Anatomical and functional results after macular hole surgery

BACKGROUND: In a retrospective study we examined the anatomical and functional effects of a combined macular hole surgery with and without the application of indocyanin green (ICG) as well as phacoemulsification. METHODS AND PATIENTS: Out of 91 patients (91 eyes) with idiopatic macular holes 82 eyes were phacic. 25 cases received during the first surgery a combined pars plana vitrectomy with phacoemulsification. In 46 eyes the vitrectomy and consecutive peeling of the inner limiting membrane (ILM) was performed without ICG (Group A), in 45 eyes with ICG-assisted staining of the ILM (Group B). The average follow-up time was 19 months (12 - 24 months). RESULTS: The primary closure rate was 82.4 % and 94.5 % after reoperation. In Group A there were primarily 76 % and at the end 89.1 % closed results compared with 88.9 % and 100 % in group 2 (p = 0.172). Five persisting holes had a preoperative diameter above 600 microm (p = 0.014). Visual acuity improved in Group A preoperatively from 0.17 to postoperatively 0.33 and in Group B from 0.22 to postoperatively 0.38. The difference between both groups was not significant (p = 0.106). From 82 phacic eyes 25 were treated by a combined vitrectomy with phacoemulsification, 23 eyes received later a phacoemulsification while 34 remained phacic. DISCUSSION: Peeling of the ILM was complete after staining with ICG resulting in an increased closure rate. The functional results between both groups did not differ significantly. Phacic eyes may keep their clear lens even after multiple surgeries.