ILM peeling aids in macular hole closure, according to study

Br J Ophthalmol. 2009;93(8):1005-1015.

While visual acuity after macular hole closure may not differ among patients who undergo peeling of the internal limiting membrane compared with patients who do not, anatomical success rates are greater in surgeries that use the extra step, according to a study.

In 77 eyes with stage 2 or 3 macular hole, closure 3 months after surgery was achieved among 12 patients (100%) with a stage 2 hole who underwent internal limiting membrane (ILM) peeling assisted by indocyanine green (ICG) staining compared with six of the 11 patients (55%) who had no peeling.

Of those with stage 3 holes, 16 of 18 patients (89%) with ILM peeling assisted by trypan blue had hole closure at 3 months, 20 of 22 patients (91%) with ILM peeling assisted by ICG had closure, and five of 14 patients (36%) with no peeling had closure.

Sixteen of 18 eyes with no closure after 3 months underwent a second surgery with ICG-assisted ILM peeling, one patient declined reoperation, and one patient had late closure between 3 and 6 months, according to the study. After 12 months, 96% (24 of 25 patients) in the initial no-peel group obtained closure of their hole. Closure rates at 12 months was 97% (33 of 34 patients) in the ICG group and 100% (18 patients) in the trypan blue group.