Study of internal limiting membrane peeling in stage-3 and-4 idiopathic macular hole surgery

Purpose: To evaluate the advantages of peeling the internal limiting membrane (ILM) in macular hole surgery. Patients and methods: Retrospective analysis of the results of macular hole surgery, comparing two surgical protocols performed by the same surgeon. Both protocols included a standard pars plana vitrectomy with intravitreous nonexpansile gas and adjunction of autologous plasma over the macular hole. In addition, in the second group, the ILM of the eyes was systematically peeled after its coloring by indocyanine green (infracyanine(R)) in the latter patients. Results: We studied 39 eyes of 36 patients with stage-3 or -4 macular hole surgery. The duration of symptoms before surgery was on average 9 months. Twenty-one eyes (53.8%) underwent ILM peeling. Macular hole closure after one procedure was significantly more frequent postoperatively in the group of eyes with ILM peeling than in the other group (90% and 50%, respectively, p<0.01); after two procedures, macular hole closure reached 61% in the second group. The macular hole seemed to have disappeared on angiographic examination and on OCT in 90% of eyes with anatomical success in the group with ILM peeling and in only 22% of eyes with anatomical success in the group without. Visual acuity improved by two lines or more in 62% of eyes with ILM peeling and in 44% of eyes without. The difference in improvement in the macular threshold was statistically significant (p<0.001). Conclusion: This study would suggest that peeling of the ILM is an important adjuvant for successful closure of macular holes. Its possible mechanism of action is discussed. Further studies are needed to confirm these data by controlled randomized trial.