Abstract:

 Objective To observe the efficacy and prognosis affecting factors of inverted internal limiting membrane (ILM) insertion for idiopathic macular hole (IMH). Design Retrospective case series. Participants 36 IMH patients (37 eyes). Methods 36 IMH patients (37 eyes) underwent pars plana vitrectomy and inverted ILM insertion. Intraocular pressure, best-corrected visual acuity (BCVA), slit lamp, funduscope, axial length (AL), minimum size of macular hole were performed. SD-OCT delineated retinal layers, including retinal nerve fiber layer(RNFL), ganglion cell layer(GCL), inner plexiform layer(IPL), inner nuclear layer(INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE) in fovea nasal and temporal regions before and 4 months after the surgery. Spearman correlation analysis was used to analyzed the correlation of the postoperative BCVA with preoperative BCVA, AL, age, minimum size of macular hole and so on. Main Outcome Measures The closure rate of MH, BCVA, retinal thickness. Results The closure rate of MH was 100% after surgery. Preoperative and postoperative mean BCVA (LogMar) was 1.23±0.64 and 0.28±0.17 (P<0.05). Both nasal and temporal postoperative RNFL, GCL, IPL, INL thickness decreased (all P<0.05). The thickness of OPL, ONL, RPE was not altered after surgery (all P>0.05). The correlation analysis showed that postoperative BCVA associated with the preoperative BCVA（r=0.641）, minimum size of macular hole（r=0.662）, phacoemulsification cataract surgery（r=0.438）, the changes of nasal RNLF （r=0.349）and nasal IPL（r=0.383） (all P<0.05). Conclusion The inverted ILM insertion for IMH can significantly improve BCVA. The preoperative BCVA, minimum size of macular hole, phacoemulsification cataract surgery, the changes of nasal RNLF and nasal IPL might associated with the postoperative BCVA.

Key words: idiopathic macular hole, vitrectomy, internal limiting membrane peeling, inverted internal limiting membrane insertion, efficacy