Results of surgical treatment of idiopathic full thicknessmacular hole with peeling of the internal limiting membrane

Background: The purpose of this study was to verify the efficiency of surgical treatment of idiopathic macular hole (IMH) using pars plana vitrectomy (PPV) with peeling of internal limiting membrane (ILM) and gas-tamponade with 15% perflouropropan (C3F8). Methods: There were placed 52 patients (54 eyes) in our test group (47 women, 5 men), Their mean age was 68.2+/-5.9 years. Two patients had surgery of both eyes at different times. The stage of macular hole has been determined based on clinical symptoms and examination using optical coherence tomography (OCT). The mean observation period in this study group was 14.0+/-9.6 months. The final result of surgery has been tested in OCT at the end of observation period. All 52 patients with IMH submitted to standard PPV with peeling of posterior hyaloid. Trypan blue (Membrane blue) has been applied into air filled eye for 1 minute. Then, we performed peeling of stained ILM in macular region and tamponade with 15% C3F8. Patient were then recommended to keep a prone position of the head for 2 weeks. The best-corrected visual accuity (BCVA) was determined at the end of ebservation period. Result: ILM staining was sufficient in all cases. Average BCVA before operation was 0.94 +/- 0.32 logMAR (0.2-1.7). Postoperative BCVA was 0.58+/-0.33 logMAR (0.0-1.7). Visual acuity improve in 48 eyes (89%), stabilized in 5 eyes (9%), and deterioted in 1 eye (2%). By statistical evaluation is BCVA improvement statistically significant (p=0.001). Metamorphopsia was elimitated in 100%. Full IMH closure (flat/ closed after Tomambe) was reached in 45 eyes (83%). Total flattening IMH borders (flat/closed after Tomambe) was reached in 6 eyes (11%). IMH remained open (open/elevated after Tomambe) in 3 eyes (6%). Conclusion: PPV with ILM peeling represents an effective way for treatment of IMH. Trypan blue (Membrane blue) staining makes ILM identification and delamination easier.