The Effect Of Internal Limiting Membrane Peeling For The Idiopathic Macular Hole Surgery Treatment

Object : To investigate macular hole's healing and effects of visual fuction improvement in the patients who had an operation for idiopathic macular hole(IMH), stageIII,IV by internal limiting membrane (ILM) peeling.Methods: Forty-three eyes (from the cases of Dec. 2005-Sep. 2007)with IMHs ,including 20 eyes in stage III and 23 eyes in stage IV,had an operation . Twenty-three eyes with IMHs ,including 11 eyes in stage III and 12 eyes in stage IV ,underwent standard subtotal three-port pars plana vitrectomy along with 20% SF6 intraocular tamponade. Twenty eyes with IMHs ,including 9 eyes in stage III and 11 eyes in stage IV ,underwent standard subtotal three-port pars plana vitrectomy along with 0.05% ICG assisted ILM peeling and 20% SF6 intraocular tamponade.Analyze the data before and after operation .Compare the closure rate, visual fuction before and after the surgery of IMH. Compare the closure rate, the effects of visual fuction after the surgery of IMH in stage III,IV by using standard subtotal three-port pars plana vitrectomy ,0.05% ICG assisted ILM peeling and 20% SF6 intraocular tamponade .Observe ultramicrostructure of tissue by transmission electron microscope (TEM).Result:1 anatomic close rate:After operation, 8 eyes with ILM peeling in stage III go to anatomic close, anatomic close rate(88.9%). 10 eyes with ILM peeling in stage IV go to anatomic close, anatomic close rate(90.9%). The anatomic close rate in these two groups was not statistically significan (P>0.05).ICG assisted ILM peeling group 18 eyes anatomic close , anatomic close rate(90.0%),without ICG assisted ILM peeling group 13 eyes anatomic close , anatomic close rate(56.5%) . ICG assisted ILM peeling group (including stage III and stage IV) 20 eyes ; without ICG assisted ILM peeling group (including stage III and stage IV) 23 eyes . The anatomic close rate in these two groups was statistically significan (P<0.05). During follow-up macular hole successful healing did not relapse again.2 visual function: 2.1 Six months after the operation, ICG assisted ILM peeling group corrected vision was improved 16 eyes (80.0%)(including stage III and stage IV) . without ICG assisted ILM peeling group 13 eyes (56.5%) (including stage III and stage IV). There was statistically significan (P<0.05).After the surgery of ILM peeling in stage IIIand IV,visual improvement rate was not statistically significan in 1,3,6 months postoperatively(P>0.05).2 eyes with ILM peeling has no improvement in vision,but macular hole is close,one in the stage III ,another in the stage IV .The vision of the patients whose macular hole is not close was not improved. 2.2 Before operation, the response densities of wave P1 of mfERG ring 1 and ring 2 decline significantly in the patients of stage IIIand IV.There is statistically significan (P<0.05). It is no statistically significance in stage III and stage IV groups(P>0.05).After operation, the response densities of wave P1 of mfERG ring 1 and ring 2 increase gradually in 6 months postoperatively.It presents that center peaks of mfERG topographies of mfERG topographies reappeared little by little .There have statistically significant differences with preoperative ones(P<0 .05).In the two groups of stageIII and IV, the response densities of wave P1 of mfERG ring 1 and ring 2 have no statistically significant differences in 1,3,6 months(P>0.05).But it is still lower than the normal eyes and the differences has significant(P<0.05).3 The result of TEM view : There are 17 samples of ILM, are homogeneous ibriform membrane,one side to face vitreous body is flat and slick,another side to face retina is gravamen .3 samples of ILM have fibro-trab structure.There is no cell structure. 1 sample of peeling epiretinal membrane (ERM), in disordered collagen fibrils can be seen macrophage like cell.Conclusion:1 After the surgery of IMH in stage III and IV, ICG—assisted ILM peeling can improve anatomic close rate and can be helpful for inchoate vision renewal.2 The clinical diagnosis of complete posterior vitreous detachment from the eyes, and some are still vitreous fibers in the retina adhesion.3 mfERG can observe and evaluate visual fuction's changes of preoperative and postoperative IMH objectively and accurately.