ILM peeling improves macular hole closure rate

Performing pars plana vitrectomy followed by peeling of the internal limiting membrane significantly improves the rate of macular hole closure compared to vitrectomy alone, a retrospective study suggests.

Daniele Tognetto, MD, and colleagues at the University of Trieste, Italy, reviewed the records for 1,627 patients treated for idiopathic macular holes by 28 surgeons. They found a significantly higher macular hole closure rate among patients treated with internal limiting membrane (ILM) peeling, with 94.1% achieving closure vs. 89% of vitrectomy-only patients (P < .001). Additionally, ILM peeling significantly increased the probability for achieving hole closure by 2.59 times (P < .001), according to the study.

Both macular hole stage and duration also significantly affected the probability of hole closure. However, “[ILM peeling] did not increase the chance of having a better visual outcome after surgery,” the authors noted.

Closure was 3.12 times more likely in patients with macular holes for less than 6 months (P < .001). Compared to patients with stage 4 holes, the probability of closure was 4.94 times higher in stage 2 patients and 2.34 times higher in stage 3 patients (P < .001).

Patients with stage 2 holes were 2.37 times more likely to improve 2 or more logMAR lines (P < .001) compared to stage 4 patients. Patients with holes for less than 6 months were 3.16 timers more likely to improve 2 or more lines. Patients with 0 to 0.7 logMAR visual acuities preoperatively were 2.37 times more likely to improve 2 or more lines, according to the study.

The study was published in the August issue of Ophthalmology.