A Double Inverted Flap Surgical Technique for the Treatment of Idiopathic Lamellar Macular Hole Associated with Atypical Epiretinal Membrane

Abstract

Objectives: To propose a new technique of a double inverted epiretinal membrane (ERM) and internal limiting membrane (ILM) flap (double flap group) for the treatment of idiopathic lamellar macular hole (LMH) with atypical ERM (AERM) and to compare surgical outcomes to those of the standard technique of ERM and ILM peeling of the fovea including LMH (control group). Methods: AERM was tomographically defined as a medium reflective thickened membrane above the retinal fiber layers without retinal traction signs. A series of patients affected by LMH with AERM were recruited. Preoperative parameters were: intraretinal cysts (IRC), intraretinal splitting diameter, residual foveal thickness, and ellipsoid zone integrity. Postoperative findings were: full-thickness macular hole (FTMH) development, and persistence or new appearance of IRC. Best-corrected visual acuity (BCVA) at baseline, first, third, and sixth postoperative month was evaluated. Results: A total of 48 eyes of 48 patients were included in this study. In the double flap group (30 eyes), a clear improvement of BCVA was noted (p = 0.004), and there were no complications. In the control group (18 eyes), BCVA did not improve and 3 patients developed postoperative FTMH. Conclusions: The double inverted flap technique is associated with better functional recovery compared to the standard technique and reduces the risk of postoperative FTMH development.

Surgery outcomes of lamellar macular eyes with or without lamellar hole-associated epiretinal proliferation: a meta-analysis

“…Comparing these two surgical methods, the difference between them lies in the disposition of ERM and ILM. Instead of peeling the membrane, the new method double inverted the ERM and flapped the ILM [28,29]. This kind of surgery can preserve the LHEP and promote LHM recovery.…”

Primary vitrectomy for degenerative and tractional lamellar macular holes: A systematic review and meta-analysis

“…With regards to those studies that enrolled eyes with LHEP, the authors were contacted to ascertain whether these cases could be classified as degenerative according to Govetto's study [3]. Author of three studies [2,5,9] confirmed that their cases with LHEP can be classified as degenerative. Degenerative LMHs were included in the degenerative LMH group.…”

Surgery Outcomes of Lamellar Macular Eyes with or without Lamellar Hole-Associated Epiretinal Proliferation: A Meta-Analysis

“…Comparing with the regular surgery method, the main difference is about the disposition of ERM and ILM. Instead of peeling the membrane, in the new method, ERM was double inverted and ILM was apped [28,29]. This kind of surgery can retain LHEP and promote the recovery of LHM, and a study indicated that the development of LHEP might be a recovery progress of LMH [15].…”