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. 2024 Oct 24;10(1):81.
doi: 10.1186/s40942-024-00599-5.

Comparison of conventional internal limiting membrane versus pars plana vitrectomy without peeling for small idiopathic macular hole

Maria Ludovica Ruggeri  1 , Alberto Quarta  2 , Paola Marolo  3 , Lucio Zeppa  4 , Lorenzo Motta  5 , Matteo Gironi  2 , Lisa Toto  2 , Michele Reibaldi #  3 , Rodolfo Mastropasqua #  6
Affiliations

Comparison of conventional internal limiting membrane versus pars plana vitrectomy without peeling for small idiopathic macular hole

Maria Ludovica Ruggeri et al. Int J Retina Vitreous. .

Abstract

Background: The aim of this study was to compare functional and anatomical changes in patients with small full thickness macular holes (FTMHs) who underwent pars plana vitrectomy (PPV) with or without Internal limiting membrane (ILM) peeling.

Methods: 42 eyes of 42 patients diagnosed for FTMHs (< 250 micron) were included in our prospective interventional study. Main outcome measures were: Best Corrected Visual Acuity (BCVA), Macular hole closure rate, Ellipsoid Zone (EZ) and External Limiting Membrane (ELM) recover, Vessel Density in both Superficial (VDSCP) and deep (VDDCP) capillary plexus, Macular pigment Optical density (MPOD) and mean Central Macular Sensitivity (CMS).Patients were randomly divided into "peeling group" (21 patients), in which the ILM peeling maneuver was performed and "no-peeling group" (21 patients) in which the ILM was not peeled off. Examinations were repeated one month (T1), three months (T2) and six months (T3) after surgery.

Results: Although significant improvements in terms of MPOD, CMS, VDSCP and VDDCP over time (p < 0.001) no significant differences were found between the peeling and no peeling group. Conversely, FTMHs closure was achieved in all cases (100%) in the peeling group, whereas 10% of cases in the no peeling group experienced the hole re-opening at T3, with reported different rates of ELM/EZ recover between the two groups. Nevertheless, BCVA improved significantly (p < 0.001) but without significant differences between the two groups.

Conclusions: No significant differences were found in terms of anatomical and functional outcomes between the peeling or not the ILM in small FTMHs at 6 months follow-up.

Keywords: FTMHs; ILM peeling; OCT; Vitreoretinal surgery.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
OCT linear macular scan at T0 (A), T1(B), T2 (C) and T3 (D) in both no peeling group (1) and peeling group (2). Case (1) shows a patient where incomplete EZ/ELM recover was noted during follow-up (*)
Fig. 2
Fig. 2
OCTA images of a peeling (A) and no peeling (B) patient of the deep (1) and superficial (2) capillary plexuses at different follow-ups times
Fig. 3
Fig. 3
Baseline (T0), one month follow-up (T1), three months follow-up (T2) and six months follow-up (T3) mean values of MPOD, BCVA, VDSCP, VDDCP and CMS
See this image and copyright information in PMC

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