Objective To observe the different changes of macular microstructure in patients with large idiopathic macular hole (IMH) treated with vitrectomy combined with internal limiting membrane (ILM) transplantation or not.Methods Forty eyes in 40 consecutive patients with giant IMH (≥500 μm) were included in the study.Twenty eyes received vitrectomy with ILM transplantation (ILM transplantation group) and others with ILM peel off (ILM removal group).During the operation,a proper size of the ILM was removed and filled in the bottom of the macular hole.The age,duration of disease and the ocular laterality of the two groups of patients were not statistically significant (P＞0.05).Minimum resolution angle in logarithmic (logMAR) best corrected visual acuity (BCVA) and frequency domain optical coherence tomography (SD-OCT) scan were examined.There was no statistically significant difference in logMAR BCVA,average defect diameter of photoreceptor ellipsoid (IS/OS) and average defect diameter of external limiting membrane (ELM) between two groups (t=0.128,1.452,1.321;P＞0.05).The logMAR BCVA and SD-OCT were examined on 1,3,6,12 months postoperatively.Results On 1 month after the surgery,there was no statistically significant difference in logMAR BCVA,average defect diameter of IS/OS and average defect diameter of ELM between two groups (t=1.226,1.435,1.018;P＞0.05).On 3,6,12 months after the surgery,compared with ILM removal group,the logMAR BCVA (t=2.059,2.871,2.415) increased and the average defect diameter of IS/OS (t =2.070,2.110,2.121) and ELM (t =2.034,3.647,3.556) significantly reduced in ILM transplantation group (P＜0.05).On 1 month after the surgery,there was statistically significant difference in CRT between two groups (t=2.113,P＜0.05).On 3,6,12 months after the surgery,there was no statistically significant difference in CRT between two groups (t=0.428,0.847,0.849;P＞0.05).Conclusion Compared with vitrectomy combined with ILM peeling surgery,the diameter of IS/OS and ELM defect were significantly decreased after vitrectomy combined with ILM transplantation in the patients with large IMH.

Background Giant idiopathic macular hole (IMH) severely affects visual acuity and increases operative difficulty during the surgery,so modifying or optimizing the operation method is helpful for improving the prognosis.Objective This study aimed to evaluate the efficacy and safty of vitrectomy combined with free internal limiting membrane transplantation for large IMH.Methods A prospective serial cases-observational study was carried out under the informed consent of each patient.Forty-two eyes of consecutive 42 patients with IMH of mean diameter (814.31±112.95)μm were included in the Second Hospital of Hebei Medical University from January 2013 to November 2015.All the eyes received vitrectomy combined with free internal limiting membrane transplantation and 12％ C3F8 filling.The best corrected visual acuity (BCVA) (LogMAR),inner segment/outer segment (IS/OS) defect range,external limiting membrane defect range,retinal thickness at macular fovea were measured with slit lamp microscope,indirect ophthalmoscope and spectral-domain optical coherence tomography (SD-OCT) before surgery and 1,3,6 and 12 months after surgery.Results IMH complete closure in 97.6％ eyes (41/44) at 12 months after surgery.BCVA was improved after operation and showed a significant difference among various time points (F =28.032,P＜0.001).The IS/OS defect range was (1 112.00±45.44),(859.00±84.55),(649.00±52.47),(486.00±46.88) and (320.00±45.13) μm before surgery and 1,3,6 and 12 months after surgery,showing a significant difference among different time points (F=38.761,P＜0.001),and the IS/OS defect range was gradually shrinked after operation compared with that before operation (all at P＜0.05).The mean defect range of external limiting membrane was (1 038.00 ±39.63),(748.00±64.12),(585.00±48.88),(438.00±42.84) and (265.00±28.97)μm before surgery and 1,3,6 and 12 months after surgery,with a significant difference among various time points (F=36.459,P＜0.001),and the mean defect range of external limiting membrane was evidently reduced (all at P＜0.05).The foveal retinal thickness value was increased at 3,6 and 12 months after surgery,which was significantly higher than that 1 month after surgery (all at P＜0.05).The high reflect signal was faded away at 3 months after operation,indicating that implanted internal limiting membrane was decomposed and metabolized.Conclusions Vitrectomy combined with autologous internal limiting membrane transplantation seems to be safe and effective for large IMH.