Macular Hole Closure With Internal Limiting Membrane Abrasion

Abstract

Purpose: : To study an internal limiting membrane abrasion technique to enhance macular hole closure.

Methods: : 1. In 100 consecutive cases the rate of macular hole closure and visual acuity outcomes were reviewed following abrasion of the ILM around the hole with a Tano diamond-dusted scraper and no peeling of the ILM. 2. Maculae of human donor eyes were examined by electron microscopy and immunohistochemistry after ILM abrasion with a Tano scraper. 3. Tano scraper instrument tips used during macular hole surgery were studied with immunohistochemistry.

Results: : 1. Macular hole closure was achieved in 94% of cases (94/100) with no difference between stage II and stage III or greater grades. Mean preoperative visual acuity was 20/125 (log MAR 0.79 ± 0.46) and mean postoperative visual acuity was 20/60 (log MAR 0.46 ± 0.31). 2. Macular abrasion in donor eyes revealed removal of vitreous, cellular material, and limited delamination of the ILM compared with no abrasion. 3. Instrument tips showed cells and fragments of ILM.

Conclusions: : Abrasion of the internal limiting membrane with a Tano scraper achieves macular hole closure rates comparable to conventional internal limiting membrane peeling. It appears to do so by removal of vitreous and cells adherent to ILM as well as fragments of ILM that may be sources of traction. This technique avoids the removal of the retinal basement membrane and subjacent tissues.

Keywords: macular holes