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Clinical science
Value of internal limiting membrane peeling in surgery for idiopathic macular hole stage 2 and 3: a randomised clinical trial
  1. U C Christensen,
  2. K Krøyer,
  3. B Sander,
  4. M Larsen,
  5. V Henning,
  6. J Villumsen,
  7. M la Cour
  1. Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Denmark
  1. Correspondence to Dr U C Christensen, Department of Ophthalmology, Glostrup Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark; ulrikchristensen{at}


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: Randomised clinical trial of stage 2 and 3 idiopathic macular hole without visible epiretinal fibrosis and with less than 1 year’s duration of symptoms. Eyes were randomised to (1) vitrectomy alone without retinal surface manipulation, (2) vitrectomy plus 0.05% isotonic Indocyanine Green (ICG)-assisted ILM peeling or (3) vitrectomy plus 0.15% Trypan Blue (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.

Trial registration number: NCT00302328.

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  • Funding The Danish Eye Health Society, The Danish Medical Research Council, The John and Birthe Meyer Foundation and The Velux Foundation.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Danish Committee for Biomedical Research Ethics.

  • Patient consent Obtained.

  • See Editorial, p 987

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