The Influence of the Idiopathic Macular Hole (IMH) Surgery with the ILM Peeling and Gas Tamponade on the Electrical Function of the Retina

Authors: M. Karkanová ;  E. Vlková ;  H. Došková ;  P. Kolář
Authors‘ workplace: Oční klinika LF MU a FN Brno, přednostka prof. MUDr. E. Vlková, CSc.
Published in: Čes. a slov. Oftal., 66, 2010, No. 2, p. 84-88


Many contemporary clinical papers establish positive influence of the pars plana vitrectomy (PPV) with the ILM (internal limiting membrane) peeling and gas tamponade in macular hole to the macular morphology. They prove diminishing or disappearing of the central scotoma and metamorphopsia and especially also improvement of the BCVA for far and near. The evaluation of the objective functional condition of the retina is still a discussed question.

This paper concerns with the comparison of the electric functions of the retina before and after the IMH surgery with the ILM peeling and the gas tamponade.

In the group 19 patients (8 men, 11 women), or 19 eyes with IMH were included. The average age was 69 ± 6 years. The group consisted of patients with transparent optical media. In none of these patients was found other macular pathology than IMH. Nobody underwent other retinal surgery. The patients were examined 1 day before and 1 and 3 months after the surgery. During each control, the following examinations were performed: the Amsler grid examination, the best corrected visual acuity (BCVA) for far (EDRTS chart) and near (Jaeger optotypes), intraocular pressure measurement (non contact tonometer NIDEK NT-2000), examination of the anterior segment on the slit lamp, examination of the posterior segment biomicroscopically and by means of indirect ophthalmoscopy, examination of the photopic, pattern, and multifocal ERG (Retiscan, according to the ISCEV methodology), and OCT examination (Stratus OCT). If necessary, the ultrasound examination (Ultrascan Alcon) was performed as well.

For the statistical evaluation of the ERG component values among the data files before the surgery (data file 1), 1 month after the surgery (data file 2), and 3 months after the surgery (data file 3), the non-parametric Wilcoxon pair test was used.

In the photopic ERG, there was statistically significant prolongation of the latency b in data file 2 and 3 comparing to the data file 1 (p < 0.05). Comparing latency b of data file 1 to data file 2, there was found no statistical significance. Comparing other parameters of photopic ERG found no statistically significant difference among data files 1, 2, and 3. In the multifocal ERG, there was found statistically significant elevation of the P1 amplitude according to the response density of given unit and the P1 amplitude in the central ring in data file 3 comparing to the data file 1 (p < 0.05). Comparison of other parameters was not statistically significant.

In the paracentral ring, there was found statistically significant extension of the N1 and P1 latency in data file 3 comparing to the data file 1 (p < 0.05). Comparison of other parameters in the paracentral ring was not statistically significant.

Statistically significant improvement of the retinal electric function in the central 4° 3 months after the surgery, confirms the positive functional effect of the surgery to the fovea. In the fovea, the increase of the number of functional nerve cells of the outer layers of the retina occurs. On the other hand, in the parafoveolar region, as well as in the whole retina, 3 months after the surgery, statistically significant decrease of the function of the retina, meaning the time prolongation of the conduction in the outer layers of the retina, occurs. According also to our results, the peeling of the ILM in the IMH surgery remains, despite its unquestionable contribution, still a controversial technique. During the short, three months lasting, follow-up period, the functional improvement in the fovea occurred, but the functional decrease in the parafoveolar region which correlates in the large extent with area of the ILM peeling was found. The discussion about the ILM peeling indication in the earlier stages is adequate. We will further follow-up the development of the retinal electric function after the IMH surgery with ILM peeling and gas tamponade.

Key words:
ERG, idiopathic macular hole, pars plana vitrectomy.


