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

Abstract

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.

Inverted Internal Limiting Membrane Flap Technique for Macular Hole Coexistent With Rhegmatogenous Retinal Detachment

“…Although it may not be the primary cause of RD, the mere presence of an additional MH in the retina's most sensitive area represents a major complicating factor that heavily affects the patient's future visual prognosis and even the reoperation rate. 9 , 12 Although the retinal surgeon's primary focus will remain the treatment of all peripheral retinal breaks to reattach the retina, 13 achieving MH closure is obviously critical to improving postoperative visual recovery. The ILM flap technique is known to achieve MH closure rates higher than 90%, 14 and according to the literature, it seems to be the most effective procedure for the primary surgical approach of large idiopathic MH and secondary MH.…”

“…The ILM flap technique is known to achieve MH closure rates higher than 90%, 14 and according to the literature, it seems to be the most effective procedure for the primary surgical approach of large idiopathic MH and secondary MH. 12 Multiple variants of the ILM flap technique have been proposed, but currently, there is no clear consensus on which technique should be routinely used. 15 , 16 In our case series, ILM flap insertion was performed as it might offer better MH closure rates, especially for bigger holes.…”

Visual improvement and regeneration of retinal layers in eyes with small, medium, and large idiopathic full-thickness macular holes treated with the inverted internal limiting membrane flap technique over a period of 12 months

“…The International Vitreomacular Traction Study Group categorized FTMH according to the size of the minimal diameter of the FTMH on SD-OCT as follows: small ( ≤ 250 μm), medium (251-400 μm), and large ( > 400 μm) [2]. Still, the classification of FTMH and the consequences on decision for a therapeutic strategy have been discussed in various studies [8][9][10][11].…”

Inverted Internal Limiting Membrane Flap Technique Without Postoperative Face-Down Positioning for Macular Hole Repair

“…This technique has become common for the repair of large full-thickness MHs. 5 After surgery for MH closure, patients are often advised to maintain face-down positioning postoperatively. The reasoning behind this is that face-down positioning will allow the injected tamponade to remain in the correct position over the MH.…”

“…This inverted ILM is believed to act as scaffolding for the proliferation and migration of Müller cells, thus leading to the production of growth factors to facilitate hole closure. 5 The ILM flap technique is followed by injection of a long-acting euvolemic gas into the vitreous cavity. This technique has become common for the repair of large full-thickness MHs.…”