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Value of Internal Limiting Membrane Peeling in Surgery for Idiopathic Macular Hole Stage 2 and 3 - A Randomized Clinical Trial
  1. Ulrik Correll Christensen (ulrikchristensen{at}dadlnet.dk),
  2. Kristian Krøyer (kroyers{at}yahoo.com),
  3. Birgit Sander (bisan{at}glo.regionh.dk),
  4. Michael Larsen (mla{at}dadlnet.dk),
  5. Vibeke Henning (vihe{at}glo.regionh.dk),
  6. Jørgen Villumsen (jrvi{at}glo.regionh.dk),
  7. Morten la Cour (m.la.cour{at}dadlnet.dk)
  1. Glostrup Hospital, University of Copenhagen, Denmark
  2. Glostrup Hospital, University of Copenhagen, Denmark
  3. Glostrup Hospital, University of Copenhagen, Denmark
  4. Glostrup Hospital, University of Copenhagen, Denmark
  5. Glostrup Hospital, University of Copenhagen, Denmark
  6. Glostrup Hospital, University of Copenhagen, Denmark
  7. Glostrup Hospital, University of Copenhagen, Denmark

    Abstract

    Aim: To determine the effect of internal limiting membrane (ILM) peeling on anatomical and functional success rates in stage 2 and 3 idiopathic macular hole surgery (MHS).

    Methods: Randomized clinical trial of stage 2 and 3 idiopathic macular hole without visible epiretinal fibrosis and with less than 1 year duration of symptoms. Eyes were randomized to (1) vitrectomy alone without retinal surface manipulation, (2) vitrectomy plus 0.05% isotonic ICG-assisted ILM peeling or (3) vitrectomy plus 0.15% TB-assisted ILM peeling. Main outcomes were hole closure after 3 and 12 months and best-corrected visual acuity after 12 months.

    Results: 78 eyes were enrolled. Primary closure rates were significantly higher with ILM peeling than without peeling for both stage 2 holes (ICG-peeling 100%, non-peeling 55%, p = 0.014) and for stage 3 holes (ICG-peeling 91%, TB-peeling 89%, non-peeling 36%, p < 0.001). Visual outcomes in eyes with primary hole closure were not significantly different between the groups.

    Conclusions: Dye-assisted ILM peeling was associated with significantly higher closure rates than non-peeling in both stage 2 and 3 MHS. Intraoperative ILM staining with 0.05% isotonic ICG was not associated with a significantly different visual outcome than non-peeling or TB-peeling in eyes with primary hole closure.

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