Internal Limiting Membrane Peeling and Air Tamponade for Stage Iii and Stage Iv Idiopathic Macular Hole

Abstract

Purpose: To evaluate the effect of internal limiting membrane peeling and air tamponade for idiopathic macular hole, and explore reasons and interventions for persistent holes. Methods: One hundred and thirty-five eyes with Stage III and IV idiopathic macular hole that underwent 23-gauge vitrectomy, internal limiting membrane peeling, and air tamponade were reviewed. Eyes with persistent holes underwent a second surgery. Outcome-related factors and interventions treating persistent holes were discussed. Results: The initial closure (Type I) rate was 89.63% (121/135). Eyes that underwent the second surgery all obtained final closure (Type I). Diameter of macular hole was significantly smaller (P < 0.001) and duration of symptoms was significantly shorter (P = 0.017) in initially closed cases than in unclosed ones. Binary logistic regression indicated large diameter of macular hole as a risk factor for initial closure (P = 0.004). A cutoff value of 677 μm was provided by receiver operating characteristic curve to predict initial closure (P < 0.001). Best-corrected visual acuity of all individuals improved significantly (P < 0.001) from 20/154 to 20/40 (mean follow-up: 4.5 months). Conclusion: Internal limiting membrane peeling and air tamponade for idiopathic macular hole provide satisfactory morphologic and functional outcomes. Large diameter of macular hole and long duration of symptoms are risk factors for initial closure. Proper second surgery can obtain satisfactory outcomes for persistent holes.

Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials

“…We were not able to perform a subgroup analysis of the closure type due to lack of relevant data. Lastly, the area of ILM peeling, air or longer-acting gas tamponade, whether lens removed and different duration of symptoms, may also influence the closure rates [33]. However, we were not able to find sufficient data to investigate these parameters.…”

Hole Diameter Ratio for Prediction of Anatomical Outcomes in Stage III or IV Idiopathic Macular Holes

“…It has been reported that IMH with a minimum diameter under 400um had a higher recovery rate. 6 Wu Liu 11 found the diameter more than 677um is a risk factors for postoperative unclosure of stage III and IV IMHs that underwent 23gauge vitrectomy, ILM peeling, and air tamponade. In the present study, the preoperative mean minimum diameter was signi cantly smaller in postoperative closed IMHs than that of unclosed IMHs (597.57.09±120.14um vs. 703.60±116.13um, P<0.01).…”

“…The results are consistent with previous studies. 6,11 HDR (hole diameter ratio) is de ned as the ratio of minimum diameter to maximum diameter in this study. It re ects the magnitude of pulling force in the tangential direction of the IMH.…”

“…These parameters are also complex and di cult to calculate, limited their application values in busy real world clinical practice. [16][17][18][19] Based on our clinical experiences 11,20,[23][24][25][26] , we feel that the preoperative MH morphological characteristics are different between postoperative closed and unclosed stage III or IV IMHs. Thus we try to nd a method to quantitatively evaluate the morphological characteristics of preoperative MHs to predict the postoperative closure for stage III or IV IMHs.…”

“…[7][8][9][10] The initial closure rates of IMHs ranged from 75.6% to 100%. [11][12][13][14][15] However, there are still some IMHs cannot close after surgery, especially in stage III or IV IMHs. The reason remains to be elucidated.…”