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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