To compare the results of surgery for idiopathic macular hole stage 4 and reduced baseline visual acuity with natural outcome without surgery.


Retrospective, nonrandomized, comparative study of consecutive case series with 19 eyes with idiopathic macular holes stage 4 and baseline visual acuity ≤0.2 (6/30) who underwent pars plana vitrectomy with ICG-stained ILM peeling to compare anatomical and visual outcome of patients without surgery in the literature.


8 of 19 eyes developed visual improvement after 12 months. 6 of these 8 patients were able to reach a reading acuity. In 10 of 19 eyes the visual acuity were stabilized with 0.2 (6/30). In all eyes the macular hole was successfully closed with surgery after 12 months.


In our experience ILM-peeling in macular hole surgery of patients with macular holes stage 4 and with poor visual acuity can improve in contrast to reported cases without surgery in the literature the visual acuity with anatomic success.