An effectiveness comparison of extensive and standard internal limiting membrane peeling for idiopathic macular hole with closed index less than 0.7

Objective

To evaluate and compare the curative effects between extensive and standard internal limited membrane peeling (ILMP) during vitrectomy for idiopathic macular hole (IMH) with closed index<0.7 and provide an alternative basis for IMH.

Methods

The clinical data of ninety-six eyes of 96 patients of IMH with closed index <0.7 who received vitrectomy with extensive (48 eyes) or standard ILMP (48 eyes) procedures from May 2012 to May 2016 in the Second Affiliated Hospital of Nanchang University under the informed consent of patients were retrospectively analyzed.Best corrected visual acuity (BCVA), central vision, direct ophthalmoscope examination, slit lamp microscope with preset lens, optical coherence tomography (OCT), intraocular pressure, Amsler grid table and fundus photography inspection were performed before surgery and 1 month, 6 and 12 months after surgery.The healing rate of IMH and the correction rate of Amsler grid table were also observed.Based on the OCT image, U-like closure was thought to be normal fovea, V-like closure was steep fovea and W-like closure exhibited the defect of sensory layer.Three types were considered as hole closure.

Results

OCT showed that retinal nurosensory layer was defect at macular area in both extensive ILMP group and standard ILMP group before surgery.At 12 months after operation, 43 cases had U type closure, 1 case had V type closure and 1 case had W type closure in the extensive ILMP group, while 33 cases had U type closure, 1 case had V type closure and 3 cases had W type closure in standard ILMP group.The BCVA was significantly better in the extensive ILMP group than that in the standard ILMP group in postoperative 1 month, 6 months and 12 months (all at P<0.05). Compared with preoperation BCVA, the number of eyes with central and paracentral scotomas was decreased in both extensive ILMP group and standard ILMP group at the end of the following up (central scotoma: χ²=80.98, 56.99, both at P<0.05; paracentral scotoma: χ²=88.21, 80.98, both at P<0.05), and the number of eyes with central scotoma in the extensive ILMP group was significantly less than that in the standard ILMP group (3 vs.11) (χ²=4.10, P<0.05). The closure rate of IMH was 93.75% in the extensive ILMP group and 77.08% in the standard ILMP group, showing a significant difference between the two groups (χ²=4.10, P<0.05). The corrected rate of Amsler grid abnormality was 93.75% in the extensive ILMP group, which was evidently higher than 75.00% in the standard ILMP group, with a significant difference between the two groups (χ²=5.06, P<0.05).

Conclusions

Both extensive ILMP and standard ILMP during vitrectomy for IMH with MCHI<0.7 are effective, and vitrectomy combined with extensive ILMP has a better outcome in comparison to vitrectomy combined with standard ILMP.

Retinal perforations/surgery; Basement membrane/surgery; Tomography, optical coherence; Treatment outcome; Comparative studies; Retrospective studies; Idiopathic macular hole/surgery