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Abstract
To determine the effectiveness of removal of the internal limiting membrane in the
treatment of full-thickness macular holes.
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 macular hole surgery. A meta-analysis
was performed to compare the outcomes of different surgical techniques in the treatment
of full-thickness macular holes.
The outcome measures were disappearance of the submacular fluid and 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 improvement 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.
Retinal 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) increase the anatomical and functional success
rates in macular hole surgery.
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 holes.