July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
The impact of extent of internal limiting membrane peeling on anatomical outcomes of macular hole surgery: a randomized clinical trial
Author Affiliations & Notes
  • Yuou Yao
    Ophthalmology, Peking University People's Hospital, Beijing, China
  • Mingwei Zhao
    Ophthalmology, Peking University People's Hospital, Beijing, China
  • Footnotes
    Commercial Relationships   Yuou Yao, None; Mingwei Zhao, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 5765. doi:
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      Yuou Yao, Mingwei Zhao; The impact of extent of internal limiting membrane peeling on anatomical outcomes of macular hole surgery: a randomized clinical trial. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5765.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To compare the anatomical outcomes of different extents of internal limiting membrane (ILM) peeling in idiopathic macular hole surgery.

Methods : 121 eyes of 121 patients with idiopathic macular hole underwent pars planavitrectomy, and peeling of the ILM with a diameter of 2 disk diameters (DD) or 4DD based on randomization. The primary outcome measure was the proportion of eyes with complete hole closure with a normal-appearing foveal morphology on optical coherence tomography (OCT) at 12 months. Secondary outcome measures included best corrected visual acuity (BCVA), hole closure grading and stratifying by macular hole closure index (MHCI) at each visit. A noninferiority approach was used, with a noninferiority margin set at -15%.

Results : At 12 months, 105 (86.8%) of 121 eyes attained complete hole closure, including 52(82.5%) of 63 eyes in the 2DD group and 53 (91.4%)of 58 eyes in the 4DD group. The difference in complete closure rates between groups (-8.8%) did not demonstrate that 2DD group was noninferior to 4DD group (P=0.15). The mean BCVA letters showed no difference between the 2DD group and 4DD groups: 66.57 and 68.53, respectively (P=0.447). For subjects with MHCI≤0.5, complete closure rate was significantly lower in the 2DD group compared to the 4DD group (P=0.012; 18.2% vs75.9%, respectively). And average BCVA was lower in 2DD group than 4DD group (P=0.014). By contrast, when MHCI was >0.5, the complete closure rate between the 2 groups showed no significant difference: 96.2% (50 patients) versus 95.6% (43 patients), respectively (P=0.185). And average BCVA was comparable between 2 groups (P=0.836).

Conclusions : In patients with idiopathic full-thickness macular hole and MHCI≤0.5, a larger ILM peel of 4DD appears to achieve better anatomical and visual outcomes than a more limited 2DD peel.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Figure 1: Measuremnet of macular hole closure index(MHCI). M and N represent the straight lengths of the detached arms. The BASE is measured as the length of RPE band without attached photoreceptors.

Figure 1: Measuremnet of macular hole closure index(MHCI). M and N represent the straight lengths of the detached arms. The BASE is measured as the length of RPE band without attached photoreceptors.

 

Macular hole closure grading based on OCT image.2a: Grade A closure. 2b: Grade B closure.2c: Grade C closure. 2d: Grade D closure. 2e: Grade E closure.Grade A and grade B were considered as good closure type. Grade C, grade d and grade e were considered as poor closure.

Macular hole closure grading based on OCT image.2a: Grade A closure. 2b: Grade B closure.2c: Grade C closure. 2d: Grade D closure. 2e: Grade E closure.Grade A and grade B were considered as good closure type. Grade C, grade d and grade e were considered as poor closure.

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