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Relationship between macular hole size and the potential benefit of internal limiting membrane peeling
  1. G A Williams
  1. Correspondence to: G A Williams 3535 W 13 Mile Road Ste 632, Royal Oak, MI 48073-6710, USA;gwilliams{at}

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Macular hole size is a predictor for anatomical closure. Holes >400 μm in aperture size on an OCT scan are more likely to close when ILM is peeled

The development of surgical repair for macular hole surely ranks among the most important advances in vitreoretinal surgery over the past 15 years. Since the seminal report of Kelly and Wendel1 in 1991, we have witnessed a remarkable evolution of surgical techniques, resulting in improved anatomical success, such that we can now confidently inform our patients that they have at least a 90% chance of anatomical closure of the macular hole. Despite this progress, two major challenges remain: firstly, to safely refine our surgical technique to allow anatomical closure of all holes and secondly, to improve the visual outcomes that all too often do not replicate the anatomical results. The resolution of these challenges constitutes the future of further advances in macular hole surgery. Various surgical techniques have been used to try to increase the rate of macular hole closure, including biological adjuncts such as serum, platelet extracts and growth factors.2–4 More recently, surgical dissection of the internal limiting membrane (ILM) or …

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  • Competing interests: None declared.

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