To evaluate the clinical effect of 25G vitrectomy combined with internal limiting membrane (ILM) transposition and air tamponade surgery in the treatment of large-diameter idiopathic macular hole (IMH).

A retrospective analysis was conducted on 15 consecutive patients (16 eyes) with large-diameter IMH (hiatus diameter >700 μm) who were treated in the Ophthalmology Department of the Second Hospital of Lanzhou University from October 2018 to March 2019. All patients underwent 25G vitrectomy combined with ILM transposition and air tamponade surgery. Best-corrected visual acuity (BCVA), slit lamp microscopy, mydriatic fundus examination, spectral-domain optical coherence tomography (SD-OCT), and MP-3 microperimetry tests were performed preoperation and 1 week and 1, 3, and 6 months postoperation. The changes in BCVA, macular hole diameter, degree of visual deformation, mean retinal sensitivity (MS) in the macular area, fixation stability and fixation position before and after surgery were observed. Data were analyzed by a t-test, χ² test and Spearman correlation analysis.

At the last follow-up, the macular hole was closed in all 16 eyes (100%) and the postoperative BCVA of 14 eyes was improved (accounting for 87%). No patient had a decreased visual acuity. Over all BCVA improved significantly compared to preoperative BCVA (t=4.08, P=0.001). No complications occurred in any patients during the follow-up period. The deformity in 10 eyes had significantly improved compared to preoperation, and had completely disappeared in 4 eyes. Seven eyes had central fixation before the operation and 14 eyes had central fixation after the operation. Five eyes had stable fixation before the operation and 12 eyes had stable fixation after the operation. Comparisons of fixation position and stability before and after surgery showed statistically significant differences (χ²=9.000, P=0.029; χ²=9.863, P=0.016). The MS before the operation was 13.7±2.8 dB and was 16.5±3.6 dB after the operation, which was significantly higher than that before the operation (t=16.072, P=0.003). Patients with better fixation stability before surgery had significantly improved postoperative corrected vision (r=0.518, P=0.040).

25G vitrectomy combined with ILM transposition and air tamponade surgery for the treatment of large-diameter idiopathic macular hole can safely and effectively promote the healing of the macular hole and further improve the visual function of patients. It is a recommended minimally invasive surgical method for a larger idiopathic macular hole diameter.

larger idiopathic macular hole; internal limiting membrane transposition; air tamponade; spectral-domain optical coherence tomography; MP-3 microperimetry