Internal limiting membrane peeling in macular hole surgery.

Abstract

To evaluate prospectively the ability to peel epiretinal membranes and to correlate the degree of membrane peeling to anatomic success rates. Consecutive, noncomparative, interventional case series. One hundred ninety-three patients. The extent of membrane peeling and other intraoperative features were correlated to endpoints. Anatomic success (inducing hole closure), visual acuity of 20/50 or better, and visual improvement of two or more Snellen lines. One hundred ninety-three eyes were eligible for the study by virtue of having a minimum follow-up interval of 6 weeks. The overall anatomic success rate was 93% in these cases. There was a two-line or more improvement in 72%; 56% attained 20/50 or better visual acuity. The internal limiting membrane was peeled completely in 23%, partially in 43%, and not at all in 34%. The degree of internal limiting membrane peeling was not correlated with the duration of the hole or rate of two-line visual improvement, but was inversely correlated with the rate of anatomic success (P = 0.045). Final visual acuity was correlated with a better preoperative visual acuity, shorter preoperative duration of macular hole, and more complete internal limiting membrane peeling. Peeling of the internal limiting membrane is not essential for anatomic or visual success in macular hole surgery, but it may be a means to standardize inducement of the proper degree of gliosis. Excessive, unsuccessful attempts at internal limiting membrane peeling may decrease visual success. Techniques delivering a more reproducible, complete, atraumatic peeling of the internal limiting membrane should be studied.