AIM: To compare the anatomical and visual outcome in primary idiopathic macular hole surgery with or without indocyanine green (ICG) stained internal limiting membrane (ILM) peeling.METHODS: The medical records of the last 40 consecurive eyes receiving primary idiopathic macular hole surgery with gas as internal tamponade performed by a single surgeon were retrospectively reviewed and ahalyzed. All eyes had a follow-up of at least 6 months. In the initial 22 consecutive eyes, no ILM peeling was performed (non-ILM peeling group). The subsequent 18eyes underwent surgery with ICG stained ILM peeling (ILM peeling group).RESULTS: The primary anatomical closure rates were 88.9% and 59.1% in the ILM peeling group and non-ILM peeling group, respectively. The difference was statistically significant (Fisher′s exact test, P=0.038). Improvement in visual acuity was more marked in the ILM peeling group than in the non-ILM peeling group, with a mean improvement of 3.6 and 1.3 lines respectively (two-tailed t-test, P=0.036). There were significantly more cases with improvement of two or more lines of visual acuity after surgery, with 66.7% in the ILM peeling group and 31.8% non-ILM peeling group (Chi-square test P =0.028). However, there was no significant difference in the final postoperative logMAR BCVA between the two groups(two-tailed t-test, P=0.073).CONCLUSION: Based on this study, ICG stained ILM peeling seems to improve the anatomical and visual outcome in primary idiopathic macular hole surgery. Further studies in this aspect are warranted.

Pachychoroid disease spectrum is a novel concept in ophthalmology upon the development of ocular diagnosis and treatment.Recent breakthroughs and advancements in OCT imaging technology such as enhanceddepth imaging spectral-domain OCT (EDI-OCT) and swept source OCT (SS-OCT) have led to improvements in scanning speed,depth,scanning mode and software.This allows better and more detailed visualization of more posterior and deeper structures such as choroid or sclera.The newly developed EDI-OCT and SS-OCT provide a new basis for the diagnosis and classification of the retinal choroidal diseases.Pachychoroid disease spectrum,a group of chronic persistent choroidal thickening associated with a similar clinical phenotype and pathogenesis of disease were named recently based on higher spatial resolution and more detailed choroidal imaging captured by EDI-OCT or SS-OCT.Ophthalmologists should pay more attentions to this new concept and its relative information.In this paper,the concept,pathogenesis,and phenotype of pachychoroid disease spectrum are emphasized.