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Comparative Study
. 2025 May;103(3):e156-e164.
doi: 10.1111/aos.16778. Epub 2024 Oct 14.

Vitrectomy in Small idiopathic MAcuLar hoLe (SMALL) study: Internal limiting membrane peeling versus no peeling

Paola Marolo  1 , Paolo Caselgrandi  1 , Matteo Fallico  2 , Guglielmo Parisi  1 , Enrico Borrelli  1 , Federico Ricardi  1 , Francesco Gelormini  1 , Luca Ceroni  3 , Michele Reibaldi  1 ; SMALL Study Group
Collaborators, Affiliations
Comparative Study

Vitrectomy in Small idiopathic MAcuLar hoLe (SMALL) study: Internal limiting membrane peeling versus no peeling

Paola Marolo et al. Acta Ophthalmol. 2025 May.

Abstract

Purpose: To compare vitrectomy with and without internal limiting membrane (ILM) peeling in small idiopathic macular holes.

Methods: Retrospective multicentre study including consecutive eyes with ≤250 μm idiopathic macular hole treated with vitrectomy. The primary outcome was hole closure rate. Best-corrected visual acuity (BCVA) change, closure patterns on optical coherence tomography, rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery, and rate of complications were also investigated.

Results: In total, 693 eyes were included. Hole closure rate was 98% in the peeling and 85% in the no-peeling group (p < 0.001). At 12 months, mean BCVA change was 0.38 ± 0.22 logMAR in the peeling and 0.45 ± 0.21 logMAR in the no-peeling group (p = 0.02); 66% versus 80% of eyes had a U-shaped morphology, respectively; EZ recovery rate was 75% and 93%, respectively (p = 0.02). In the no-peeling group, eyes with a vitreomacular traction (VMT) showed a 96% closure rate, comparable to the peeling group (p = 0.40). The incidence of adverse events was similar except for dissociated optic nerve fibre layer (55% in the peeling vs. 9% in the no-peeling group, p < 0.001).

Conclusions: In small idiopathic macular holes, ILM peeling provides a higher closure rate compared to no-peeling; however, if a VMT is present closure rates are comparable. In closed macular holes, the no-peeling technique provides advantages in terms of visual outcome and anatomical recovery.

Keywords: closure rate; macular hole; no‐peeling; optical coherence tomography; peeling; small; visual acuity; vitrectomy; vitreomacular traction.

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Conflict of interest statement

No conflicting relationship exists for any author.

Figures

FIGURE 1
FIGURE 1
Mean best‐corrected visual acuity (BCVA) over time for peeling versus no‐peeling group. BCVA was assessed at baseline, 1 month, 6 months and 12 months after treatment. The peeling group (black circles, dashed line) showed a consistent improvement, with BCVA decreasing from 0.55 logMAR at baseline to 0.17 logMAR at 12 months (ANOVA, p < 0.001). The no‐peeling group (grey squares, solid line) also demonstrated a significant improvement, with BCVA decreasing from 0.47 logMAR at baseline to 0.02 logMAR at 12 months (ANOVA, p < 0.001).
See this image and copyright information in PMC

References

    1. Almeida, D.R.P. , Chin, E.K. , Tarantola, R.M. , Folk, J.C. , Boldt, H.C. , Skeie, J.M. et al. (2015) Effect of internal limiting membrane abrasion on retinal tissues in macular holes. Investigative Ophthalmology & Visual Science, 56, 2783–2789. - PMC - PubMed
    1. Azuma, K. , Hirasawa, K. , Araki, F. , Shiraya, T. , Yashiro, S. , Kato, S. et al. (2021) Fovea‐sparing as opposed to Total peeling of internal limiting membrane for myopic Foveoschisis: a systematic review and meta‐analysis. Ophthalmol Retin, 5, 670–679. - PubMed
    1. Bringmann, A. , Unterlauft, J.D. , Barth, T. , Wiedemann, R. , Rehak, M. & Wiedemann, P. (2022) Müller cells and astrocytes in tractional macular disorders. Progress in Retinal and Eye Research, 86, 100977. - PubMed
    1. Chan, C.K. , Crosson, J.N. , Mein, C.E. & Daher, N. (2017) Pneumatic vitreolysis for relief of vitreomacular traction. Retina, 37, 1820–1831. - PMC - PubMed
    1. Chan, C.K. , Mein, C.E. , Glassman, A.R. , Beaulieu, W.T. , Calhoun, C.T. , Jaffe, G.J. et al. (2021) Pneumatic Vitreolysis with Perfluoropropane for vitreomacular traction with and without macular hole: DRCR retina network protocols AG and AH. Ophthalmology, 128, 1592–1603. - PMC - PubMed