Macular hole surgery with and without internal limiting membrane peeling
Section snippets
Patients and methods
This study consists of a retrospective consecutive series of patients seen between October 1992 and October 1997 and operated on by one physician (HLB). A total of 231 eyes (217 patients) was identified. Six patients were excluded from this series: three patients did not attain minimal follow-up periods and three other patients had previous vitrectomy for macular hole and were excluded from the stage IV data.
The remaining 225 eyes (211 patients) with idiopathic macular holes were reviewed.
Surgical technique
Standard three-port vitrectomy was performed, followed by surgical separation of the posterior cortical vitreous from the optic nerve and posterior retina in both groups. Eyes without ILM peeling had no epiretinal tissue removed. ILM peeling was performed by making a small opening and flap tear in the ILM with a bent microvitrealretinal blade about 1.5 mm from the fovea (Fig 3). The ILM flap was then grasped with an end-gripping forceps and carefully started in a circular capsulorrhexis
Postoperative evaluation
On the first postoperative day, vision testing, applanation tonometry, and indirect ophthalmoscopy were performed. Postoperative face-prone positioning instructions were given, and patients typically maintained the position for 5 days to 2 weeks, about 18 to 20 hours per 24-hour day, with good compliance as manifested by a positioning spot on the cornea.13 During the last 2 years of the study, positioning was used for 5 days only. Postoperative visual acuity was measured with the Topcon
Statistical analysis
Data were obtained from charts of 211 patients (225) eyes with idiopathic macular holes. Conversion of Snellen acuity to logarithm of the minimum angle of resolution values was performed with 20/20 converting to logarithm of the minimum angle of resolution of zero and 20/200 to 1, and the values in between according to the standard equation.22 Chi square was used to compare preprocedure and postprocedure results with a significance level set at P < 0.05. We used Student’s t test to compare
Results
Medical records of 211 patients with idiopathic macular hole were reviewed. Fourteen patients had bilateral macular holes that were repaired, so a total of 225 eyes had surgery to repair idiopathic full-thickness macular holes. Table 1 (no ILM peeling) and Table 2 (ILM peeling) summarize the results of each stage hole with duration of 6 months or less. Holes with duration greater than 6 months all had ILM peeling (Table 4). At the time of the final examination, 98% were pseudophakic. Cataract
Discussion
The impetus for this study came in early 1991 when I successfully treated two impending macular holes with complete posterior vitrectomy, only to have full-thickness macular holes develop in them 8 to 10 months later. I was puzzled how a full-thickness macular hole could develop much later on without persistent vitreous traction. Both patients were repaired with ILM peeling but excluded from this study because of the prior vitrectomy. In 1992, a report of vitrectomy and pathosis of an
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