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The impact of extent of internal limiting membrane peeling on anatomical outcomes of macular hole surgery: results of a 54‐week randomized clinical trial
Author(s) -
Yao Yuou,
Qu Jinfeng,
Dong Chongya,
Li Xiaoxin,
Liang Jianhong,
Yin Hong,
Huang Lvzhen,
Li Yan,
Liu Peipei,
Pan Chungting,
Ding Xue,
Song Dan,
Sadda Srinivas R.,
Zhao Mingwei
Publication year - 2019
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.13853
Subject(s) - macular hole , medicine , vitrectomy , randomization , internal limiting membrane , surgery , randomized controlled trial , pars plana , ophthalmology , limiting , prospective cohort study , significant difference , visual acuity , mechanical engineering , engineering
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.