Epiretinal proliferation around full-thickness macular holes- intrasurgical visualization of the whole size with membrane blue dual.

PURPOSE: Epiretinal proliferation (EP) is a thick isoreflective material seen in optical coherence tomography (OCT) above the retinal nerve fiber layer (RNFL). In full-thickness macular holes (FTMH), EP at the hole's margin might be a negative prognostic factor. This study evaluates the EP area visible during surgery after membrane blue dual (MBD) staining and assesses anatomical and functional outcomes.

METHODS

This retrospective analysis included consecutive surgical videos to identify eyes with negative MBD staining around the macular hole. A control group consisted of patients with smooth blue staining around the hole. All patients underwent vitrectomy with the temporal inverted ILM flap technique and had 12 months of follow-up. SS-OCT B-scans and en face images were evaluated preoperatively and during follow-up.

RESULTS

We included 33 patients with EP (group 1) and 26 without (group 2). Group 1 had significantly larger FTMH diameters and more frequent ELM and IZ defects (p < 0.05). However, final visual acuity did not differ (p = 0.13). The intraoperative unstained EP area was larger than seen on SS-OCT.

CONCLUSIONS

Negative MBD staining reveals a larger EP area than SS-OCT. Despite larger holes, closure rates and vision outcomes were comparable, likely due to neural tissue preservation within EP, possibly aiding regeneration.