TO DETERMINE THE CHANGE IN THE SIZE OF MACULAR HOLE DURING SURGERY BEFORE AND AFTER THE INTERNAL LIMITING MEMBRANE PEELING USING INTRAOPERATIVE OPTICAL COHERENCE TOMOGRAPHY

Abstract

Background: Macular hole (MH) surgery has evolved significantly with the advent of intraoperative optical coherence tomography (iOCT), which allows real-time visualization of retinal architecture during key surgical steps such as internal limiting membrane (ILM) peeling.

Objective: To determine the change in the size of macular hole diameter before and after ILM peeling using intraoperative OCT during macular hole surgery.

Methodology: This prospective interventional study was conducted at LRBT, Tertiary Care Eye Hospital, Karachi, for six months, i.e, from 1st January 2023 to 30^th June 2023, on 10 patients with idiopathic full-thickness macular holes undergoing standard 25-gauge pars plana vitrectomy with ILM peeling. Intraoperative OCT was used to measure the minimal MH diameter immediately before and after ILM peeling. Data was analyzed using SPSS version 26. A paired t- test was used with a significance of p ≤ 0.05.

Results: The mean minimal MH diameter significantly decreased from 466.3 ± 75.1 µm before ILM peeling to 394.9 ± 40.5 µm after peeling (p = 0.0009). Most patients were female (60%) with a mean age of 61.3 years, and 50% were pseudophakic. A majority (60%) presented within three months of symptom onset.

Conclusion: ILM peeling leads to a significant intraoperative reduction in macular hole diameter, confirming its role in relieving traction and facilitating retinal tissue approximation. iOCT provides a valuable tool for real-time assessment and may help predict surgical success.