Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Macular holes with minimal diameter greater than 650 µm close in 85% of cases after vitrectomy and ILM peeling with visual benefit

Eye volume 38, pages 3341–3346 (2024)Cite this article

Subjects

Abstract

Purpose

To describe the postoperative outcomes of eyes with primary full-thickness macular holes (MH) greater than 650 μm.

Design

Retrospective, monocentric, consecutive case series.

Participants

Patients with primary MH operated at Lariboisière Hospital, Paris, France.

Methods

Records of patients with MH with a minimum horizontal diameter greater than 650 μm that underwent primary surgery with internal limiting membrane (ILM) peeling (complete or with inverted ILM flap) between January 2010 and January 2022 were reviewed.

Main outcome measures

Postoperative MH closure rate and visual acuity.

Results

74 eyes of 73 patients met the inclusion criteria. The mean minimum horizontal diameter was 777 ± 108 µm (650-1114). It ranged between 650 and 800 µm in 40 eyes (54%) and was ≧ 800 µm in 34 eyes (46%). The closure rate was 77% (57/74) after primary surgery and was significantly higher in MH between 650 and 800 µm, than in MH ≧ 800 µm (87.5% versus 64.7%, p = 0.02). In the 58/74 eyes in which conventional ILM peeling was performed, closure rate was 74.1% (43/58), significantly higher in MH ranging between 650 and 800 µm than in MH ≧ 800 µm (84.8% versus 60.0%, p = 0.03). In closed MH, 50/64 (78%) eyes achieved a VA gain ≥0.2 logMAR (3 lines), and 14 (21.9%) eyes a final BCVA ≥ 0.3 logMAR.

Conclusion

MH surgery with conventional ILM peeling allowed closed MH ≧ 650 μm and < 800 μm with a success rate close to 85% that decreased in larger MH. A significant visual improvement was achieved after MH closure, even in MH ≧ 800 μm.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Closure of macular holes with a minimum horizontal diameter greater than 1000 µm after a single surgery and closure rate according to the minimum diameter.

Similar content being viewed by others

References

  1. Meuer SM, Myers CE, Klein BEK, Swift MK, Huang Y, Gangaputra S, et al. The epidemiology of vitreoretinal interface abnormalities as detected by spectral-domain optical coherence tomography. Ophthalmology. 2015;122:787–95.

    Article  PubMed  Google Scholar 

  2. Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes: results of a pilot study. Retina. 1991;11:447.

    Article  Google Scholar 

  3. Tadayoni R, Gaudric A, Haouchine B, Massin P. Relationship between macular hole size and the potential benefit of internal limiting membrane peeling. Br J Ophthalmol. 2006;90:1239–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Duker JS, Kaiser PK, Binder S, de Smet MD, Gaudric A, Reichel E, et al. The international vitreomacular traction study group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology. 2013;120:2611–9.

    Article  PubMed  Google Scholar 

  5. Ch’ng SW, Patton N, Ahmed M, Ivanova T, Baumann C, Charles S, et al. The Manchester large macular hole study: is it time to reclassify large macular holes? Am J Ophthalmol. 2018;195:36–42.

    Article  PubMed  Google Scholar 

  6. Yamashita T, Sakamoto T, Terasaki H, Iwasaki M, Ogushi Y, Okamoto F, et al. Best surgical technique and outcomes for large macular holes: retrospective multicentre study in Japan. Acta Ophthalmol. 2018;96:e904–10.

    Article  PubMed  Google Scholar 

  7. Michalewska Z, Michalewski J, Adelman RA, Nawrocki J. Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology. 2010;117:2018–25.

    Article  PubMed  Google Scholar 

  8. Rezende FA, Ferreira BG, Rampakakis E, Steel DH, Koss MJ, Nawrocka ZA, et al. Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group. Int J Retina Vitr. 2023;9:4.

    Article  Google Scholar 

  9. Ip MS, Baker BJ, Duker JS, Reichel E, Baumal CR, Gangnon R, et al. Anatomical outcomes of surgery for idiopathic macular hole as determined by optical coherence tomography. Arch Ophthalmol. 2002;120:29.

    Article  PubMed  Google Scholar 

  10. Ullrich S. Macular hole size as a prognostic factor in macular hole surgery. Br J Ophthalmol. 2002;86:390–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Schulze-Bonsel K, Feltgen N, Burau H, Hansen L, Bach M. Visual acuities “hand motion” and “counting fingers” can be quantified with the Freiburg visual acuity test. Investig Opthalmology Vis Sci. 2006;47:1236.

