Macular hole surgery with or without indocyanine green stained internal limiting membrane peeling (original) (raw)
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Journal of Ophthalmology
Purpose. This study aimed to show the impact of different extents of internal limiting membrane (ILM) peeling on visual and anatomical outcomes following idiopathic full-thickness macular hole (FTMH) surgery. Methods. In this single-center prospective study, patients with idiopathic FTMH underwent standard pars plana vitrectomy with two different extents of ILM peeling: 2-disc diameters (DD) or 4 DD. The main outcome measures were the closure rate of the holes based on optical coherence tomography (OCT) findings at three months after surgery. Results. Forty eyes from 39 patients were enrolled in the study. After three months, anatomical closure was achieved in 78% and 76% eyes in 2 DD peel and 4 DD peel groups, respectively. From 29 eyes with macular hole index (MHI) ≤ 0.5, type 1 closure was achieved in 42% eyes receiving a 2 DD ILM peel, compared to 66% eyes receiving a 4 DD peel p=0.041. In comparison, this significant difference was not seen in the subgroup of MHI > 0.5 p=061...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017
OBJECTIVE To evaluate the anatomical success of stage 3 and 4 macular hole surgery after removal of internal limiting membrane (ILM) with the help of Indocyanine green (ICG). STUDY DESIGN An experimental study. PLACE AND DURATION OF STUDY LRBTTertiary Care Eye Hospital, Karachi, October 2015 to August 2016. METHODOLOGY Twenty patients with stage 3 and 4 macular hole (confirmed by spectral domain optical coherence tomography) underwent standard 3 ports pars plana vitrectomy. Staining of ILM was performed with the help of 0.5% ICG to aid in visualization. ILM was removed by using intraocular forceps in circular fashion. Finally, gas fluid exchange with internal tamponade of SF6 20% was performed. Postoperative face down posture was maintained for seven days. Patients were followed-up for 8 months and assessment of macular hole closure was done using SD-OCT. RESULTS After a follow-up of 8 months, macular hole was closed in 17 eyes (85%) and vision had improved in 6 patients. Postoperat...
BMC Ophthalmology, 2020
Background Internal limiting membrane (ILM) peeling increases the idiopathic macular hole (IMH) closure rate but causes the inner retina dimplings. This study is to introduce a method to minimally peel the ILM, and with the ILM flap to ensure the IMH closure. Methods Twelve consecutive IMH eyes were treated with the minimal ILM peeling with ILM flap technique. The ILM around the MH is peeled off in an annular shape with a width of approximately 200 to 300 μm. A tongue-shape ILM flap is created in the superior retina and the inferior margin of ILM is not peeled off. The ILM flap is then inverted to cover the MH, followed by fluid-air exchange and air or silicon tamponade. Spectral domain-optical coherence tomography (SD-OCT) and en face OCT for morphological assessment, best corrected visual acuity (BCVA) and multifocal electroretinogram (ERG) for functional evaluation were performed at baseline and at each postoperative follow-up. Results All the 12 eyes achieved macular hole closur...
Long-term follow-up after macular hole surgery with internal limiting membrane peeling
American Journal of Ophthalmology, 2002
To report long-term anatomical and functional results after pars plana vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular hole. Prospective, nonrandomized, consecutive series. Ninety-nine patients with a follow-up of at least 12 months were included. The surgical technique consisted of a standard pars plana vitrectomy, removal of the ILM, and an intraocular gas tamponade (15% hexafluoroethane [C(2)F(6)] gas mixture) followed by head-down positioning for at least 5 days. Follow-up examinations included a clinical examination, Goldmann perimetry, optical coherence tomography, and static microperimetry using a Rodenstock scanning laser ophthalmoscope (SLO-105). Stimulus size was 0.2 degrees (Goldmann II), intensities employed were 0 and 12 dB. Twenty-degree fields were used for all tests. Mean period of review was 32 months (median 34). Anatomic closure was achieved in 86 (87%) of 99 patients by one surgical procedure. Nine patients underwent a successful second operation with an improvement of visual acuity in 7 patients. The closure rate after two surgical interventions was 96%. Best-corrected visual acuity improved from a median of 20/100 preoperatively to a median of 20/40 postoperatively (P <.001). An improvement of visual acuity was achieved in 94% of patients. In 13 of 99 patients (13%) a combined vitrectomy and cataract surgery with intraocular lens implant was performed; 72 patients (73%) underwent cataract surgery later. Ninety of 99 patients (91%) were pseudophakic on last presentation. Paracentral scotomata did not change in size, density, or shape over time. Its incidence was not correlated with the stage of the macular hole. No postoperative epiretinal membrane formation or late reopening of the macular hole was observed. One patient presented with a peripheral visual field defect after vitrectomy. Macular hole surgery with peeling of the ILM without the use of adjuvants or ILM staining leads to good functional long-term results. Paracentral scotomata remained subclinical in most cases and may be due to a mechanical trauma of the nerve fiber layer.
World Journal of Retina and Vitreous, 2011
To evaluate and compare the anatomical and functional outcomes of internal limiting membrane (ILM) peeling in macular hole surgery (MHS) assisted by Brilliant Blue G (BBG) or triamcinolone acetonide (TA). Study design: Retrospective, non-randomized, interventional single center study. Methods: 51 eyes of 51 patients with idiopathic macular holes (≥ stage 2) who underwent MHS at our center were included. An OCT evaluation of hole status was followed by pars plana vitrectomy for each of these eyes. Those who underwent TA-assisted ILM peeling were considered as group 1 (n = 26) and those with BBG-assisted ILM peeling were considered as group 2 (n = 25). The primary outcome measures included anatomical hole closure, postoperative visual acuity and operative complications for either group. Results: Anatomical hole closure was achieved in 46 eyes (90%). The mean postoperative follow-up duration was 15.9 ± 2.3 months. The mean preoperative visual acuity was 1.0702 ± 0.37 Log MAR (equivalent to 20/240) and the final acuity was 0.7122 ± 0.22 Log MAR (equivalent to 20/100) (p < 0.0001). There were no significant postoperative complications apart from progression of nuclear sclerosis in 8/35 phakic eyes. After adjusting for age and preoperative visual acuity, there was no significant difference between the two groups with respect to hole closure rate and postoperative visual acuity. Conclusion: BBG-assisted ILM peeling offers an effective alternative to triamcinolone with the added advantage of marked enhancement of vitreoretinal interface contrast with comparable hole closure rates and visual outcomes.
Internal limiting membrane peeling in macular hole surgery
Ophthalmology, 2001
Purpose: To review the current rationale for internal limiting membrane (ILM) peeling in macular hole (MH) surgery and to discuss the evidence base behind why, when, and how surgeons peel the ILM. Methods: Review of the current literature. Results: Pars plana vitrectomy is an effective treatment for idiopathic MH, and peeling of the ILM has been shown to improve closure rates and to prevent postoperative reopening. However, some authors argue against ILM peeling because it results in a number of changes in retinal structure and function and may not be necessary in all cases. Furthermore, the extent of ILM peeling optimally performed and the most favorable techniques to remove the ILM are uncertain. Several technique variations including ILM flaps, ILM scraping, and foveal sparing ILM peeling have been described as alternatives to conventional peeling in specific clinical scenarios. Conclusion: Internal limiting membrane peeling improves MH closure rates but can have several consequences on retinal structure and function. Adjuvants to aid peeling, instrumentation, technique, and experience may all alter the outcome. Hole size and other variables are important in assessing the requirement for peeling and potentially its extent. A variety of evolving alternatives to conventional peeling may improve outcomes and need further study.