The Effect of Internal Limiting Membrane Peeling During Vitreous Surgery for Macular Hole Retinal Detachment

Abstract

Abstract: : Purpose: Internal limiting membrane (ILM) peeling has recently been recommended as an adjunct to vitrectomy for macular hole retinal detachment (MHRD). However, the effect of the technique has not been well studied. We investigated the role of ILM peeling for MHRD by comparing surgical outcomes. Methods: Medical records of 30 eyes (30 patients) that underwent vitrectomy and gas tamponade from 1992 to 2002 were retrospectively reviewed. The follow-up period after the final surgery was at least 6 months. The inclusion criteria were refractive error higher than -8.0 diopters or axial length longer than 25 mm. We divided the eyes into 2 groups: 17 eyes without ILM peeling (non-ILM group) and 13 eyes with ILM peeling (ILM group). We evaluated macular hole closure postoperatively using optical coherence tomography (OCT). OCT data at least 6 months postoperatively were available for 20 eyes (11 eyes in ILM group and 9 in non-ILM group). We compared reattachment rates in the groups after the initial surgery, and the macular hole closure rate and visual acuity (VA) after the reattachment surgeries. Results: All eyes achieved total retinal reattachment at the final visit. The reattachment rate after the initial surgery was 82% (14 eyes) in the non-ILM group and 92% (12 eyes) in the ILM group. The median final VA was 0.1 in the non-ILM group and 0.07 in the ILM group. The macular hole closure rate was 36% (4 eyes) in the non-ILM group and 43% (6 eyes) in the ILM group. Conclusions: Although there was no statistically significant difference between the groups, ILM peeling tended to enhance retinal reattachment and reduce the final VA.

Keywords: macular holes • retinal detachment • myopia