Abstract
Objective
To compare the surgical outcomes of 1-disc diameter (DD) and 2-DD conventional internal limiting membrane peeling (C-ILMP) in large full-thickness macular holes (FTMHs).
Materials and methods
A prospective randomized controlled trial. One hundred patients with large idiopathic full-thickness macular hole (FTMH) were randomized into C-ILMP and extended C-ILMP (EC-ILMP) groups. The primary outcome was closure rate at 6 months after surgery. Secondary outcomes were visual acuity (VA), closure type, consequence of ILMP and complications.
Results
The mean symptom duration was 12.19 ± 9.64 months. Mean preoperative VA was 1.25 ± 0.37 logMAR. The average minimum linear diameter was 633.05 ± 129.82 µm and basal linear dimension was 1158.49 ± 249.07 µm. The two groups did not differ in term of demographic data. Closure rate was significantly higher in the EC-ILMP group (76.47% vs. 51.02%, 95% CI 7.24–43.66; p = 0.008). There were also no significant differences in closure type, central foveal thickness, dissociated optic nerve fibre layer detection, or change in fovea-to-disc distance. There were also no significant differences in postoperative VA (p = 0.069) or visual improvement (mean 0.39 ± 0.43 logMAR; p = 0.286). According to subgroup analysis, EC-ILMP resulted in a higher closure rate in patients with chronic FTMH for >6 months, (p = 0.008). Furthermore, EC-ILMP resulted in better anatomical closure and visual result in patients with FTMH with macular hole closure index ≤0.5, p = 0.003 and p = 0.010, respectively.
Conclusion
Extended C-ILMP yielded a significantly higher closure rate in large FTMHs, but visual outcome did not differ significantly. According to subgroup analysis, extended C-ILMP was more effective in chronic large FTMH with MHCI ≤ 0.5.
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Acknowledgements
The authors would like to thank Dr. Watcharaporn Thongmee for illustrating the figures and Dr. Sasinun Pipatbanditsakul for helping in data collection. The authors would like to thank Dr. Kaewjai Thepsuthammarat, Clinical Epidemiology Unit, Faculty of Medicine, Khon Kaen University for statistical analyses. We would like to acknowledge Dr. Dylan Southard for the English language editing of this manuscript via the KKU Publication Clinic (Thailand).
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Sinawat, S., Srihatrai, P., Sutra, P. et al. Comparative study of 1 DD and 2 DD radius conventional internal limiting membrane peeling in large idiopathic full-thickness macular holes: a randomized controlled trial. Eye 35, 2506–2513 (2021). https://doi.org/10.1038/s41433-020-01259-2
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DOI: https://doi.org/10.1038/s41433-020-01259-2
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