Internal Limiting Membrane Peeling and Gas Tamponade For Full-Thickness Macular Holes of Different Etiology – Is It Still Relevant?

Abstract

Background Despite the abundance of novel surgical approaches proposed for full thickness macular hole (FTMH) treatment, the choice of the optimal technique remains debatable Vitrectomy with «classic» internal limiting membrane peeling and gas tamponade remains the standard of FTMH surgery in many cases, but there are still very limited recent publications on the outcomes of such surgery. Purpose To investigate the anatomical and functional result and to analyze the significance of outcome-related risk factors of the classic 25-gauge pars plana vitrectomy (PPV) with ILM peeling and gas tamponade (GT) for treatment of FTMH of different etiology. Patients and methods Thirty-eight eyes of thirty-seven patients with FTMH who underwent 25-gauge PPV, ILM peeling and GT were recruited for this retrospective, consecutive, interventional study. Four eyes with persistent holes underwent a re-operation. Outcome-related factors were discussed. Results The primary closure rate was 89.5% (34/38). All eyes that underwent the repeated surgery (4 cases) obtained final closure. A hole size of >500 μm has a statistically significant effect on the primary macular hole closure (F = 0.048; φ = 0.38; p ˂ 0.05). In the general group (N = 38), the duration of symptoms directly correlated with age ( ρ = 0.34; p = 0.04), size of the hole ( ρ = 0.66; p ˂ 0.001) and BCVA before surgery ( ρ = 0.59; p ˂ 0.001), after 1 month ( ρ = 0.36; p = 0.03), and after 3 months ( ρ = 0.35; p = 0.03). Preoperative BCVA was better in initially closed cases (Group 1) (U = 26.0; p = 0.05). In the Group 2 with primary unclosed holes, 75% of the eyes (3/4) had an axial length (AL) >26 mm, while in Group 1 such eyes were 12.5 times less (2/34) 5.9% (F = 0.004; φ = 0.63; р ˂ 0.01). The ELM recovery rate at 3 months was 92% (35/38 eyes) and the restoration of EZ at 3 months was 47% (18/38 eyes). Best-corrected visual acuity of all individuals improved significantly from 0.72 ± 0.35 (logMAR) (Me = 0.7; IQR: 0.5–0.8) to 0.25±0.14 (logMAR) (Me = 0.2; IQR: 0.2 – 0.3) at 1 month and 0.17 ± 0.13 (logMAR) (Me = 0.2; IQR: 0.1 – 0.2) at 3 months after surgery (P = 0.0001). Conclusion 25G PPV with ILM and GT for FTMH of different etiology provide satisfactory morphologic and functional outcomes. Elongated AL, large diameter of MH and long duration of symptoms are the risk factors for initial closure. Proper second surgery can obtain satisfactory outcomes for persistent holes.

Comments on: Internal Limiting Membrane Peeling and Gas Tamponade for Full-Thickness Macular Holes of Different Etiology – Is It Still Relevant? [Response to Letter]

“…Surprisingly, a gas bubble size of 73% obtained on the first postoperative day in this study is lower than the 83.8% reported by Kusuhara et al 1 with 25% SF 6 . Postoperative elevation in IOP (≥30 mmHg) was documented in only 3 eyes (4%), which is significantly less than in our study (10.5%) 13 and the study by Wong et al (20.4%). 14 …”

“…Surprisingly, a gas bubble size of 73% obtained on the first postoperative day in this study is lower than the 83.8% reported by Kusuhara et al 1 with 25% SF 6 . Postoperative elevation in IOP (≥30 mmHg) was documented in only 3 eyes (4%), which is significantly less than in our study (10.5%) 13 and the study by Wong et al (20.4%). 14 Indeed, we cannot always accurately predict the behavior of the gas in the eye because clinically, the dynamics of the gas tamponade may differ from a theoretical model.…”

Persistent Macular Hole Management Options

“…This method boasts a high success rate of 80-100%. The inverted ILM flap technique is gaining popularity, especially for large or myopic FTMHs [22].…”

“…This procedure also eliminates potential vitreous remnants, reducing postoperative epiretinal membrane occurrence and hole reopening. Gas tamponade is employed to seal the hole, creating retinal isolation that promotes subretinal fluid absorption and Müller cell gliosis and migration [22][23][24].…”

Comments on: Internal Limiting Membrane Peeling and Gas Tamponade for Full-Thickness Macular Holes of Different Etiology – Is It Still Relevant? [Letter]

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Sir,We have read with great interest the article entitled "Internal Limiting Membrane Peeling and Gas Tamponade for Full-Thickness Macular Holes of Different Etiology -Is it Still Relevant?" by Ruban et al 1 The authors evaluate 38 eyes of 37 patients with full thickness macular hole (FTMH) who were underwent classic 25-gauge pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling and gas tamponade (GT). We would like to thank the authors for their detailed study, and we want to contribute further on the surgical method and complications of GT.

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