Macular Hole Surgery and Retinal Tectonics: The Impact of Internal Limiting Membrane Peeling Size on Tangential Retinal Displacement

Purpose: The aim of the study was to evaluate the tangential retinal displacement occurring following macular hole surgery, and to assess the impact of the internal limiting membrane (ILM) peeling size on the extent of the retinal movement. Methods: This retrospective study included patients with full-thickness macular hole undergoing 25-gauge pars plana vitrectomy with ILM peeling. Patients received either a small ILM peeling with a size of 2-disc diameters or a large peeling extended up to the vascular arcades. Near-infrared retinal imaging was performed with the Spectralis (Heidelberg Engineering, Carlsbad, Germany) before and 6 months after surgery. The tangential retinal displacement was evaluated comparing the optical flow of near-infrared images with a custom digital image analysis algorithm. Results: 44 eyes of 44 patients undergoing vitrectomy with small (n = 24) or large (n = 20) ILM peeling were included. An average overall displacement of 31.3 ± 22.8 µm towards the optic disc was observed after surgery. Large ILM peeling was associated with a significantly higher overall displacement (P = 0.009), displacement in the central 4-mm circle (P < 0.001) and outer 8-mm ring (P = 0.001). Macular holes closure was achieved in 100% and 83.3% of patients in the large and small peeling group, respectively (P = 0.055). Conclusions: Pars plana vitrectomy with ILM peeling for macular hole results in a tangential retinal displacement towards the optic disc. A larger extent of the ILM peeling leads to a greater tangential movement, possibly improving the macular hole closure rate.