Does ILM Peeling Improve Macular Hole Closure?

September 10, 2009

A study reports in the British Journal of Ophthalmology of higher anatomical success rates in macular hole surgery when the internal limiting membrane (ILM) is dissected.

The authors operated on stage 2 and 3 macular holes.  In this prospective, randomized trial, stage 2 and 3 eyes with macular holes were separated into peeling vs. non-peeling of the ILM.  Peeling was achieved using either ICG dye or trypan blue.  Results were monitored at 3 and 12 months.

In all groupings, the anatomic success rate was higher when the ILM was removed.  In those patients where the macular hole did not close and the ILM was not removed, anatomic success was achieved when the ILM was removed during a second surgery.

Visual results were similar in those holes that were successfully repaired without ILM peeling and with ILM peeling.

The study did not test stage 4 macular holes.

As a vitreo-retinal specialist, these results are not surprising.  While I have not kept my own data, my impression is that macular hole closure rates are enhanced with ILM peeling.  

Does anyone have a comment about trypan blue vs. ICG dye?

Read the abstract.


Randall V. Wong, M.D.
Retina Specialist




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