Floating flap of internal limiting membrane in myopic macular hole surgery

Abstract

MH with or without RD in highly myopic eyes could be successfully treated with PPV leaving ILM flap floating in vitreous fluid at the edge of the MH. After the ILM peeling, further manipulation of the ILM flap to cover the MH would not be necessary for the treatment of MH in high myopia.

<p>Optical Coherence Tomography Morphological Features Following Modified Internal Limiting Membrane Surgical Technique In Traumatic Macular Holes</p>

“…We consider this maneuver unnecessary as the ILM flap in our cases crumbled on itself and inside the hole on its own during the post-operative period in most of the cases. Similar finding was reported by Yamashiro et al,17 who found that remnants of the ILM might get adsorbed into the depth of the hole after surgery while the RPE pumps out fluid from the cuff of neurosensory detachment around the hole edges. The present study corroborates the hypotheses from other studies that shearing of the foot plates of the Müller cells during ILM peel and incomplete lifting of the ILM flap that remained anchored to the hole edges would provide an adequate stimulus to initiate the healing process 8,9,17–19.…”

“…Similar finding was reported by Yamashiro et al,17 who found that remnants of the ILM might get adsorbed into the depth of the hole after surgery while the RPE pumps out fluid from the cuff of neurosensory detachment around the hole edges. The present study corroborates the hypotheses from other studies that shearing of the foot plates of the Müller cells during ILM peel and incomplete lifting of the ILM flap that remained anchored to the hole edges would provide an adequate stimulus to initiate the healing process 8,9,17–19. Attempts to manipulate the flap as folding it over the hole or tucking inside the hole are unnecessary and might induce further trauma to the RPE 9,19.…”

Comparative Study between Pars Plana Vitrectomy with Internal Limiting Membrane Peel and Pars Plana Vitrectomy with Internal Limiting Membrane Flap Technique for Management of Traumatic Full Thickness Macular Holes

“…It is worthy of note that, in the IFT group in the present study, we adopted Casini et al [28] modification of the classic inverted ILM flap technique described by Michalewska et al [24] in the sense that we did not attempt to invert the ILM flap and fold it inside the hole to avoid damaging the RPE at the bed of the hole. The rationale of our modified approach is that shearing of the foot plates of the Müller cells during ILM peel and residual attachment of the ILM flap to the hole edges would suffice to incite glial cell proliferation and that eventually fills up the macular hole and promotes its closure [11, 24, 31].…”

Macular hole closure at seven years after surgery

“…ILM removal may relieve tangential traction, 2 while the inverted ILM flap may induce glial cell proliferation, resulting in MH filling with proliferating cells that enhance closure. 3 Although there is insufficient understanding of the roles of ILM removal or ILM flap in MH closure, further modified surgical techniques manipulating ILM have been proposed, 5 , 6 , 7 , 8 , 9 , 10 and different surgical techniques are used to treat MHs according to surgeons’ discretion. The relief of tangential traction would not directly contribute to the MH closure after the delayed MH closer in the present case.…”

“… 2 Although the precise mechanisms of ILM peeling to promote MH closure have not been elucidated, inverted ILM flap technique was introduced in 2010 and further modified surgical techniques manipulating ILM have been proposed by various study groups. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 Recently, we experienced a case of delayed MH closure after ILM peeling. Sharing the serial optical coherence tomography (OCT) images until the MH closure would help us explore the mechanisms of ILM peeling to close MH.…”