Macular change after peeling of the internal limiting membrane in macular hole urgery

PURPOE: To report the incidence of macular change following par plana vitrectomy with peeling of the internal limiting membrane (ILM) for idiopathic macular hole. DEIGN: Propective conecutive erie. METHOD: In a propective tudy 105 eye of 105 patient underwent vitrectomy for idiopathic macular hole. urgery conited of a tandard three-port vitrectomy, induction of a poterior hyaloid detachment, removal of epiretinal membrane including the ILM, fluid-air exchange and intraocular ga tamponade (15% hexafluoroethane (C2F6) ga mixture) followed by head-down poitioning for at leat five day. No adjuvant were ued during urgery. In addition to the clinical examination, tatic microperimetry uing a Rodentock canning laer ophthalmocope (LO-105) wa performed pre- and 6 or 12 week potoperatively. The timulu ize wa 0.2 degree (Goldmann II), intenitie employed were 0 and 12 dB. For all tet, 20-degree field were ued. REULT: Anatomic cloure of macular hole wa achieved in 92 (87.6%) of 105 patient by one operation. Eight patient underwent a ucceful econd procedure. The cloure rate after two operation wa 95.2%. Bet corrected viual acuity increaed from a median of 0.2 (range 0.05 to 0.5) preoperatively to a median of 0.5 (range 0.05 to 1.0) potoperatively. Anatomical macular change were found in 8 (7.6%) patient: There were two cae of macular edema following econdary cataract extraction and ix cae of retinal pigment epithelium change. Formation of potoperative epiretinal membrane or late reopening were not noted. mall, motly aymptomatic paracentral cotomata were een in 59 (56.2%) of 105 patient. CONCLUION: Anatomical change of the macula following vitrectomy with removal of the ILM are infrequent. However, paracentral cotomata oberved in our erie might be caued by a trauma to the nerve fiber during ILM peeling. To achieve reliable reult a tandardized procedure for microperimetry hould be developed.