Inverted ILM Flap for the Treatment of Myopic Macular Holes: Healing Processes and Morphological Changes in Comparison with Complete ILM Removal

Mete, Maurizio; Alfano, Alessandro; Maggio, Emilia; Guerriero, Massimo; Pertile, Grazia

doi:10.1155/2019/1314989

Cited by 7 publications

(6 citation statements)

References 48 publications

(51 reference statements)

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“…In their recent research article, Mete et al [ 30 ] observed no difference between the inverted-flap group and the ILM peeling group regarding timing and restoration rate of the ELM and EZ, affirming that the presence of the ILM plug does not prevent the physiological healing process occurring after ILM peeling [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Inverted ILM Flap Technique in Idiopathic Full-Thickness Macular Hole Surgery: Functional Outcomes and Their Correlation with Morphologic Findings

Carpineto

Borrelli

Cerino

et al. 2021

Journal of Ophthalmology

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Objectives. The inverted internal limiting membrane (ILM) flap technique has been shown to increase the success rate in large full-thickness macular holes (FTMHs) and in FTMHs associated with high myopia. The aim of our study was to confirm the efficacy and safety of inverted ILM flap technique in idiopathic FTMHs independent of their dimensions and to assess functional outcomes and their correlation to morphologic findings. Methods. Sixteen consecutive patients affected by idiopathic FTMH were enrolled in this prospective study. The preoperative mean (±SD) diameter of the FTMH was 422 (±106) µm. All patients underwent vitrectomy and ILM peeling with inverted ILM flap. At 1-, 3-, and 6-month postoperative visits, visual acuity measurement, indirect ophthalmoscopy, and microperimetry were performed, and the foveal contour and the integrity of the ellipsoid zone (EZ) and external limiting membrane (ELM) were investigated using spectral domain optical coherence tomography (SD-OCT). Results. At six months postoperatively, 15 out of 16 (93.75%) patients obtained FTMH closure. The mean best corrected visual acuity (BCVA) improved from 1.1 LogMAR to 0.3 LogMAR, and the mean retinal sensitivity (MS) improved from 7.2 to 23.4 dB. ELM defects were evident in 1 out of 16 (6.25%) eyes, and EZ defects were detected in 2 out of 16 (12,50%) eyes. A statistically significant relationship was observed between BCVA, MS, and EZ reconstitution at each follow-up visit. Conclusions. Results confirm that the inverted ILM flap technique is a safe and effective option for FTMH treatment and show a strong correlation between higher BCVAs and MSs and EZ reconstitution after surgery.

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Section: Discussionmentioning

confidence: 99%

Inverted ILM Flap Technique in Idiopathic Full-Thickness Macular Hole Surgery: Functional Outcomes and Their Correlation with Morphologic Findings

Carpineto

Borrelli

Cerino

et al. 2021

Journal of Ophthalmology

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“…82 Regarding the outer retina recovery, inverted ILM flap and ILM peeling techniques were no different in two studies. 83,84 A third comparative study showed a higher rate of ELM and EZ recovery after inverted ILM flap technique. 85 The use of perfluorocarbon liquid in FTMHs with RD and viscoat ® in FTMHs without RD combined with inverted ILM flap technique were proposed to increase the success rate of the surgery.…”

Section: Secondary Ftmhmentioning

confidence: 97%

Inverted Internal Limiting Membrane Flap Technique: Is It the Best Option for Macular Holes?

Silva¹,

Ferreira²,

Michalewska³

et al. 2021

OPTH

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Surgical treatment is generally necessary to repair full-thickness macular holes (FTMH). Although vitrectomy with or without internal limiting membrane (ILM) peeling remains the standard surgical technique, the inverted ILM flap procedure has increasingly assumed a role in the primary surgical repair of FTMHs. Some vitreoretinal surgeons reserve this technique to treat large or myopic holes, whereas others use it routinely in all cases. This paper is a comprehensive review of the current scientific evidence on the anatomical and functional outcomes of the inverted ILM flap technique in the repair of macular holes, following the International Vitreomacular Traction Study (IVTS) group classification.

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“…The improved VA outcomes are correlated with higher rates of external limiting membrane and ellipsoid zone recovery and gliosis rates for eyes receiving inverted ILM flaps. [ 52 57 58 ] Beyond morphologic outcomes, microperimetry shows improved retinal sensitivity following closure with inverted ILM flap in eyes with MH > 400 μm, though degree of recovery is limited by pre-operative retinal sensitivity. [ 59 ]…”

Section: Internal Limiting Membrane Scaffoldmentioning

confidence: 99%

Current management strategies for atypical macular holes

Marlow

Mahmoud

2021

Taiwan Journal of Ophthalmology

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This review evaluates the current surgical management options for refractory and atypical macular holes (MH) and proposes a treatment paradigm for approaching complex cases. A review of literature was performed to deliver a thorough discussion of the epidemiology and pathophysiology of MH as well as the historic evolution of surgical management strategies. With this context established, an update on recent surgical advances for management of large, chronic, and highly myopic MH is provided. New small MH may be adequately treated with pars plana vitrectomy, while those ≥300 μm should undergo internal limiting membrane (ILM) peel. For MH ≥400 μm with risk factors for failure, primary intervention should involve creation of an ILM flap and various methods of flap creation are discussed. For very large MH ≥700 μm or in refractory cases, autologous retinal transplants and other recently proposed procedures should be considered. While typical MHs enjoy high initial surgical success rates, atypical and refractory MH require additional intraoperative and postoperative considerations to maximize surgical success and optimize vision. With many techniques at the surgeon's disposal, patient selection becomes critical to improving outcomes.

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Inverted ILM Flap for the Treatment of Myopic Macular Holes: Healing Processes and Morphological Changes in Comparison with Complete ILM Removal

Cited by 7 publications

References 48 publications

Inverted ILM Flap Technique in Idiopathic Full-Thickness Macular Hole Surgery: Functional Outcomes and Their Correlation with Morphologic Findings

Inverted ILM Flap Technique in Idiopathic Full-Thickness Macular Hole Surgery: Functional Outcomes and Their Correlation with Morphologic Findings

Inverted Internal Limiting Membrane Flap Technique: Is It the Best Option for Macular Holes?

Current management strategies for atypical macular holes

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