Is Removal of Internal Limiting Membrane Always Necessary During Stage 3 Idiopathic Macular Hole Surgery?

In Brief Purpose: To determine the indications for internal limiting membrane (ILM) removal in stage 3 idiopathic macular holes (MHs). Methods: Focal posterior vitreous detachments (PVDs) at MH rims were examined preoperatively by optical coherence tomography and binocular slit-lamp fundus examination in 19 patients retrospectively. All eyes underwent pars plana vitrectomy and creation of a PVD, and some eyes underwent a second surgery to remove the ILM. Indications of ILM removal for MH closure were discussed. Results: Preoperatively, 9 eyes did not (non-PVD group) and 10 eyes did (PVD group) have complete focal PVDs. In all nine eyes in the non-PVD group, MHs were closed after the creation of a PVD without ILM peeling (P < 0.05, χ2 test). In the PVD group, 5 eyes (50%) had MHs closed by making PVD complete without ILM removal, and 5 eyes (50%) required ILM removal in a second surgery. In the end, closure of MHs was achieved in all eyes. Conclusion: Anatomic closure of stage 3 idiopathic MHs without a PVD at the rim of the hole may be achieved only by creating a PVD without ILM removal. The posterior vitreous at the rim of the stage 3 idiopathic macular hole (MH) was examined preoperatively. Indications for ILM removal were discussed. Anatomical closure of MHs without PVD at the rim of the MH may be achieved by only creating a PVD without ILM removal.