Comparisons of foveal thickness and slope after macular hole surgery with and without internal limiting membrane peeling

Abstract

BackgroundWe have shown that the foveal contour was asymmetrical after idiopathic macular hole (MH) closure by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. The purpose of this study was to determine whether these morphological changes differ in eyes after PPV without ILM peeling.MethodsTen eyes of 10 patients that underwent PPV without ILM peeling and 12 eyes of 11 patients with ILM peeling were studied. The MH in all eyes was <400 µm in diameter. Six months after the PPV, the macular thickness and foveal slope around the closed MH were determined by spectral-domain optical coherence tomography. The thickness of the ganglion cell complex was measured by another spectral-domain optical coherence tomography instrument >6 months after the surgery.ResultsThe mean parafoveal retinal thickness in the non-peeled group was 367.1 µm in the nasal (N), 353.0 µm in the temporal (T), 366.9 µm in the superior (S), and 357.3 µm in the inferior (I) sectors. The T, S, and I sectors were significantly thicker than the corresponding sectors in the ILM peeled group (p=0.0008, 0.003, and 0.03, respectively). The mean ganglion cell complex was thicker not only in the N sector but also in the T sector in the non-peeled group. The mean retinal slopes in the non-peeled group (N, 40.2°; T, 37.6°; S, 41.2°; I, 39.5°) were flatter than those in the peeled group (N, 52.3°; T, 43.6°; S, 50.8°; I, 51.9°; p=0.009, 0.09, 0.008, and 0.017, respectively).ConclusionThe symmetrical fovea after MH surgery in the non-ILM peeled eyes indicates that the asymmetrical fovea after ILM peeling was probably due to the ILM peeling.

Minimal internal limiting membrane peeling with ILM flap technique for idiopathic macular holes: a preliminary study

“…Peeling or not peeling the ILM has been frequently discussed over the past decades [1,4]. Recently, more and more evidence has indicated inner retinal damage after ILM peeling on en face SD-OCT [2,3,6,18].…”

“…Although ILM peeling is favorable for macular hole closure [1], especially for those with large hole sizes, it may also cause side-effects on retinal microstructure and function. The reported retinal microstructure abnormities after ILM peeling include inner retinal dimplings [2], dissociated retinal nerve fiber layer (RNFL) [3], and reduced parafoveal retinal thickness [4].…”

<p>Stereopsis After Unilateral Macular Hole Surgery with Internal Limiting Membrane Peeling</p>

“…Patients with secondary MH associated with rhegmatogenous retinal detachment, an epiretinal membrane (ERM), high pathological myopia, and diabetic retinopathy were excluded. 16 Eyes with glaucoma and uveitis were also excluded. In this retrospective study, the patients with a BCVA < 20/30 were excluded because of these criteria and short follow-up periods.…”

“…A written informed consent was obtained for the surgery and for the use of data for research studies. 16 The procedures used conformed to the tenets of the Declaration of Helsinki.…”

“…15,16 When the ILM was still not clearly visible, approximately 0.5 mL of 0.25% indocyanine green (ICG; Ophthagreen ® , Santen Pharmacy, Osaka, Japan) was injected in 5 eyes, or 0.025% Brilliant Blue G (Brilliant Peel ® , Geuder, Heidelberg, Germany) was injected in 26 eyes. 15,16 The ILM was peeled off over 2 to 4 disc areas. After fluid/air exchange, 20% sulfur hexafluoride (SF 6 ) was injected for a gas tamponade.…”