    Article  Google Scholar 

  12. Yuguchi T, Ogura S, Hirano Y, Suzuki N, Yasukawa T, Ogura Y. Autologous posterior capsule flap transplantation in the management of refractory macular hole in a pseudophakic eye. Retin Cases Brief Rep. 2023;17:85–8.

    Article  PubMed  Google Scholar 

  13. The BEAVRS Macular hole outcome group, Steel DH, Donachie PHJ, Aylward GW, Laidlaw DA, Williamson TH, et al. Factors affecting anatomical and visual outcome after macular hole surgery: findings from a large prospective UK cohort. Eye. 2021;35:316–25.

    Article  Google Scholar 

  14. Shukla D, Kalliath J. Internal limiting membrane peeling for large macular hole: tailoring the rhexis to the shape of the hole. Indian J Ophthalmol. 2022;70:182.

    Article  PubMed  Google Scholar 

  15. Gu C, Qiu Q. Inverted internal limiting membrane flap technique for large macular holes: a systematic review and single-arm meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2018;256:1041–9.

    Article  PubMed  Google Scholar 

  16. Rizzo S, Tartaro R, Barca F, Caporossi T, Bacherini D, Giansanti F. Internal limiting membrane peeling versus inverted flap technique for treatment of full-thickness macular holes: a comparative study in a large series of patients. Retina. 2018;38:S73–8.

    Article  PubMed  Google Scholar 

  17. Kannan NB, Kohli P, Parida H, Adenuga OO, Ramasamy K. Comparative study of inverted internal limiting membrane (ILM) flap and ILM peeling technique in large macular holes: a randomized-control trial. BMC Ophthalmol. 2018;18:177.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Shen Y, Lin X, Zhang L, Wu M. Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis. BMC Ophthalmol. 2020;20:14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Bottoni F, Parrulli S, Mete M, D’Agostino I, Cereda M, Cigada M, et al. Large idiopathic macular hole surgery: remodelling of outer retinal layers after traditional internal limiting membrane peeling or inverted flap technique. Int J Ophthalmol. 2020;243:334–41.

    Google Scholar 

  20. Iwasaki M, Ando R, Aoki S, Miyamoto H. Restoration process of the outer retinal layers after surgical macular hole closure. Retina. 2022;42:313–20.

    Article  PubMed  Google Scholar 

  21. Bolo KA, Chang S. Broad internal limiting membrane peeling with adjunctive plasma–thrombin for repair of large macular holes: a retrospective case series. Eur J Ophthalmol. 2021;31:1338–44

  22. Zhang H, Li Y, Chen G, Han F, Jiang W. Human amniotic membrane graft for refractory macular hole: a single-arm meta-analysis and systematic review. J Fr Ophtalmol. 2023;46:276–86.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ophthalmology Department, Université Paris Cité, AP-HP Hôpital Lariboisière, Paris, France

    Mehdi Bencheqroun, Aude Couturier, Ramin Tadayoni & Elise Philippakis

  2. Retina Division, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France

    Ismael Chehaibou & Ramin Tadayoni

Authors
  1. Mehdi Bencheqroun
    View author publications

    Search author on:PubMed Google Scholar

  2. Aude Couturier
    View author publications

    Search author on:PubMed Google Scholar

  3. Ismael Chehaibou
    View author publications

    Search author on:PubMed Google Scholar

  4. Ramin Tadayoni
    View author publications

    Search author on:PubMed Google Scholar

  5. Elise Philippakis
    View author publications

    Search author on:PubMed Google Scholar

Contributions

Design (RT, MB, IC, AC), Data collection (MB, IC), Data analysis (MB, IC, AC, EP, RT), Drafting the manuscript (MB, IC, EP), Manuscript Revision (RT, EP), Submission (EP). All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Data are available for queries.

Corresponding author

Correspondence to Elise Philippakis.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bencheqroun, M., Couturier, A., Chehaibou, I. et al. Macular holes with minimal diameter greater than 650 µm close in 85% of cases after vitrectomy and ILM peeling with visual benefit. Eye 38, 3341–3346 (2024). https://doi.org/10.1038/s41433-024-03302-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41433-024-03302-y

Search

Advanced search

Quick links