Materials and Methods: The data related to a total of 28 eyes of 28 patients who had PPV due to grade 3 and 4 MH were retrospectively examined. Three-port PPV and posterior hyaloid peeling were performed in all eyes. In all cases, ILM was peeled by staining and internal gas tamponade was injected. Supine position was maintained for postoperative 5 days. Postoperative anatomical success, best corrected visual acuity (BCVA) and complications were evaluated.

Results: The mean age of patients was 65.5±8.4. The etiologies of the MH were trauma in 3 cases, cystoid macular edema in 2 cases, high myopia in 1 case. 22 eyes had idiopathic MH. Thirteen cases (46.5%) had grade 3, 15 cases (53.5%) had grade 4 MH. The preoperative mean period was 4.6 (1-13) months. Postoperative mean follow-up period was 7.8 (1-34) months. The MHs were anatomically closed in 20 (71.4%) eyes after the first operation, in 25 (89.3%) eyes after the second operation. Postoperatively, BCVA was improved for 1 or more Snellen lines in 15 eyes (53.5%), for 2 or more Snellen lines in 8 (28.5%) eyes; however it did not change in 7 eyes (25%) and decreased in 6 eyes (21.5%). The mean preoperative BCVA of 0.099±0.09 Snellen lines improved to 0.171±0.16 Snellen lines postoperatively (p=0.01). Postoperatively cataract was developed in 5 (20.8%) eyes and retina detachment was developed in 2 (7.1%) eyes.

Conclusion: PPV and ILM peeling can yield significant anatomical success and acceptable increase in visual acuity in grade 3 and 4 macular holes. Keywords : Macular hole, vitrectomy, internal limiting membrane peeling