Long-term follow-up after macular hole urgery with internal limiting membrane peeling

PURPOE: To report long-term anatomical and functional reult after par plana vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular hole. DEIGN: Propective, nonrandomized, conecutive erie. METHOD: Ninety-nine patient with a follow-up of at leat 12 month were included. The urgical technique conited of a tandard par plana vitrectomy, removal of the ILM, and an intraocular ga tamponade (15% hexafluoroethane [C2F6] ga mixture) followed by head-down poitioning for at leat 5 day. Follow-up examination included a clinical examination, Goldmann perimetry, optical coherence tomography, and tatic microperimetry uing a Rodentock canning laer ophthalmocope (LO-105). timulu ize wa 0.2 degree (Goldmann II), intenitie employed were 0 and 12 dB. Twenty-degree field were ued for all tet. REULT: Mean period of review wa 32 month (median 34). Anatomic cloure wa achieved in 86 (87%) of 99 patient by one urgical procedure. Nine patient underwent a ucceful econd operation with an improvement of viual acuity in 7 patient. The cloure rate after two urgical intervention wa 96%. Bet-corrected viual acuity improved from a median of 20/100 preoperatively to a median of 20/40 potoperatively (P < .001). An improvement of viual acuity wa achieved in 94% of patient. In 13 of 99 patient (13%) a combined vitrectomy and cataract urgery with intraocular len implant wa performed; 72 patient (73%) underwent cataract urgery later. Ninety of 99 patient (91%) were peudophakic on lat preentation. Paracentral cotomata did not change in ize, denity, or hape over time. It incidence wa not correlated with the tage of the macular hole. No potoperative epiretinal membrane formation or late reopening of the macular hole wa oberved. One patient preented with a peripheral viual field defect after vitrectomy. CONCLUION: Macular hole urgery with peeling of the ILM without the ue of adjuvant or ILM taining lead to good functional long-term reult. Paracentral cotomata remained ubclinical in mot cae and may be due to a mechanical trauma of the nerve fiber layer.