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Purpose  To compare the anatomical outcomes of different extents of internal limiting membrane ( ILM ) peeling in idiopathic macular hole surgery.    Methods  Prospective, parallel‐group, randomized clinical trial. A total of 121 eyes of 121 patients with idiopathic macular hole underwent pars plana vitrectomy, and peeling of the  ILM  with a diameter of two disk diameters ( DD ) or 4 DD  based on randomization. The main outcome was the proportion of eyes with complete hole closure at 12 months. The second outcome was the hole closure grading stratified by macular hole closure index ( MHCI ) at each visit.    Results  At 12 months, there was no significant difference in anatomical outcomes with complete closure achieved in 52 (82.5%) of 63 eyes in the 2 DD  group and 53 (91.4%) of 58 eyes in the 4 DD  group (p = 0.15). For subjects with  MHCI  ≤0.5 ( n  = 24), complete closure rate was significantly lower in the 2 DD  group compared to the 4 DD  group (p = 0.012; 18.2% versus 75.9%, respectively). Average  BCVA  was lower in 2 DD  group than 4 DD  group (p = 0.014). By contrast, when  MHCI  was >0.5, the complete closure rate between the two groups showed no significant difference: 96.2% (50 patients) versus 95.6% (43 patients), respectively (p = 0.185).    Conclusion  In patients with idiopathic full‐thickness macular hole and  MHCI  ≤0.5, a larger  ILM  peel of 4 DD  tends to achieve better anatomical outcomes than a more limited 2 DD  peel.

acta ophthalmologica

The impact of extent of internal limiting membrane peeling on anatomical outcomes of macular hole surgery: results of a 54‐week randomized clinical trial