1. Apostolopoulos, M.N., Koutsandrea, CH.N., Moschos, M.N. et al.: Evaluation of sucessful macular hole surgery by optical coherence tomography and multifocal electroretinography. Am. J. Ophthalmol. 2002, 5, s. 667–674

2. Brooks, HL.: Macular hole surgery with and without internal limiting membrane peeling. Ophthalmology. 2000, 107, s. 1939–1948

3. Da Mata, A.P., Burk, S.E., Riemann, C.D. et al.: Indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for macular hole repair. Ophthalmology. 2001, 108, s. 1187–1192

4. Gass, J.D.M.: Reappraisal of biomicroscopic classification of stage of development of macular hole. Am. J. Ophthalmol. 1995, 119, s. 752–759

5. Haritoglou, C., Gass, C.A., Schaumberger, M. et al.: Long-term follow-up after macular hole surgery with internal limiting membrane peeling. Am. J. Ophthalmol. 2002, 134, s. 661–666

6. Haritoglou, C.H., Reiniger, I.W., Schaumberger, M. et al.: Five-years follow-up of macular hole surgery with peeling of the internal limiting membrane. Retina. 2006, 26, s. 618–622

7. Karkanová, M., Kolář, P., Vlková, E. et al.: ERG před a po PPV s peelingem MLI a plynnou tamponádou pro makulární díru. 73, In: Sborník abstrakt XVI. výročního sjezdu České oftalmologické společnosti s mezinárodní účastí ve Špindlerově Mlýně. Ed. Nucleus HK, 2008, s. 123, ISBN 978-80-87009-53-6.

8. Kimura, T., Takahashi, M., Takagi, H. et al.: Is removal of internal limiting membrane always necessary during stage 3 idiopathic macular hole surgery? Retina. 2005, 25, s. 54–58

9. Kolář, P., Vlková, E.: Dlouhodobé výsledky chirurgického řešení idiopatické makulární díry s peelingem vnitřní limitující membrány. Čes. Slov. Oftalmol. 2006, 1, s. 34–41

10. Korda, V., Dusová, D., Studnička, J. et al.: Chirurgické řešení makulární díry. Čes. a Slov. Oftal. 2005, 61, 5, s. 316–320

11. Kuchyňka, P. a kol.: Oční lékařství. Praha. Grada Publishing. 2007, 768 s.

12. Kumagai, K., Furukawa, M., Ogino, N. et al.: Long-term outcomes of internal limiting membrane peeling with and without indocyanine green in macular hole surgery. Retina. 2006, 26, s. 613–617

13. Kumagai, K., Furukawa, M., Ogino, N. et al.: Vitreous surgery with and without internal limiting membrane peeling for macular hole repair. Retina. 2004, 24, s. 721–727

14. Kumagai, K., Furukawa, M., Ogino, N.: Long-term outcomes of macular hole surgery with triamcinolone acetonide-assisted internal limiting membrane peeling. Retina. 2007, 27, s. 1249–1254

15. Margherio, R.R., Margherio, A.R., Wiliams, G.A. et al.: Effect of perifoveal tissue dissection in the management of acute idiopathic full-thickness macular holes. Arch. Ophthalmol. 2000, 118, s. 495–498

16. Marmor, M.F., Holder, G.E., Seeliger, M.W.: Standard for clinical electroretinography (2004 update). Doc. Ophthalmol. 2004, 108, s. 107–114

17. Marmor, M.F., Hood, D., Kratiny, D., Kondo, M. et al.: Guidelines for basic multifocal electroretinography (mfERG). Doc. Ophthalmol. 2003, 106, s. 105–115.

18. Mester, V., Kuhn, F.: Internal limiting membrane removal in the management of full-thickness macular holes. Am. J. Ophthalmol. 2000, 129, s. 769–777

19. Sheidow, T.G., Blinder, K.J., Holekamp, N. et al.: Outcomes results in macular hole surgery: an evaluation of internal limiting membrane peeling with and without indocyanine green. Ophthalmology. 2003, 110, s. 1697–1701

20. Si, Ying-Jie, Kishi, Shoji, Aoyagi, Koji: Assessment of macular function by multifocal elektroretinogram before and after macular hole surgery. Br. J. Ophthalmol. 1999, 83, s. 420–424

21. Smiddy, W.E., Feuer, W., Cordahi, G.: Internal limiting membrane peeling in macular hole surgery. Ophthalmology. 2001, 108, s. 1471–1476

22. Vote, B.J., Russel, M.K., Joondeph, B.C.: Trypan blue-assisted vitrectomy. Retina. 2004, 24, s. 736–737

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