Idiopathic macular hole closure toward the optic disc after internal limiting membrane peeling

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To compare the distance between the optic disc and the fovea before and after successful closure of a macular hole (MH) by pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling. In addition, to investigate whether the distance is significantly correlated with the retinal thickness around the MH.


Thirty-seven eyes of 36 patients with an idiopathic MH that underwent PPV with ILM peeling were studied. The distance between the point of intersection of the disc margin with a temporal-inferior vessel and the center of the opened or closed MH was measured manually with the Spectralis HRA+OCT (Heidelberg Engineering, Germany). The retinal thickness of macula was also measured by the volume scan mode.


The mean disc-foveal distance was significantly shorter postoperatively than preoperatively (3783.7 ±308.5 um and 3914.5 ± 320.4 um, respectively; P<0.0001). The distance in eyes with stage 3 and 4 MH (n=22) was significantly greater than in eyes with stage 2 MH (n=15) (136.7 ± 134.9 um vs. 107.8 ± 107.7 um, respectively; P=0.012). The distance in stage 3 and 4 MHs (n=21) was weakly but significantly correlated with the mean postoperative parafoveal nasal thickness (r=0.45; P=0.038).


The significantly shorter postoperative disc to fovea distance in eyes with closed MH especially in stage 3 or 4 MH suggests that the MH moves nasally after PPV with ILM peeling.

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