Abstract

Purpose:
Muller cells appear to be important in maintaining foveal morphology through connections between their foot processes and the Internal limiting membrane (ILM). ILM peeling causes Muller cell trauma. We hypothesised that leaving a rim of unpeeled ILM around idiopathic macular holes (MH) undergoing vitrectomy surgery would improve postoperative foveal morphology and vision.
Methods:
Prospective pilot study of fovea-sparing ILM peeling in a consecutive cohort of patients with MHs over a 12-month period. SD-OCT and ETDRS letters visual acuity (BCVA) were assessed pre- and postoperatively, and foveal morphology and metamorphopsia postoperatively. The foveal sparing group (FSG) were compared to a second consecutive cohort who received standard ILM peeling (Control group, CG).
Results:
34 eyes of 34 patients were included in each group. Groups showed no significant preoperative differences. 34/34 holes were successfully closed with surgery in FSG and 32/34 in CG. FSG showed better postoperative BCVA (67.7 versus 63.8, p=0.003) and BCVA improvement (25.1 versus 20.2, p=0.03). FSG demonstrated thicker minimum foveal thickness (211 versus 173 microns, p=0.002) and less steep foveal depression (158 versus 149, p=0.002).
Conclusion:
Preserving non-peeled ILM around MHs resulted in a high closure rate, improved foveal morphology and better postoperative BCVA. An appropriately powered randomised controlled study is warranted.