AIM: To observe the surgical effect and influential factors of idiopathic macular hole(IMH)treated with vitrectomy and internal limiting membrane peeling combined with intravitreal gas tamponade.

METHODS: The clinical data of 22 IMH patients(23 eyes)were retrospectively analyzed. All the patients were diagnosed with IMH by optical coherence tomography(OCT)and their macular hole patterns were measured before and after surgery by OCT in addition to the routine examinations. All patients were treated with vitrectomy, internal limiting membrane peeling combined with gas injection(air or inert gas). The postoperative visual acuity, macular hole closure rate and the incidence of surgical complications were observed. The correlation between the patients' age, course of disease, preoperative best corrected visual acuity(BCVA), macular hole diameter, the type of vitreous cavity filling gas, the postoperative BCVA, and the macular hole closure rate was analyzed with SPSS 13.0 statistical software.

RESULTS: Postoperative OCT examination results showed that the macular hole closure rate was 100%. The macular hole closure rate was 79%(11 eyes of 14 eyes)after the first intravitreal air injection and 100%(9 eyes)after fist intravitreal inert gas injection(100mL/L C₃F₈). There was no significant difference between the air injection and inert gas injection(χ²=2.1214, P>0.05). The mean preoperational BCVA was 0.11±0.05 and the mean postoperative BCVA 0.23±0.12; there was a statistically significant difference between them(t=4.023,P<0.05). Compared with the patients without visual acuity improvement after surgery, the diameters of the hole were smaller in the patients whose postoperative visual acuity got improved(t=3.92, P<0.05). There was a significant difference in the visual acuity before and after the surgery(P<0.05). The age of the patients(r=-0.415, P=0.256), duration of disease(r=0.193, P= 0.498), preoperative VA(r=0.152, P=0.673)had no significant influence on IMH visual outcomes.

CONCLUSION: The vitrectomy combined with internal limiting membrane peeling and intravitreal gas tamponade is an effective treatment for IMH; the macular hole diameter is the major influence factor in the postoperative closure and visual prognosis of IMH; while the preoperative visual acuity, age, duration and the type of gas filled in the visual cavity have no effects on the postoperative closure and visual prognosis in IMH.