Results of macular hole surgery with and without epiretinal dissection or internal limiting membrane removal

Purpose: To evaluate the results of idiopathic macular hole surgery with or without epiretinal dissection or peeling of the internal limiting membrane (ILM). Design: Retrospective consecutive nonrandomized comparative interventional trial. Participants: One hundred seventy-two eyes of 162 patients with previously untreated idiopathic macular holes of <24 months duration. Intervention: All eyes were treated with pars plana vitrectomy by 1 surgeon using 1 of 3 techniques: no epiretinal dissection (116 eyes), epiretinal dissection (27 eyes), or ILM peeling (29 eyes). Main Outcome Measures: Closure of the macular hole and visual acuity. Results: The macular hole was closed with 1 surgery in 92.9% of 56 eyes with epiretinal dissection/ILM peeling versus 79.3% of 116 eyes without dissection (P = 0.03) and was closed with 1 surgery in 85.1% of 27 eyes in the epiretinal dissection group compared with 100% of 29 eyes in the ILM peeling group (P = 0.05). Visual acuity improved 3 or more lines in 57.1% of 56 eyes in the epiretinal dissection/ILM peeling group compared with 38.8% of 116 eyes in the no dissection group 3 months postoperatively (P = 0.03). Visual acuity improved 3 or more lines at 3 months in the no dissection group in 32.2% of 87 eyes placed faceup for 24 hours compared with 58.6% of 29 eyes placed immediately prone postoperatively (P = 0.02). The visual and anatomic results of the no dissection and epiretinal dissection/ILM peeling groups were similar when comparing eyes in the no dissection group placed immediately prone with the epiretinal dissection/ILM peeling eyes also placed immediately prone. Visual improvement of 3 or more lines at 3 months occurred in 79.2% of 24 eyes in the epiretinal dissection group versus 44.8% of 29 eyes in the ILM peeling group (P = 0.01) in eyes with successful macular hole closure. Visual acuity results were similar in all subgroups at the final examination after reoperations. Conclusions: The faceup position for 24 hours using adjuvants reduced the initial anatomic and visual outcomes of macular hole surgery. Internal limiting membrane peeling improved the likelihood of successful macular hole closure but reduced the amount of initial visual improvement at 3 months compared with epiretinal dissection alone. Final visual acuities were similar in all groups.