Epiretinal membrane peeling helps anatomic macular hole closure, but not VA

LA JOLLA, Calif. — Epiretinal membrane peeling increased the rate of anatomic closure of macular holes in a multicenter study, but did not improve postoperative visual acuity. Preoperative hole size was the best predictor of postop visual acuity, the study authors found.

Researchers at the University of California San Diego analyzed data from the Vitrectomy for Macular Hole Study Group to determine the effects of epiretinal membranes on macular hole surgical and visual results. They identified 91 phakic eyes with an idiopathic macular hole that underwent standard vitrectomy for macular hole repair with or without epiretinal membrane (ERM) peeling.

ERM peeling was associated with greater anatomic hole closure success (67% of the ERM peeled vs. 35% of the nonpeeled) but was not associated with visual improvement in eyes with anatomic hole closure. Postoperative ERMs were more common in the aphakic eyes that underwent cataract surgery after vitrectomy (77%) than in phakic eyes (36%). Macular hole edge approximation or hole appearance after initial vitrectomy for hole repair was stable over the average 18 months follow-up in 89% of the eyes. About 10% of the eyes underwent changes in their hole appearance.

Hole edge approximation or hole appearance was associated with preoperative hole size and postoperative visual acuity. Preop hole size was found to be the major predictor of postop visual acuity (P < .005). In addition, smaller macular holes had a higher surgical success rate (90%) than larger holes (62%).

The authors note that their closure rate is lower than those in previous reports. “We believe many factors may enter into these reported higher rates, including patient selection. The closure rate reported in our study may be closer to what results when macular holes of all sizes and durations undergo initial vitrectomy,” they report in Ophthalmology.