. In group CP, conventional 360° peeling was done, while in group LP, ILM was spared over PMB. The changes in peripapillary retinal nerve fiber layer (pRNFL) thickness and ganglion cell-inner plexiform layer (GC-IPL) thickness were analyzed at 3 months.
Results:
MH was closed in all with comparable visual improvement. Postoperatively, retinal nerve fiber layer (RNFL) was significantly thinner in the temporal quadrant in group CP. GC-IPL was significantly thinner in the temporal quadrants in group LP, whereas it was comparable in group CP.
Conclusion:
PMB sparing ILM peeling is comparable to conventional ILM peeling in terms of closure rate and visual gain, with the advantage of less retinal damage at 3 months.
Insights
Papillomacular bundle (PMB) sparing internal limiting membrane (ILM) peeling offers comparable outcomes to conventional ILM peeling for macular holes (MH). This technique shows less retinal damage, preserving retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GC-IPL) thickness.
Area of Science:
- Ophthalmology
- Retinal Surgery
Background:
- Idiopathic macular holes (MH) are a significant cause of visual impairment.
- Internal limiting membrane (ILM) peeling is a standard surgical technique for MH repair.
- Potential damage to the papillomacular bundle (PMB) during ILM peeling is a concern.
Purpose of the Study:
- To compare the efficacy and safety of PMB-sparing ILM peeling versus conventional ILM peeling for small idiopathic MH (≤400 μm).
Main Methods:
- A comparative study involving 30 eyes with idiopathic MH (≤400 μm).
- Group LP underwent PMB-sparing ILM peeling; Group CP underwent conventional 360° ILM peeling.
- Analysis of peripapillary retinal nerve fiber layer (pRNFL) and ganglion cell-inner plexiform layer (GC-IPL) thickness at 3 months postoperatively.
Main Results:
- Macular hole closure and visual improvement were comparable between both groups.
- Group CP showed significant thinning of the temporal pRNFL.
- Group LP demonstrated significant thinning of the temporal GC-IPL, while it remained comparable in Group CP.
Conclusions:
- PMB-sparing ILM peeling is a viable alternative to conventional ILM peeling for small MH, achieving similar closure rates and visual gains.
- This technique offers the advantage of reduced retinal damage, specifically to the RNFL and GC-IPL, at 3 months post-surgery.
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