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Clinical science
Macular morphology and visual acuity after macular hole surgery with or without internal limiting membrane peeling
  1. U C Christensen1,
  2. K Krøyer1,
  3. B Sander1,
  4. T M Jorgensen2,
  5. M Larsen1,
  6. M la Cour1
  1. 1
    Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Denmark
  2. 2
    Department of Optics and Plasma Research, Risø National Laboratory, Roskilde, Technical University of Denmark, Denmark
  1. Correspondence to Dr U C Christensen, Department of Ophthalmology, Glostrup Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark; ulrikchristensen{at}


Aim: To examine postoperative macular morphology and visual outcome after 12 months in relation to internal limiting membrane (ILM) peeling versus no peeling, indocyanine green (ICG) staining and re-operation in eyes that achieved macular hole closure after surgery.

Methods: Seventy-four eyes with closed stage 2 or 3 macular holes were recruited from a randomised clinical trial comparing: (1) vitrectomy without ILM peeling; (2) vitrectomy with 0.05% isotonic ICG-assisted ILM peeling; and (3) vitrectomy with 0.15% trypan blue-assisted ILM peeling. Contrast-enhanced Stratus optical coherence tomography was used to assess central foveal thickness, central photoreceptor layer thickness (CPRT), central photoreceptor layer discontinuity (PRD) and relative reflectivity of the outer nuclear layer. Outcomes were correlated with best corrected visual acuity (BCVA) 12 months after surgery.

Results: BCVA was correlated with CPRT and PRD. Regression analysis and receiver operating characteristics curve analysis showed that CPRT >33 μm (OR 12.5) and PRD <177 μm (OR 9.86) were highly predictive for regaining reading vision (⩾69 Early Treatment of Diabetic Retinopathy Study letters) 12 months after surgery. No significant difference was found in postoperative macular morphology between subgroups.

Conclusions: Poor vision after 12 months despite macular hole closure was associated with attenuation and disruption of the foveolar photoreceptor matrix. The extent of attenuation and disruption was independent of peeling and staining.

Trial registration number: NCT00302328

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  • Funding The study was supported by the Danish Eye Health Society, the Danish Medical Research Council, the John and Birthe Meyer Foundation, the Juvenile Diabetes Research Foundation (grant no. 8-2002-130) and the Velux Foundation.

  • Competing interests None declared.

  • Ethics approval Approval was obtained from the local Committee on Biomedical Research Ethics.

  • Patient consent Informed consent according to the tenets of the Declaration of Helsinki was obtained from all subjects before inclusion in the study.

  • Provenance and Peer review Not commissioned; externally peer reviewed.