Visual Outcomes after Internal Limiting Membrane Peeling vs. Flap in the Closure of Full Thickness Macular Holes

Abstract

Purpose: To examine postoperative outcomes of internal limiting membrane peeling (ILMP) versus flap (ILMF) in the closure of full thickness macular holes (FTMH). Methods: Retrospective chart review of patients who underwent pars plana vitrectomy and gas tamponade with ILMP or ILMF to close FTMH at the Atrium Health Wake Forest Baptist from January 2012 to October 2022 with at least 3 months follow up. Main outcome measures were type 1 primary FTMH closure and postoperative best corrected visual acuity (BCVA) in mean logMAR. Results: 130 and 30 eyes underwent ILMP and ILMF respectively. There were no significant differences in baseline characteristics between the groups. 96% of ILMP eyes and 90% of ILMF eyes achieved primary hole closure (p=0.29). Among all eyes with primary hole closure, BCVA at 1 year was not different between the groups but when stratified by lens status, was superior in the ILMP versus ILMF group in pseudophakic eyes: the estimated least-squares mean BCVA (Snellen equivalent) [95% confidence interval] was 0.42 (20/50) [0.34, 0.49] in the ILMP group and 0.71 (20/100) [0.50, 0.92] in the ILMF group. Conclusions: ILMP and ILMF techniques yielded similarly high FTMH closure rates. In pseudophakic eyes with primary hole closure, ILMF eyes had worse BCVA at 1 year.