Vitrectomy with inner limiting membrane peeling effectively reduces ellipsoid zone defect diameter in patients with idiopathic macular holes.

OBJECTIVE: To comparatively assess the clinical outcomes of vitrectomy combined with either inner limiting membrane (ILM) peeling or ILM flap insertion for treatment of an idiopathic macular hole (IMH). METHODS: A total of 116 IMH patients were enrolled, who underwent vitrectomy plus ILM peeling or vitrectomy with ILM flap insertion. They were divided into a peeling group (n=55, vitrectomy combined with ILM peeling) and an insertion group (n=61, vitrectomy plus ILM flap insertion). Intergroup differences were analyzed in postoperative lens status, best-corrected visual acuity (BCVA), intraocular pressure (IOP), hole closure rate/morphology, ellipsoid zone defect diameter, nasal/temporal inner retinal cyst (IRC) thickness, P1 wave amplitude (1-2 rings) of the first-order function in multifocal electroretinography (mfERG), safety, and vision-specific quality of life. RESULTS: No significant intergroup differences were observed in postoperative lens status, hole closure rate, closure morphology, BCVA, IOP, nasal/temporal IRC thickness, P1 wave amplitude (1-2 rings) of mfERG first-order function, or vision-specific quality of life (all P > 0.05). However, the peeling group exhibited a smaller ellipsoid zone defect diameter than the insertion group (P < 0.05). No complications occurred in either group. CONCLUSION: Although vitrectomy combined with ILM peeling and that with ILM flap insertion yield comparable therapeutic effects and clinical safety, the former is more effective in reducing the size of ellipsoid zone defects in IMH treatment.