Macular Hole Repair: Surgical Options & Procedures

Macular Hole Surgery Options

There are two methods of macular hole surgery. The type of surgery recommended depends on the characteristics of the macular hole, and can be either:

1. Pars plana vitrectomy (PPV) – This is the standard type of surgery for repairing a macular hole. During PPV, a surgeon removes the overlying vitreous (the jelly-like substance in the eye) and a thin layer of the inner retina. The surgeon then uses instruments to gently separate the edges of the hole and encourage them to close. Usually some form of tamponade is used, such as a gas bubble, air or silicone oil. This tamponade acts like a patch on the outside of the retina to allow it to heal.

2. Internal Limiting Membrane (ILM) peeling – This procedure involves removing a very fine membrane (called the internal limiting membrane) that lies over the surface of the retina. ILM peeling is often performed in combination with PPV, especially if the macular hole is large.

Which macular hole surgery is better?

In a 2017 meta-analysis (comparative study) of randomized clinical trials, researchers compared PPV with and without ILM peeling for the treatment of idiopathic macular holes. Results of this study showed that ILM peeling significantly improved the rate of macular hole closure compared with PPV alone (92% vs 80%). There were no significant differences in visual acuity or adverse events between the two groups.

Another study found that ILM peeling significantly improved the rate of complete macular hole closure in eyes with large macular holes (greater than 400 µm in diameter).