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Idiopathic macular hole surgery in Chinese patients:
a randomised study to compare indocyanine green–assisted internal
limiting membrane peeling with no internal limiting membrane peeling
AKH Kwok, TYY Lai, VWY Wong
Department of Ophthalmology, Hong Kong Sanatorium and Hospital,
Happy Valley, Hong Kong
OBJECTIVE. To compare the anatomical and visual
outcomes of primary idiopathic macular hole surgery using indocyanine
green–assisted internal limiting membrane peeling versus no
internal limiting membrane peeling.
DESIGN. Prospective randomised controlled clinical
trial.
SETTING. University teaching hospital, Hong Kong.
PATIENTS. Fifty-one eyes of 49 Chinese patients
with primary idiopathic macular hole were studied.
INTERVENTIONS. Patients were randomised to undergo
pars plana vitrectomy with indocyanine green–assisted internal
limiting membrane peeling (26 eyes) or surgery without internal
limiting membrane peeling (25 eyes). Perfluorocarbon gas was used
in all cases as internal tamponade.
MAIN OUTCOME MEASURES. Primary macular hole closure
rate and best-corrected visual acuity.
RESULTS. The mean follow-up duration was 12 months
(range, 6-23 months). Respectively to the indocyanine green–assisted
internal limiting membrane peeling group and non–internal limiting
membrane peeling group, the primary anatomical closure rate was
92.3% and 32.0% (P<0.001), whereas improvement in best-corrected
visual acuity was 3.7 and 1.5 lines (P=0.002). More eyes in the
first group (84.6%) had improvement of 2 or more lines of best-corrected
visual acuity after surgery than in the second group (32.0%) [P<0.001].
Multivariate logistic regression showed indocyanine green–assisted
internal limiting membrane peeling was the only significant predictor
for primary closure of the macular hole (adjusted odds ratio=30.8).
CONCLUSION. Indocyanine green–assisted internal
limiting membrane peeling in idiopathic macular hole surgery results
in significantly better anatomical and visual outcomes compared
with non–internal limiting membrane peeling in Chinese patients.
Hong Kong Med J 2005;11:259-66
Key words: Basement membrane; Epiretinal membrane;
Indocyanine green; Retinal perforations; Vitrectomy
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