Efficacy of vitrectomy combined with internal limiting membrane peeling for idiopathic macular hole at different stages

Objective To summarize the efficacy of vitrectomy combined with internal limiting membrane(ILM) peeling for stage Ⅱ,Ⅲ and IV idiopathic macular hole(IMH) and to discuss the time of the surgery.Methods Totally 48 eyes of 47 patients with IMH underwent vitrectomy combined with ILM peeling from January 2006 to December 2008 were retrospectively analyzed.The macular holes before and after the surgeries were observed by optical coherence tomography(OCT) and the best preoperative and postoperative corrected visual acuity(BCVA) were counted.The results were analyzed statistically.Results(1) According to Gass classification,10 eyes were at stage II,20 eyes at stage Ⅲ and 18 eyes at stage IV.The hole size increased and preoperative BCVA decreased with progression of IMH stages.Hole size at stage Ⅲ and IV was signifisantly bigger than that at stage Ⅱ(P0.01),however,no significant difference of hole size was found between stage Ⅲ and IV.Preoperative BCVA was negatively correlated with the stage of IMH(r=0.42,P0.05).(2) According to the results of OCT,93.75%(45/48 eyes) showed anatomic closure after the surgery;6.25%(3/48 eye) showed smaller hole size before operation but expressed failure of anatomic closure during the follow-up;85.42%(41/48 eyes) showed improved BCVA postoperatively and 14.58%(7/48 eyes) kept stable with no eye showed decreased vision.Postoperative BCVA improved statically compared with preoperative BCVA(P0.01).(3) The postoperative anatomical closure rate decreased with the progression of IMH stages(100% at stage Ⅱ,95% at stage III and 88.89% at stage IV) and there were no statically difference among different stages(P0.05).Postoperative BCVA improved significantly compared with preoperative BCVA at three stages(90%,90% and 77.89% at three stages respectively)(P0.05).(P0.01).Postoperative BCVA was negatively correlated with IMH stage.(r=0.45,P0.05).Conclusion Vitrectomy combined with ILM peeling is an effective method to cure the IMH.Earlier surgery is strongly recommended for IMH patients after stage Ⅱ.