Research progress of internal limiting membrane dissection for idiopathic macular hole

Vitrectomy combined with internal limiting membrane (ILM) dissection is an effective therapeutic method for idiopathic macular hole (IMH). The prognosis of IMH is closely related to size of hole and course of disease. The hole with a diameter < 400 μm may close spontaneously, while MH with a diameter >400 μm can rarely close spontaneously, and vitrectomy combined with ILM dissection is required to relieve the vitreous fovea traction, so as to achieve the ideal closure rate of macular hole. For some IMH patients with diameter >400 μm and a long course of disease (6 to 12 months), the ILM dissection alone is not well, and often requires to combined with gas filling, massage around macular hole and autologous blood filling to optimize surgery effect. However, some researchers believe that ILM dissection can cause damage to retinal microstructure and visual function. In recent years, the ILM dissection technology has been continuously improving, technologies are derived such as ILM dissection retaining fovea, centripetal traction ILM dissection, customized ILM dissection according to macular hole (MH) shape, various types of ILM flaps, and other methods such as ILM abrasion and ocriplasmin treatment, so as to reduce retinal damage as far as possible on the basis of ensuring the therapeutic effect. This paper reviewed the latest progresses of ILM dissection in the treatment of IMH based on the clinical experience of domestic and foreign scholars, in order to clarify the characteristics and applicability of different treatment and surgical methods, and provide reference for the clinical treatment of IMH.