Internal limiting membrane removal in the management of full-thickness macular holes

doi:10.1016/S0002-9394(00)00358-5

American Journal of Ophthalmology

Volume 129, Issue 6, June 2000, Pages 769-777

Presented at the Biannual Meeting of the European Society of Ophthalmology, Stockholm, Sweden, June 28, 1999.

https://doi.org/10.1016/S0002-9394(00)00358-5 Get rights and content

Abstract

PURPOSE: To determine the effectiveness of removal of the internal limiting membrane in the treatment of full-thickness macular holes.

METHODS: Data were reviewed from a prospective study on 47 consecutive eyes with full-thickness macular holes undergoing vitrectomy, internal limiting membrane maculorhexis, and fluid-gas exchange. No eye underwent repeat macular hole surgery. A meta-analysis was performed to compare the outcomes of different surgical techniques in the treatment of full-thickness macular holes.

RESULTS: The outcome measures were disappearance of the submacular fluid and the change in best-corrected visual acuity. The surgery was anatomically successful in 44 of the 46 eyes (96%) and 39 of the eyes (85%) showed an improvement of at least two Snellen lines. Best-corrected final vision was 20/40 in 18 (39%) eyes. No permanent complications specifically caused by the removal of the macular internal limiting membrane were detected; the minor hemorrhages and retinal edema seen in most eyes resolved spontaneously. Retinal detachment developed and was successfully treated in three eyes (7%). A meta-analysis on 1,654 eyes from published reports showed that internal limiting membrane maculorhexis appears to significantly (P < .0001) increase the anatomical and functional success rates in macular hole surgery.

CONCLUSIONS: Internal limiting membrane removal is an important development in the evolving field of macular hole surgery. A randomized, prospective, multicenter clinical trial should be performed to determine which surgical technique is the most beneficial in patients with full-thickness macular holes.

Section snippets

Patients and methods

Included in this prospective series were eyes that developed a full-thickness macular hole with a best-corrected preoperative visual acuity equal to or worse than 20/50. All preoperative and postoperative examinations were performed by the two surgeons, and the following criteria were monitored: age and sex of the patient; stage of hole; duration of visual complaints; best-corrected preoperative visual acuity; presence and stage of cataract; presence of posterior vitreous detachment; presence

Results

In this prospective series of 47 consecutive eyes with full-thickness macular holes, 11 (23%) of the 47 patients were male. The ages ranged from 13 to 78 years (average, 50 years); 23% were younger than 60 years. All complained of decreased vision, and approximately half of them also complained of distorted vision. Duration of the visual complaints was known in 38 patients (81%). The hole existed for an average of 5 months (range, 1–26 months). Six eyes (13%) were pseudophakic, 12 (26%) had

Discussion

The original surgical technique to close idiopathic macular holes involved a complete vitrectomy and stripping of all epiretinal membranes.5 A variety of adjuvants have been also been advocated,6, 7, 8, 10, 15, 16, 17, 18, 19, 20, 21, 27, 28, 31, 32, 33, 34, 35, 36, 37, 38 two of which promised significant improvement in the initial studies. However, transforming growth factor-beta 2 in a prospective, randomized, double-masked, placebo-controlled clinical trial has not been found beneficial,28

Acknowledgements

We wish to thank Hans E. Grossniklaus, MD (Emory Eye Center, Atlanta, Georgia), for evaluating the histologic specimens and Richard Maisiak, PhD, MSPH (School of Medicine, University of Alabama at Birmingham), for the statistical analyses.

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Original articleInternal limiting membrane removal in the management of full-thickness macular holes

Abstract

Section snippets

Patients and methods

Results

Discussion

Acknowledgements

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Original article
Internal limiting membrane removal in the management of full-thickness macular holes