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Removal of the internal limiting membrane for idiopathic macular hole may improve visual outcomes
Retina. 2008;28(9):1276-1279.
The usefulness of internal limiting membrane removal in idiopathic macular hole remains in dispute, but a retrospective chart review showed that using intravitreal triamcinolone acetonide to assist with the procedure achieved effective anatomic closure and gains in visual acuity.
Closure of the macular hole after surgery was achieved in 36 of the 37 (97%) eyes in the series. Mean overall preoperative visual acuity was 20/150. After surgery, mean best corrected visual acuity taken at the patient’s most recent visit improved to 20/63.
The investigators noted no intraoperative or postoperative complications attributable to triamcinolone acetonide. However, cataracts in 18 of 26 phakic eyes in the study progressed postoperatively and 12 patients underwent cataract extraction and IOL implantation.
Despite reports in published literature discounting the need for internal limiting membrane removal to treat macular hole, the study authors said removal can reduce tractional forces and may lead to cytokine release that assists in closure.
There is consensus that internal limiting membrane (ILM) peeling improves the anatomic closure rate in macular hole. Whether or not ILM peeling improves visual results is less certain because of the risks of ILM peeling, which include the potential toxicity of staining agents, such as indocyanine green, that are used to improve visualization of the ILM. Triamcinolone has been suggested as a visualization aid in previous studies. The study by Tewari et al confirms earlier reports that triamcinolone-assisted visualization of the ILM is associated with excellent anatomic closure and good final visual acuity. Although additional work is needed to determine if this technique is superior to other techniques for visualization of the ILM in terms of final visual acuity, the use of triamcinolone appears to be a reasonable choice for surgeons when peeling the ILM in macular hole surgery.
– George A. Williams, MD
OSN Retina/Vitreous Section Member