Macular hole surgery with internal-limiting membrane peeling and intravitreous air

Objective: To examine the results of macular hole surgery using pars plana vitrectomy, internal-limiting membrane peeling, and intravitreous air in a series of consecutive patients. Design: A retrospective, interventional, noncomparative case series. Patients: Fifty consecutive patients (58 eyes) with full-thickness macular holes. Intervention: All eyes underwent a pars plana vitrectomy with internal-limi ting membrane peeling and intravitreous air, and patients were asked to pos ition face-down for only 4 days. Main Outcome Measures: Status of macular holes, visual acuity, and associat ed findings and complications. Results: All patients had postsurgical follow-up of 6 months or greater. Ei ght eyes (14%) presented with stage-2 macular holes, 48 eyes (83%) with sta ge-3 macular holes, and 2 eyes (3%) with stage-4 macular holes. Only 26 eye s (45%) had a macular epiretinal membrane seen before surgery. Fifty-three (91%) of the 58 macular holes were closed with 1 operation, and 55 (95%) ha d closure of the macular holes with subsequent operations. Five (9%) of 58 eyes had an initial visual acuity of 20/50 or better, and 31 eyes (53%) had a final visual acuity of 20/50 or better. Of the 45 eyes with symptoms of less than 6 months' duration, 44 (98%) had macular holes that were closed w ith 1 operation and 27 (60%) had a final visual acuity of 20/50 or better. Of the 13 eyes with symptoms of 6 months' duration or longer, 9 (69%) had m acular holes that were closed with 1 operation and 4 (31%) had a final visu al acuity of 20/50 or better. Complications attributed to the operation inc luded retinal tears, retinal detachments, postoperative macular puckers, an d macular light toxicity. Conclusions: The anatomic and visual results in this series are good. The c urrent technique is similar to that of conventional macular hole surgery ex cept for the use of intravitreous air, internal-limiting membrane peeling i n all eyes, and only 4 days of postoperative positioning. This study would suggest that peeling of the internal-limiting membrane is an important adju vant for successful closure of macular holes.