Internal limiting membrane insertion technique combined with nerve growth factor injection for large macular hole

Abstract

Background The study was proposed to determine whether the nerve growth factor (NGF) combined with an internal limiting membrane (ILM) insertion technique was effective in the large idiopathic full-thickness macular hole (iFTMH) surgery. Methods A subset of 18 eyes (July 2015-October 2017) diagnosed as a large iFTMH were enrolled in this study. The subjects were treated using ILM insertion technique alone (ILM group) or ILM combined with NGF injection (NGF group) and the follow-up period was 6 months. Macular hole closure rates, best-corrected visual acuity (BCVA, improvements using ETDRS), and optical coherence tomography (OCT) findings were analyzed at 1, 3, and 6 months postoperatively. Results We found that macular hole in both groups are fully closed. In comparison to ILM insertion group, the NGF group had better BCVA at the 3-month (48.00 ± 2.392 vs 58.22 ± 2.957, 95% confidence interval (CI): 2.159 to 18.29). The mean external limiting membrane (ELM, 422.2 ± 96 vs 674.9 ± 103.6, 95% CI: -47.26 to 552.8) and ellipsoid zone (EZ, 496.7 ± 101.6 vs 766.7 ± 111.8, 95% CI: -50.29 to 590.4) defects were significantly smaller in the NGF group at the 6-month follow-up examination. Complete recovery of ELM and EZ was observed in the NGF group in one eye of a patient and two eyes of two patients, respectively. In comparison to that, one eye’s ELM and another eye’s EZ was completely recovered in the ILM insertion group. Conclusion Our results indicated that ILM insertion with NGF injection might be an effective technique for the initial surgical treatment of eyes with large MHs. The proposed approach yielded better recovery of the photoreceptor layers and consequently superior postoperative visual acuity.

Comparative Study of Conventional Inverted ILM Flap Covering and ILM Flap Filling Technique in Idiopathic Macular Hole Treatment: A Meta-Analysis and Systematic Review

“…However, it was still imprudent to conclude that both 2 surgical techniques performed equal effectiveness on MH over 650 μm for only 2 included studies (98 eyes) in the subgroup that reported the surgical outcomes. Since a large number of studies reported the prompt and efficient reconstruction of the super large MH treated with the filling technique [3,32], it is of great importance to conduct more comparative studies to explore the role of ILM flap filling technology in recovering giant neuroepithelial defects in the future.…”

Current Trends in Macular Hole Repair

“…Other techniques that have been described in limited case reports or series include novel adjuvant agents such as mesenchymal stem cells [135] and intravitreal nerve growth factor [136], increasing perifoveal compliance by hydrodissection [137], and increasing the macular hole index (which has been correlated with better post operative BCVA) by tapping the edges of the MH, that have all reported excellent rates of anatomical closure. In addition, multiple recent techniques specific to addressing myopic macular holes in the presence of concurrent retinal detachments have been described, such as macular buckling [138], suprachoroidal buckling [139], and scleral imbrication [140], which are out of the scope of this review.…”

Efficacy of Internal Limiting Membrane Peeling Combined with Mouse Nerve Growth Factor Injection for Idiopathic Macular Hole

“…Recently, some scholars have proposed that mNGF may promote the postoperative recovery of visual function of IMH. Research showed that PPV combined with ILM peeling and intravitreal injection of mNGF is a safe and effective treatment for large macular holes, which can not only improve the BCVA, but also promote functional recovery of External Limiting Membrane (ELM) and Ellipsoid Zone (EZ) [7] . With the ophthalmic imaging technology developed rapidly, OCTA has been widely used in ophthalmology due to the advantages of non-invasive, repeatable, safe, and convenient.…”