Anatomical and Functional Outcomes in Eyes with Idiopathic Macular Holes that Underwent Surgery Using the Inverted Internal Limiting Membrane (ILM) Flap Technique Versus the Conventional ILM Peeling Technique

Yan, Yujie; Zhao, Tong; Sun, Chuan; Zhao, Hongbo; Jia, Xingwu; Wang, Zhijun

doi:10.1007/s12325-021-01682-1

Cited by 5 publications

(8 citation statements)

References 35 publications

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“…Since Michalewska reported the inverted ILM flap in 2014, researchers have generally believed that it can improve hole closure rates and visual function in patients with refractory MH ( 7 , 17 ), but most previous studies involved few cases and did not assess postoperative ELM reconstruction. Recent studies have reported results similar to those of our study ( 10 , 16 , 18 ). Yan ( 16 ) suggested that there were no differences between the closure rates and visual acuities after the inverted ILM flap and ILM peeling for iMH.…”

Section: Discussionsupporting

confidence: 92%

“…Recent studies have reported results similar to those of our study ( 10 , 16 , 18 ). Yan ( 16 ) suggested that there were no differences between the closure rates and visual acuities after the inverted ILM flap and ILM peeling for iMH. Hasegawa ( 19 ) believed that the inverted ILM flap improved the closure rate of large iMHs but not visual function compared with ILM peeling.…”

Section: Discussionsupporting

confidence: 92%

“…The inverted ILM flap provides a scaffold for the proliferation and migration of Muller cells and this may account for these findings. However, the ILM flap inevitably fills the hole, and this hinders the rearrangement of the retinal structure and improvement of postoperative visual acuity ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…Some previous studies have also reported that the inverted ILM flap improves the closure rate of large iMHs but not visual function compared with ILM peeling ( 14 , 15 ). Yan et al found no difference between the closure rates after the inverted ILM flap and ILM peeling for large iMH ( 16 ). However, these studies had fewer cases and shorter follow-ups.…”

Section: Introductionmentioning

confidence: 99%

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The effect comparison of ILM flap and traditional ILM peeling in iMH

Chen

Xu²,

Ye³

et al. 2023

Front. Med.

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PurposeTo compare the changes in anatomical structure and visual function after idiopathic macular hole (iMH) treatment with internal limiting membrane (ILM) peeling and inverted ILM flap and determine the value of the inverted ILM flap for the treatment of iMH.MethodsForty-nine patients with iMH (49 eyes) were included in this study and followed up for 1 year (12 months) after treatment with inverted ILM flap and ILM peeling respectively. The main foveal parameters assessed included the preoperative minimum diameter (MD), intraoperative residual fragments, and postoperative ELM reconstruction. Visual function was assessed using best-corrected visual acuity.ResultsThe hole closure rate was 100% for 49 patients; 15 patients were treated with the inverted ILM flap, and 34 patients underwent ILM peeling. There were no differences between the postoperative best-corrected visual acuities and the rates of ELM reconstruction for the flap and peeling groups with different MDs. In the flap group, ELM reconstruction was associated with the preoperative MD, presence of an ILM flap, and hyperreflective changes in the inner retina 1 month after surgery. In the peeling group, ELM reconstruction was associated with the preoperative MD, intraoperative residual fragments at the hole edge, and hyperreflective changes in the inner retina.ConclusionThe inverted ILM flap and the ILM Peeling were both able to obtain high closure rate. However, the inverted ILM flap showed no obvious advantages related to anatomical morphology and visual function over ILM peeling.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effect comparison of ILM flap and traditional ILM peeling in iMH

Chen

Xu²,

Ye³

et al. 2023

Front. Med.

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“…Yan et al also found no significant differences in BCVA at 6 months between classic and inverted flap technique. 34…”

Section: Discussionmentioning

confidence: 99%

Modification of the inverted flap technique compared to conventional internal limiting membrane peeling in complete macular hole surgery

Carballés

Sastre-Ibáñez

Cura

et al. 2023

European Journal of Ophthalmology

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Aim To describe the efficacy of a modification of the superior inverted flap technique, with maculorrhexis, in vitrectomy for full-thickness macular hole (MH) surgery compared to internal limiting membrane peeling (ILM). Methods Retrospective and comparative study of patients with MH. In group A, a superior ILM flap is created to cover the macular hole, and in group B conventional ILM peeling was performed. Results A total of 80 eyes were included (44 group A and 36 group B). MH closure occurred in 100% in group A and 91.67% in group B (p = 0.0869). There were more U-type closures in group A(90.91%) than in group B(58.33%), p = 0.0017. Both groups showed Best corrected visual acuity (BCVA) improvement at 3 and 6 months. At 3 months BCVA in group A was significantly better but at 6 months results were similar. Ellipsoid layer (EZ) recovery at 6 months was achieved in 81.82% patients in group A and 52.78% in B (p = 0.005), and external limiting membrane in 81.82% in group A and 69.44% in B (p = 0.1957). Conclusions The superior inverted flap maculorrhexis technique is suitable for idiopathic MH treatment, with better anatomical and non-inferior functional results than the classic ILM peeling. It achieves functional recoveries earlier, better BCVA and greater gains at 3 months compared to the classic ILM peeling. It also obtains a higher number of U-shaped closures and higher EZ restorations.

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