Evaluation of the Morphology of Ganglion Cell Complex and Functional Outcomes after Internal Limiting Membrane Peeling with Macular Abrasion in Idiopathic Macular Hole

Abstract

Aim. This study aims to evaluate the morphology of ganglion cell complex (GCC) along with functional outcomes in patients undergoing vitrectomy with ILM peeling and macular abrasion with Tano diamond dusted membrane scrapers (DDMS) for three different stages of the idiopathic macular hole (IMH). Methods. This retrospective study was conducted between April 2019 and December 2019. 33 patients with IMH were included and divided into three groups: stage I, stage II, and stage IV. All patients were subjected to vitrectomy with ILM peeling. Gentle and vigorous macular abrasion was additionally performed for stage II and stage IV patients, respectively. The best-corrected visual acuity (BCVA), GCC thickness (measured by spectral domain-optical coherence tomography (SD-OCT)), and photopic contrast sensitivity (Rodenstock CV 900 Chart Panel) were determined before surgery and at 1- and 3-month follow-ups. Results. Closure of MH was achieved in all the patients. The difference between the preoperative and one- and three-month postoperative values of BCVA was statistically significant in the three groups ( P < 0.01 ). Contrast sensitivity progressively improved in all patients and was statistically significant ( P < 0.01 ). The reduction in GCC thickness during follow-up was 34%–42% of the preoperative measurements. On comparing the mean GCC thickness of the operated and healthy eyes, it was not statistically significant in stage I patients. However, the same when done in stage II and IV was statistically significant with P value < 0.05 and P < 0.01 , respectively. Conclusion. Combining ILM peeling with macular abrasion in advanced stages of MH may facilitate its closure without significantly affecting the functional outcome.

Macular Surgery: Classification, Management and Surgical Techniques

“…Tis is generally confrmed by immunohistochemistry (IHC) of excised ILM tissue. Te same can be confrmed in vivo by noting decreased GCC (ganglion cells complex) thickness on OCT scan [6]. Tis OCT fnding points towards hazards of indiscriminate ILM peeling.…”