Inverted ILM flap technique versus conventional ILM peeling for idiopathic large macular holes: A meta-analysis of randomized controlled trials

Abstract

To compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique with the conventional ILM peeling for idiopathic large macular holes (MHs). Methods A meta-analysis of randomized control trials (RCTs) using online databases including NCBI PubMed, ClinicalTrials.gov, and ISI Web of Science was performed. Anatomic success and type 1 closure rates, the mean postoperative best-corrected visual acuity (BCVA) and the mean change of BCVA from baseline were analyzed. Results Out of 251 articles, four described clinical trials matching the inclusion criteria and were selected. They included 276 eyes (135 eyes in the inverted ILM flap group and 141 eyes in the ILM peeling group). All the studies used gas tamponade, with two studies having a follow-up duration of 3 months, while one study had a follow-up of 6 months and one study-12 months. The meta-analysis demonstrated that anatomic success and type 1 closure rates (presence of neurosensory retina in MH) were better in the inverted ILM flap technique (odds ratio (OR) = 4.89; 95% confidence interval (CI), 2.09-11.47; P = 0.0003 and OR = 5.23; 95% CI, 2.83-9.66; P<0.00001). Similarly, the inverted flap technique was superior in terms of postoperative logMAR BCVA and mean change of logMAR BCVA from baseline

Simultaneous development of full-thickness macular hole and neovascular age-related macular degeneration

“…The inverted ILM flap technique has demonstrated a higher or similar closure rate in large MHs than the conventional ILM peeling technique, although its superiority with respect to long-term functional outcome is inconclusive. 23 , 24 , 25 Some studies suggested that the inverted ILM flap technique is effective in MH complicated by other macular pathologies, such as type 2 idiopathic macular telangiectasia 26 and dry age-related macular degeneration. 27 The inverted ILM flap technique was selected in the current case because exudative changes due to nAMD might have hampered MH closure.…”

Long-Term Outcomes of Macular Hole Repair with Triamcinolone Acetonide Visualization

“…31 We did not attempt closure with ILM flap inversion or amniotic membrane transplant. 32,33 There has been concern raised previously that cataract surgery and, specifically, the development of CME following cataract surgery are risk factors in recurrent MHs. [34][35][36] Within the recurrent MHs in the presented study group, 1 (3.6%) eye recently underwent cataract surgery and subsequently developed CME.…”

“…Also, more recent research has proposed the use of amniotic membranes or inverting the ILM within the MH to assist in larger MHs and those associated with pathologic myopia which was not available in the treatment of any of these eyes. 32,33,64 Such novel approaches may have further improved the results in this cohort of eyes. Finally, being a tertiary referral center, complex MHs are often referred from other ophthalmologists and, occasionally, other retina surgeons.…”

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

“…Two meta-analyses has demonstrated better anatomical and functional outcomes after inverted ILM flap technique versus ILM peeling in large FTMHs. 59 , 60 In one of the comparative studies, the hole closure rate and VA improvement for FTMHs >400µm were 95% and 75%, respectively, after inverted ILM flap technique, and 87% and 57%, respectively, after indocyanine green-assisted ILM peeling. 61 Nevertheless, the differences in VA improvement between both techniques were more evident in the short term than in the long term.…”