Internal Limiting Membrane Peeling and its impact on Large Macular Hole Surgery

Abstract

Background & Aim:  To determine the effectiveness of removal of the internal limiting membrane in the treatment of large macular holes.

Material & Methods: 13 consecutive eyes (of 12 patients) with large macular hole “greater than 400 microns” were prospectively recruited for vitrectomy and ILM peeling. Surgery consisted of a standard three-port vitrectomy, induction of a posterior hyaloid detachment, internal limiting membrane maculorhexis, fluid-air exchange and intraocular gas tamponade (12% perfluoropropane (C3F8) gas mixture) followed by head-down positioning for at least 15 days. Visual acuity was evaluated before and after surgery, at one month, then at three months, and every six months.  In addition to the clinical examination, macular optical coherence tomography (OCT) was performed preoperatively and during follow up visits.

Results: Complete anatomic closure of macular holes was achieved in 9 (69.2%) of 13 eyes, partly closed in 2 eyes (15.4%), and had not closed in 2 eyes (15.4%). Eight of the eyes (61.5%) showed an improvement in visual acuity “of at least two Snellen letter chart lines”. Visual acuity did not improve in 3 eyes (23.1%) and fell down in 2 eyes (15.4%).

Conclusions: Peeling of the internal limiting membrane of a large area in the treatment of large macular hole plays an important role in both anatomical closure of macular holes and recuperation of vision.