A novel standardized reproducible method to calculate the area of internal limiting membrane peeled intra-operatively in macular hole surgery by using a video overlay—A long-term study in cases of idiopathic macular holes

A novel video overlay guided enlargement of area of ILM peeled versus inverted flap technique: A long-term study in large macular holes

“…We had seen in our previous study that Type I closure was significantly high in cases where AIP was beyond 3DD in size in both large and small macular holes. 8 Video overlay guided ILM peeling of more than 3DD in size results in removal of tangential traction in large extent and more centripetal mobilization of peri-hole retinal tissue with more glial proliferation. On the other hand, the inversion of ILM flap provides fragments of Muller cells to stimulate proliferation of glial cells and also provides a basement membrane substrate as a scaffold to ensure tissue proliferation.…”

“…Smiddy et al highlighted the fact that dissection of the ILM may provide the predominant stimulus for proliferation of glial cells, which helps in the closure of macular hole in large extent ILM peeling cases. 17 Our previous study 8 was a pilot study , which highlighted a standardized, reproducible method of measuring AIP and it also highlighted the association between AIP and post-operative type of hole closure. 8 To the best of our knowledge, method of measuring AIP intra-operatively has not been described before.…”

“…17 Our previous study 8 was a pilot study , which highlighted a standardized, reproducible method of measuring AIP and it also highlighted the association between AIP and post-operative type of hole closure. 8 To the best of our knowledge, method of measuring AIP intra-operatively has not been described before. We had seen in our previous study that Type I closure was significantly high in cases where AIP was beyond 3DD in size in both large and small macular holes.…”

“…7 In our previous study, we introduced a novel technique which used the intra-operative video overlay for objective calculation of Area of ILM Peeled (AIP), and concluded that Type I closure was significantly higher when area of Internal Limiting Membrane (ILM) Peeled (AIP) was more than three Disc Diameter (DD) in size, for both small and large macular hole cases. 8 A macular hole was defined as large when the Minimum Linear Diameter (MLD) of the hole was more than 400 µm. 9 Inverted ILM flap technique was first described by Michalewska et al in 2010 and the closure rate of large FTMH using this technique was reported to be as high as 98%.…”

“…As shown by the authors in previous study, ILM peeling of more than 3DD, measured using intra-operative video overlay, helps in closure of large FTMH. 8 In the present article, we intended to compare the anatomical as well as functional outcomes after surgery on large FTMHs using this novel technique of intra-operative video-overlay guided enlargement of Area of ILM peeled (AIP) more than 3DD in size and inverted flap technique.…”