Internal Limiting Membrane Peeling for Large Macular Holes Induces Only Structural Remodeling without Functional...

Area of Science:

• Ophthalmology
• Retinal Surgery
• Macular Diseases

Background:

• Internal limiting membrane (ILM) peeling is a common surgical technique for treating full-thickness macular holes (FTMH).
• Long-term outcomes of ILM peeling, particularly structural changes, require further investigation.

Purpose of the Study:

• To evaluate the very long-term functional and structural outcomes of ILM peeling for FTMH.
• To compare visual acuity, retinal sensitivity, and OCT/OCTA findings between eyes with and without ILM peeling after a minimum of 10 years.

Main Methods:

• Observational case series nested within a multicenter RCT (NCT00190190).
• Included patients who underwent vitrectomy with or without ILM peeling for idiopathic large FTMH.
• Utilized spectral-domain OCT (SD-OCT), OCT angiography (OCTA), and microperimetry for assessment with a mean follow-up of 12 years.

Main Results:

• No significant difference in mean retinal sensitivity (RS) or best-corrected visual acuity (BCVA) between ILM peeling (n=8) and no peeling (n=5) groups (P > 0.05).
• Dissociated optic nerve fiber layers observed in 20% of peeled eyes.
• Significantly lower mean total retinal thickness and inner retinal thickness in the parafoveal ring of peeled eyes (P=0.037, P=0.040).
• Lower superficial capillary plexus density and smaller foveal avascular zone area in peeled eyes (P=0.005).

Conclusions:

• ILM peeling for idiopathic large FTMH did not negatively impact long-term functional outcomes (RS, BCVA) over 12 years.
• Persistent structural changes, including inner retinal thinning and altered vascularity, were observed in the parafoveal ring after ILM peeling.