Comparison of the Inverted Internal Limiting Membrane Flap Technique and the Internal Limiting Membrane Peeling for Macular Hole with Retinal Detachment

Abstract

PurposeTo evaluate the efficacy of the inverted internal limiting membrane (ILM) flap technique in vitrectomy for macular hole (MH) with retinal detachment (RD) compared with vitrectomy using ILM peeling.MethodsA retrospective case series study was performed. Twenty-two eyes of 22 patients who underwent vitrectomy for MH with RD and followed-up more than 12 months after the surgery were included in this study. We retrospectively reviewed the medical records of patients who underwent vitrectomy with inverted ILM flap technique or vitrectomy with ILM peeling. Ten patients who had been treated vitrectomy with inverted ILM flap technique, and 12 patients who had been treated vitrectomy with ILM peeling were analyzed. We evaluated changes in best-corrected visual acuity (BCVA) before and after surgery, closing rates of MH, and retinal reattachment rates and compared between both groups.ResultsMH was closed and RD was reattached postoperatively in 9 eyes (90%) in the inverted ILM flap group. In the ILM peeling group, the MH was closed in 4 eyes (33.3%) and the retinas were reattached in 6 eyes (50%) after surgery. Significant improvement in BCVA after surgery (P = 0.0017) was only found in the inverted ILM flap group.ConclusionsHigher rates of closed MH and retinal reattachment, and small but significant improvement in BCVA were found in the inverted ILM flap group. Based on our data, the inverted ILM flap technique may be useful in vitrectomy for MH with RD.

Vitrectomy with internal limiting membrane peeling versus inverted internal limiting membrane flap technique for macular hole-induced retinal detachment: a systematic review of literature and meta-analysis

“…After reading carefully of remaining potentially relevant articles, Finally, a total of 4 studies, were selected for the meta-analysis (Fig. 1 ) [ 22 – 25 ]. The methodologic quality of the included trials is explained comprehensively in Table 1 .…”

Autologous Neurosensory Retinal Transplantation for Unclosed and Large Macular Holes

“…With continuous developments of the vitreoretinal surgery technique in recent years, the success rate of MH surgery is 80-95% [17][18][19][20]. Nevertheless, compared with idiopathic MHs, the postoperative closure rates and functional outcomes for large MHs, MHs associated with high myopia, and some secondary MHs are low and there are more cases needing reoperations.…”

Closure of an Intraoperatively Enlarged Macular Hole by Revision Surgery with Free ILM Flaps

“…Since the description of the inverted "ILM flap" technique by Michalewska et al [3], there have been case series reporting improved closure rates in eyes with a relatively poor prognosis, e.g., large refractory macular holes and macular holes in high myopia and after uveitis. Direct comparison of the "inverted ILM flap" technique with the classic ILM peeling-assisted pars-plana vitrectomy seems to support the favorable outcomes of the flap technique, reporting closure rates of 98 % with ILM flap vs. 88 % with ILM peeling [3] [4]. The introduction of the inverted ILM flap technique has improved closure rates.…”