Macular hole surgery with or without indocyanine green stained internal limiting membrane peeling

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Abstract
Background: To compare the anatomical and visual outcome in primary idiopathic macular hole surgery with or without indocyanine green (ICG) stained internal limiting membrane (ILM) peeling. Methods: The medical records of the last 40 consecutive eyes receiving primary idiopathic macular hole surgery with gas as internal tamponade performed by a single surgeon were retrospectively reviewed and analysed. All eyes had a follow‐up period of at least 6 months. In the initial 22 consecutive eyes, no ILM peeling was performed (non‐ILM peeling group). The subsequent 18 eyes underwent surgery with ICG‐stained ILM peeling (ILM peeling group). Results: The primary anatomical closure rates were 88.9% and 59.1% in the ILM peeling group and non‐ILM peeling group, respectively. The difference was statistically significant (Fisher's exact test, P = 0.038). Improvement in visual acuity was more marked in the ILM peeling group than in the non‐ILM peeling group, with a mean improvement of 3.6 and 1.3 lines, respectively (two‐tailed t‐test, P = 0.036). There were significantly more cases with improvement of two or more lines of visual acuity after surgery, with 66.7% in the ILM peeling group and 31.8% non‐ILM peeling group (Chi‐square test P = 0.028). However, there was no significant difference in the final postoperative logMAR best‐corrected visual acuity between the two groups (two‐tailed t‐test, P = 0.073). Conclusions: Based on this study, ICG‐stained ILM peeling seems to improve the anatomical and visual outcome in primary idiopathic macular hole surgery. Further studies in this aspect are warranted.