Macular Hole Surgery: Pars Plana Vitrectomy vs. ILM Peeling—Which Is Better?
Two Surgical Options
- Pars plana vitrectomy (PPV): Standard approach—remove vitreous and inner retinal layer, bring hole edges together, use gas/air/silicone oil tamponade.
- Internal Limiting Membrane (ILM) peeling: Remove fine membrane over retina; often combined with PPV, especially for large holes.
Evidence
- 2017 meta-analysis: ILM peeling + PPV achieved 92% closure vs. 80% with PPV alone; no difference in visual acuity or complications.
- Another study: ILM peeling significantly improved closure rates for large holes (>400 µm).
Surgeon chooses based on hole size, chronicity, and patient factors.
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