Success of macular hole surgery with or without internal limiting membrane peeling
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This consecutive nonrandomized comparative interventional study was designed to examine the association between pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling in the treatment of idiopathic macular holes (IMH). The ILM is the innermost layer of the retina. The macula is located within the retina, and is responsible for central vision. Although IMH manifests in a relatively small region within the retina, patients notice significant drops in visual acuity up to the 20/400 - 20/800 level (legally blind in the affected eye). In the literature, the anatomic success rate of macular hole surgery has been reported between 48% - 94%. To best treat idiopathic macular holes, it is imperative that physicians have access to the most up-to-date information regarding the treatment outcomes. This study included 55 eyes of 52 patients who received surgery at the Beth Israel Deaconess Medical Center for idiopathic macular holes between December 1999 and January 2015. Patients were non-randomly assigned to PPV with or without ILM peeling. Early patients did not receive ILM peeling, while more recent patients did. The primary endpoint measured was macular hole (MH) status as established by ocular coherence tomography (OCT) within 6 to 12 months of the vii procedure. 36 out of 39 (92.3%) eyes in the ILM peeling group had closed MH. In the comparison group without ILM peeling, 11 out of 16 (68.8%) eyes had closed MH. In comparison to the conventional PPV without ILM peeling, these findings suggest that PPV with ILM peeling is associated with a significantly higher anatomic success rate (OR, 5.45; [95% CI, 1.12 to 26.55]; P = 0.023).