COMPARATIVE ANALYSIS OF OUTCOMES WITH VARIABLE DIAMETER INTERNAL LIMITING MEMBRANE PEELING IN SURGERY FOR IDIOPATHIC MACULAR HOLE REPAIR.

Abstract

To analyse whether the size of internal limiting membrane peeling influences the outcome of macular hole surgery. Prospective, comparative, interventional study. Fifty eyes were included. Twenty-five eyes had smaller (3-mm) peel (Group 1), whereas the other 25 had larger (5-mm) peel (Group 2). Outcome measures were macular hole closure rate, improvement in best corrected visual acuity, retinal nerve fiber layer, and ganglion cell layer thickness (0.5 mm, 1.5 mm, and 2.5 mm temporal and medial to the fovea), external limiting membrane, inner segment outer segment layer, and cone outer segment tip restoration. Both the groups were matched for demographic parameters, spectral-domain optical coherence tomography-based macular hole staging and dimensions. Hole closure rates were similar, 80% and 65% in Group 1 and 2, respectively (P = 0.20). No difference was observed in anatomical success rate, irrespective of size, stage, or duration of hole. Visual improvement was better in Group 1 (4 lines vs. 2-line Early Treatment Diabetic Retinopathy Study equivalent; P = 0.04); the retinal nerve fiber layer was thinner at all locations in Group 2, with the difference being significant, 2.5 mm temporal to the fovea (P < 0.05), whereas the ganglion cell layer was thicker in the 3-mm group, significantly so at the location, 1.5 mm temporal to the fovea (P = 0.01). Outer layer restoration rates were also similar in both the groups. Macular hole closure rate was similar in both the groups; however, smaller (3-mm) peel group demonstrated better functional improvement and nerve fiber layer preservation.