Comparisons of foveal thickness and slope after macular hole surgery with and without internal limiting membrane peeling

Figures & data

Table 1 Demography and clinical characteristics of eyes undergoing pars plana vitrectomy

	With ILM peeling Mean ± SD	Without ILM peeling Mean ± SD	p-value
Eyes	12	10
Men, women	3 (4 eyes), 8	3, 7
Age (years)	66.0±4.9	69.1±5.7	0.19
Axial length (mm)	23.8±1.0	23.5±1.0	0.53
Macular hole (µm)
Minimal	267.7±78.7	271.2±78.7	0.86
Basal	324.7±72.4	315.9±111.1	0.83
Macular hole stage
2:3 (eyes)	6:6	7:3	0.90
BCVA (logMAR)
Baseline	0.40±0.16	0.38±0.16	0.80
6 months	0.08±0.09**	−0.045±0.11**	0.45

Note:

** p<0.00001.

Abbreviations: BCVA, best-corrected visual acuity; ILM, internal limiting membrane; logMAR, logarithm of minimum angle of resolution.

Table 2 Comparison of the mean retinal thickness of postoperative eyes after macular hole surgery at 6 months and corresponding fellow eyes (µm, mean ± SD)

	With ILM peeling (n=11)			Without ILM peeling (n=8)
	Operated eye	Fellow eye	p-value	Operated eye	Fellow eye	p-value
Central retinal thickness	300.1±19.2	257.5±21.8	0.0001	278.7±26.6	276.0±25.6	0.64
Parafovea
Nasal	359.2±9.0	336.9±13.6	0.0002	366.3±23.8	346.3±12.4	0.02
Temporal	316.2±7.1	322.3±12.1	0.27	354.4±25.6	333.5±11.1	0.03
Superior	342.4±11.9	331.4±14.0	0.09	368.0±27.8	341.6±10.4	0.009
Inferior	339.7±10.1	328.1±12.4	0.02	358.9±22.2	339.4±9.9	0.03
Perifovea
Nasal	314.9±15.5	304.5±18.8	0.24	327.7±26.6	310.0±16.4	0.04
Temporal	283.4±10.0	274.9±12.0	0.14	305.3±24.0	282.6±10.8	0.02
Superior	304.4±12.0	290.0±19.3	0.11	314.6±22.7	291.0±12.6	0.003
Inferior	288.1±16.3	275.7±16.6	0.13	301.9±21.4	285.5±12.6	0.07

Notes: One eye in each group was excluded as bilateral cases. One eye without ILM peeling was excluded due to thick retina caused by epiretinal membrane.

Abbreviation: ILM, internal limiting membrane.

Figure 1 SD-OCT images of a 71-year-old man with a stage 2 MH who underwent PPV with peeling of the ILM.

Notes: The BCVA improved from 20/30 preoperatively to 20/16 at 6 months postoperatively. The total retinal thickness is shown as a color map obtained by Spectralis HRA+OCT (A) at 6 months. The thickness of the GCC is also shown and analyzed by RS-3000 (B) at 6 months after the surgery. A preoperative horizontal SD-OCT image is shown (C). The angle between the flat line of RPE and the slope around the closed MH was manually measured with ImageJ (D; horizontal image). The angles are shown as the degrees between the red lines (nasal side) and the blue lines (temporal side).
Abbreviations: BCVA, best-corrected visual acuity; GCC, ganglion cell complex; ILM, internal limiting membrane; MH, macular hole; PPV, pars plana vitrectomy; RPE, retinal pigment epithelium; SD-OCT, spectral-domain optical coherence tomography.

Figure 2 SD-OCT images of a 62-year-old woman with stage 3 MH after PPV without peeling of the ILM.

Notes: The BCVA improved from 20/32 at baseline to 20/16 at 6 months postoperatively. The total retinal thickness is shown as a color map obtained by Spectralis HRA+OCT (A) at 6 months. The thickness of the GCC was analyzed by RS-3000 (B) at 6 months after the surgery. A preoperative horizontal SD-OCT image is shown (C). The angle between the flat line of the RPE and the slope around the closed MH was manually measured with ImageJ (D; horizontal image). The angles are shown as the degrees between red lines (nasal side) and blue lines (temporal side).
Abbreviations: BCVA, best-corrected visual acuity; GCC, ganglion cell complex; ILM, internal limiting membrane; MH, macular hole; PPV, pars plana vitrectomy; RPE, retinal pigment epithelium; SD-OCT, spectral-domain optical coherence tomography.

Table 3 Comparison of the mean retinal thickness of postoperative eyes after macular hole surgery at 6 months with and without ILM peeling (µm, mean ± SD)

	With ILM peeling (n=12)	Without ILM peeling (n=10)	p-value
Central retinal thickness	302.8±20.6	282.1±27.7	0.07
Parafovea
Nasal	359.7±8.7a	367.1±20.2	0.30
Temporal	317.4±8.0b	353.0±23.2	0.0008
Superior	341.2±12.1	366.9±23.3	0.008
Inferior	340.3±9.8	357.3±20.4	0.03
Perifovea
Nasal	313.4±15.6	330.2±22.3	0.06
Temporal	282.2±10.4	303.6±20.9	0.01
Superior	301.9±14.2	319.2±20.9	0.04
Inferior	286.5±16.5	299.6±18.4	0.10

Notes:

a The mean retinal thickness in nasal parafoveal retina was significantly larger than that in temporal (p=0.000), superior (p=0.00), and inferior (p=0.00) ones.

b The mean retinal thickness in temporal parafoveal retina was significantly less than that in nasal (p=0.000), superior (p=0.00), and inferior (p=0.00) ones.

Abbreviation: ILM, internal limiting membrane.

Table 4 Comparison of the mean parafoveal GCC of postoperative eyes after macular hole surgery with ILM peeling and without ILM peeling (µm, mean ± SD)

	With ILM peeling	Without ILM peeling	p-value
Nasal superior	117.9±10.2	128.5±17.0	0.11
Nasal inferior	119.7±8.2	123.7±15.8	0.49
Temporal superior	98.3±8.9*	116.8±16.3	0.008
Temporal inferior	101.0±9.9*	115.9±15.2	0.02

Notes:

* p=0.001; between nasal superior vs temporal superior and nasal inferior vs temporal inferior with the ILM peeling group. There was no significant difference between the with and without ILM peeling groups, although the GCC thickness after surgery was thicker in the nasal lesion and thinner in the temporal one compared with the fellow eye (data not shown). There was no significant difference in the perifoveal lesions (data not shown).

Abbreviations: GCC, ganglion cell complex; ILM, internal limiting membrane.

Table 5 Comparison of the mean retinal slope of postoperative eyes after macular hole surgery with ILM peeling and without ILM peeling (°, mean ± SD)

	With ILM peeling			Without ILM peeling			With vs without
	Operated eye	Fellow eye	p-value	Operated eye	Fellow eye	p-value	p-value
Nasal	52.3±6.6	35.3±6.7	0.0003	40.2±7.9	30.3±3.3	0.008	0.009
Temporal	43.6±9.0	33.7±6.9	0.07	37.6±7.0	30.3±5.2	0.04	0.09
Superior	50.8±9.8	34.2±4.8	0.005	41.2±7.6	31.2±4.9	0.006	0.008
Inferior	51.9±10.7	35.0±6.2	0.004	39.5±7.9	33.1±5.2	0.09	0.017

Abbreviation: ILM, internal limiting membrane.