Comparative analysis of large macular hole surgery using an internal limiting membrane insertion versus inverted flap technique

Abstract

The ILM insertion technique may be as effective as the inverted ILM flap technique for the closure of large MHs. However, the latter technique results in better recovery of photoreceptor layers and, consequently, better postoperative visual acuity.

Infracyanine Green vs. Brilliant Blue G in Inverted Flap Surgery for Large Macular Holes: A Long-Term Swept-Source OCT Analysis

“…At 12-month follow-up, the majority of cases in both groups exhibited the physiological U-shaped foveal morphology, with a very few cases of W and V-shaped pattern, as similarly described in a recent study using I-ILMFS and SS-OCT analysis [37]. We did not evaluate CDVA separately in different closure types due to the small number of eyes with the latter two patterns.…”

“…In fact, EZ and ELM mean defect values are directly related, CFT and CDVA inversely correlated with EZ and ELM defect, and CDVA directly correlated with the preoperative value and with the use of BBG. On the contrary, the lack of correlation between CFT and CDVA, already reported in previous studies [29,37], could be also justified by the dependence of the CFT on the degree of glial cell proliferation facilitating the hole closure. All the above considerations rely on the possibility of chronic long-term toxicity of the IFCG phagocytosed by RPE cells, even if some authors failed to find any experimental or clinical sign of toxicity with the low IFCG concentration we used [21][22][23][24]51].…”

“…As mentioned above, we chose to not measure the EZ and ELM preoperative defects, assuming them to approximate the base diameter of the hole, because the difficulties in identifying these layers while approaching the hole's cuff in many of our cases, together with the variable degree of their vertical elevation along the hole walls, could make their measurement sometimes subjective. Data in the literature report that the preoperative EZ defect is usually wider than the FTMH's base diameter, while the ELM defect is equivalent or smaller, but the great variability of the mean values among different authors may reflect the difficulty in measurement [29,37].…”

“…All the above considerations rely on the possibility of chronic long-term toxicity of the IFCG phagocytosed by RPE cells, even if some authors failed to find any experimental or clinical sign of toxicity with the low IFCG concentration we used [21][22][23][24]51]. The higher water solubility would, on the contrary, allow for less intracellular penetration of BBG, despite the possible contact of the dyed inverted ILM with RPE during the first days under air/gas tamponade [22,24,37].…”

“…The 3D macular scan images were used to determine the foveal configuration following hole closure and the thickness of different retinal layers, whereas the radial-scan images were used to measure the hole diameter and defects in both the EZ and ELM. The foveal closure configuration included U-shaped, V-shaped, and W-shaped cases [2,37].…”