Retrospective Analysis of Vitrectomy With and Without Internal Limiting Membrane Peeling for Stage 3 and 4 Macular Hole

BACKGROUND AND OBJECTIVE: To evaluate the efficacy and safety of pars plana vitrectomy with indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling versus pars plana vitrectomy without ILM peeling for stage 3 and 4 primary idiopathic macular hole. PATIENTS AND METHODS: Sixty-two eyes of 60 consecutive patients with idiopathic macular hole underwent vitrectomy with gas (C3F8) injection. The first 46 eyes underwent vitrectomy without ILM peeling; of these, 14 had epiretinal membrane peeling and were excluded, leaving 32 eyes (no ILM group). The remaining 16 eyes underwent vitrectomy with ICG-assisted ILM peeling (ICG-ILM group). Follow-up data at 6 to 48 months postoperatively were recorded and analyzed. RESULTS: Macular hole closure was achieved in 13 (81%) of 16 patients in the ICG-ILM group and 16 (50%) of 32 patients in the no ILM group (P = .036). Analysis of the data from eyes with closed holes indicates that the ICG-ILM group achieved a better mean final visual acuity compared with the no ILM group (20/60 vs 20/100, respectively) (P = .017). No complications were attributed to the use of ICG. CONCLUSIONS: ICG-assisted ILM peeling significantly increased the rate of hole closure in eyes with stage 3 or 4 idiopathic macular hole. The use of ICG did not adversely affect the visual acuity results, and it appears to be a safe adjunct to macular hole surgery.