Internal limiting membrane removal in the management of full-thickness macular holes

PURPOSE: To determine the effectiveness of removal of the internal limiting membrane in the treatment of full-thickness macular holes. METHODS: Data were reviewed from a prospective study on 47 consecutive eyes with full-thickness macular holes undergoing vitrectomy, internal limiting membrane maculorhexis, and fluid gas exchange. No eye underwent repeat mac ular hole surgery, A meta-analysis was performed to compare the outcomes of different surgical techniques in the treatment of full-thickness macular h oles. RESULTS: The outcome measures were disappearance of the submacular fluid an d the change in best-corrected visual acuity. The surgery was anatomically successful in 44 of the 46 eyes (96%) and 39 of the eyes (85%) showed an im provement of at least two Snellen lines. Best corrected final vision was 20 /40 in 18 (39%) eyes. No permanent complications specifically caused by the removal of the macular internal limiting membrane were detected; the minor hemorrhages and retinal edema seen in most eyes resolved spontaneously. Re tinal detachment developed and was successfully treated in three eyes (7%). A meta-analysis on 1,654 eyes from published reports showed that internal limiting membrane maculorhexis appears to significantly (P < .0001) increas e the anatomical and functional success rates in macular hole surgery. CONCLUSIONS: Internal limiting membrane removal is an important development in the evolving field of macular hole surgery. A randomized, prospective, multicenter clinical trial should be performed to determine which surgical technique is the most beneficial in patients with full thickness macular ho les. (C) 2000 by Elsevier Science Inc, All rights reserved.