Search

Purpose: To investigate the impact of foveal glial tissue on the anatomical and functional results after macular hole (MH) surgery., Methods: This study included 141 consecutive eyes that underwent successful vitrectomy for full-thickness MH between January 2015 and December 2022. The best-corrected visual acuity and the length of outer retinal defects were evaluated preoperatively and at 6 months postoperatively. Macular hole with retinal detachment, recurrent MH, and traumatic MH were excluded. Multiple regression analyses were conducted on outer retinal restoration and visual acuity using foveal glial tissue size, surgical technique of internal limiting membrane peeling or inverted internal limiting membrane flap, and high myopia as explanatory variables., Results: Analyses revealed that the foveal glial tissue significantly limited the outer nuclear layer, external limiting membrane restoration, and ellipsoid zone restoration as well as best-corrected visual acuity improvement (r = -0.380, P < 0.001; r = -0.314, P = 0.035; r = -0.530, P = 0.015; r = -0.00027, P = 0.001; respectively). Meanwhile, the surgical technique and high myopia did not significantly affect the restoration of outer nuclear layer, external limiting membrane, ellipsoid zone, and best-corrected visual acuity after surgery., Conclusion: Foveal glial tissue after MH surgery attenuated outer nuclear layer, external limiting membrane, and ellipsoid zone restoration as well as best-corrected visual acuity improvement.

Purpose: To investigate surgical results for medium-sized (251-400 µ m) macular holes (MHs)., Methods: This retrospective observational study involved 266 eyes of 262 consecutive patients who underwent internal limiting membrane (ILM) peeling (147 eyes in the ILM peeling group) or inverted ILM flap cover technique (119 eyes in the inverted flap group) for primary medium-sized full-thickness MHs. Macular hole associated with retinal detachment, recurrent MH, and traumatic MH were excluded., Results: The primary closure rate for overall medium-sized MHs was 100% (119 of 119 eyes) in the inverted flap group, which was significantly higher than that (94.6% [139/147 eyes]; P = 0.010) in the ILM peeling group. Notably, even after adjusting for the minimum MH diameter, presence of high myopia, or preexisting posterior vitreous detachment, the primary closure rate was significantly better in the inverted flap group than in the ILM peeling group (Cochran-Mantel-Haenszel test, overall adjusted P = 0.006, 0.009, 0.005, respectively). The preoperative and postoperative restoration of the outer retinal layers and visual acuity were comparable between the inverted ILM flap and ILM peeling techniques., Conclusion: Primary closure for medium-sized MHs was significantly superior in the inverted flap group than in the ILM peeling group.