Autologous Internal Limiting Membrane Plug Technique for Treatment Naive Large Macular Holes



The aim of our study was to examine the anatomical and functional outcome of autologous internal limiting membrane (ILM) plug technique for large macular holes.


This study was a prospective, interventional case study of patients with macular hole having maximum basal diameter of more than 400 microns. We included 8 treatment naive eyes with large macular holes (>400 μ basal diameter). Patients with macular hole were evaluated using optical coherence tomography (DRI OCT-1 Atlantis, Japan) and the smallest and largest internal (i.e. horizontal) diameter of the hole was measured parallel to the retinal pigment epithelium (RPE). Then the minimal and maximum linear (i.e. vertical) diameter of macular hole was also calculated. After ILM peeling, a small plug of the free ILM was tucked under the edges of the macular hole with ILM forceps. 20% SF6 gas was injected at the end of surgery as a tamponade agent. Postoperative vision and type of macular hole closure was noted at 1 month.


Majority (7 out of 8 eyes) had idiopathic macular hole and 1 patient had macular hole secondary to tractional retinal detachment due to sarcoidosis induced vasculitis. The mean duration of symptoms of patients was 4.5 months. The mean maximum base diameter was 1172+322 microns. The mean preoperative BCVA was 1.46+0.08 logarithm of minimal angle of resolution (logMAR) units and improved to 0.84+0.3 log-MAR units at the 1-month postoperatively (p=0.01). The mean macular hole index was 0.75 and mean hole form factor was 0.40. The mean preoperative minimum linear diameter of the macular hole was 587+216 microns and mean maximum base diameter as 1172+322 microns. Type 1 macular hole closure was observed in all eyes and one patient developed retinal pigment epithelium atrophy.


Large macular holes with maximal basal diameter greater than 400 microns (1) are at a higher risk of non closure after vitrectomy and internal limiting membrane (ILM) peeling.Autologous internal limiting membrane plug has good anatomical and functional outcomes and can be considered at the time of primary vitrectomy for large macular holes.


Hetal Mehta
Pune, India
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