Effect of debridement of the retinal pigment epithelium in full-thickness macular hole surgery.

We assessed the efficacy of debridement of the retinal pigment epithelium (RPE) from the base of the macular hole during vitrectomy to treat 83 eyes of 75 patients with a stage 2 (n=29), stage 3 (n=35) or stage 4 (n=19) macular hole. Patients ranged in age from 51 to 77 years (mean, 67.6 years). Duration of symptoms preoperatively ranged from 1 to 120 months (average, 19.2 months). During vitrectomy for macular hole, the RPE at the base of the hole was gently aspirated with either a silicone-tipped extrusion needle or a blunt-tipped 27-gauge needle. Follow-up averaged 13.0 months (range, 3 to 36 months). The holes resolved in 73 (88%) of the 83 eyes after one surgical procedure. In 73 eyes with a follow-up period of 6 months or more, sixty-five (89%) showed improved VA of at least two lines of Snellen equivalent. Fifty-five (75%) eyes had a visual acuity (VA) of > or = 20/40. Our preliminary results suggest that RPE debridement from the base of the hole is a useful adjunct to vitrectomy for treating full-thickness macular holes.