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

Ruparelia, Sunil; Tuli, Raman; Park, John S Y; Shoham-Hazon, Nir; Berco, Efraim

doi:10.1097/iae.0000000000003350

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…The technique has evolved over the years, and generally, there is mounting evidence that the inverted ILM flap technique in all its variations seems to produce reliably good outcomes, even in challenging MHs and with limited posturing. Recently, Ruparelia et al [6] reported their experience with the inverted ILM flap technique without postoperative facedown positioning in 63 large MHs and also found encouraging results. Prospective randomised trials like the one by Kannan et al are still rare though, thereby somewhat limiting generalisability of the published outcomes so far [7].…”

Section: Discussionmentioning

confidence: 96%

“…Die Technik hat sich im Laufe der Jahre weiterentwickelt und im Allgemeinen gibt es immer mehr Belege dafür, dass die inverse MLI-Lappentechnik in all ihren Variationen zu verlässlich guten Ergebnissen zu führen scheint, selbst bei schwierigen MF und bei begrenzter postoperativer Lagerung. Kürzlich berichteten Ruparelia et al [6] über ihre Erfahrungen mit der inversen MLI-Lappentechnik ohne postoperative Bauchlagerung bei 63 großen MF und kamen ebenfalls zu ermutigenden Ergebnissen. Prospektive, randomisierte Studien wie die von Kannan et al sind jedoch immer noch selten, wodurch die Verallgemeinerung der bisher veröffentlichten Ergebnisse nur eingeschränkt möglich ist [7].…”

Section: Materials Und Methodikunclassified

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Eine Modifikation der inversen Membrana-limitans-interna-Lappentechnik ohne Einsatz schwerer Flüssigkeiten und Bauchlagerung

Kaiser

Ernst

Somfai

et al. 2022

Klin Monbl Augenheilkd

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ZusammenfassungDer primäre Verschluss großer Makulaforamina ist nach wie vor eine Herausforderung, wobei verschiedene Varianten einer Operation mit einem inversen Lappen der Membrana limitans interna (MLI) beschrieben worden sind. In der vorliegenden retrospektiven interventionellen Fallserie eines einzelnen Zentrums präsentieren wir eine Lappentechnik mit minimaler postoperativer Lagerung. Acht Augen von 8 Patienten (4 Frauen und 4 Männer) unterzogen sich im Zeitraum zwischen Juli 2020 und März 2022 einer von demselben erfahrenen Chirurgen (FMH) durchgeführten 23-G-3-Port-Vitrektomie mit einem umgekehrten MLI-Lappen und einer 20%igen SF6-Endotamponade für ein durchgreifendes Makulaloch. Sieben Makulaforamina wurden als groß (> 400 µm) und eines als mittelgroß (250 – 400 µm) eingestuft. Der mittlere minimale Durchmesser betrug 638,0 µm ± 166,4 µm (Bereich: 353 – 851 µm). Der Verschluss des Makulaforamens wurde bei allen Patienten (8/8, 100%) mit einem einzigen Eingriff erreicht. Der mediane bestkorrigierte Visus (BCVA) verbesserte sich von 6/120 (Snellen; Bereich: Fingerzählung [FC]) bis 6/19) präoperativ auf 6/19 (Bereich: FC bis 6/9,5) nach der Operation ohne intra- oder postoperative Komplikationen. Die Technik des superioren invertierten MLI-Lappens scheint ein sicherer und erfolgreicher Ansatz für den primären Verschluss großer Makulaforamina zu sein. In weiteren Studien sollte die von uns vorgeschlagene Operationstechnik an einer größeren Population untersucht werden, möglicherweise als Weiterentwicklung ohne Einsatz einer Luft- oder Gasendotamponade.

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Section: Discussionmentioning

confidence: 96%

Section: Materials Und Methodikunclassified

Eine Modifikation der inversen Membrana-limitans-interna-Lappentechnik ohne Einsatz schwerer Flüssigkeiten und Bauchlagerung

Kaiser

Ernst

Somfai

et al. 2022

Klin Monbl Augenheilkd

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“…13,14 To avoid ILM flap displacement, some researchers have proposed using autologous blood to cover the ILM flap, 25 whereas others have used a method of injecting a dispersive OVD under perfluorocarbon liquid to fix the ILM flap. 26 Although these two methods effectively fix the inverted ILM flap, they increase the complexity of the surgical procedure or the cost of the operation. Dis-CoVisc (hyaluronic acid 1.6%-chondroitin sulfate 4%) is a viscous dispersive OVD with the properties of cohesive and dispersive OVDs.…”

Section: Discussionmentioning

confidence: 99%

Minimal posterior pole vitrectomy and fixing the inverted ILM flap with DisCoVisc® for macular hole: no gas or air tamponade

Liu,

Jiang,

Chen

et al. 2023

Retina

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Purpose: To investigate an alternative surgical method for macular hole (MH) repair without fluid-air exchange, gas tamponade, and prone positioning. Methods: Eighteen eyes of 17 patients with MHs underwent minimal posterior pole vitrectomy with an inverted internal limiting membrane (ILM) flap technique. Ophthalmic viscosurgical device(OVD) was used to fix the inverted ILM flap in the balanced salt solution. No fluid-air exchange, gas tamponade, or prone positioning was needed. Follow-ups were performed at 1 day, 1 week, and the last visit (ranging from 3 to 6 months) after surgery. Optical coherence tomography (OCT) examination, intraocular pressure (IOP), and best-corrected visual acuity (BCVA) measurements were performed preoperatively and at every follow-up postoperatively. Results: Primary closure of the MH was observed in all 18 eyes (100%). OCT showed U-type closure in 12 eyes, V-type closure in 5 eyes, and W-type closure in 1 eye. Preoperative, postoperative 1 week, and last follow-up BCVA were 0.90 (Snellen equivalent 20/159) ± 0.31 LogMAR, 0.72 (Snellen equivalent 20/105) ± 0.33 LogMAR, and 0.48 (Snellen equivalent 20/60) ± 0.32 LogMAR, respectively. Postoperative visual acuity was significantly improved compared with preoperative values (F=19.250, P=0.000). No significant difference in IOP was found compared with preoperative values (F=1.933, P=0.168). No significant complications were observed. Conclusion: This surgical method can effectively close MHs, improve visual acuity, enhance surgical efficiency, reduce surgical complications, and improve patients' postoperative experience without the need for fluid-air exchange, gas tamponade, or prone positioning.

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“…Furthermore, some rare postoperative complications, like ulnar nerve palsies, pulmonary embolism, thrombophlebitis, and decubitus, would develop after a long period of face-down position (23,24). Multiple groups have reported the efficacy of postoperative positioning without the maintenance of a face-down positioning after vitrectomy for MH (22,(25)(26)(27)(28)(29)(30) and retinal detachment (RD) (31)(32)(33)(34)(35). However, MHRD is excluded from their observation.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Face-Down Positioning and Adjustable Positioning After Pars Plana Vitrectomy for Macular Hole Retinal Detachment in High Myopia

et al. 2022

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PurposeTo compare the anatomical and functional outcomes of macular hole retinal detachment (MHRD) in high myopia after pars plana vitrectomy (PPV) with face-down positioning and adjustable positioning.MethodsFifty-three eyes from 53 patients with MHRD were analyzed in this study. All patients received PPV with silicon oil for tamponade and then subdivided into 2 groups: 28 were included in a face-down positioning group and 25 were included in the adjustable positioning group. Patients were followed up for at least 6 months. The main outcome was the rate of anatomical macular hole (MH) closure and retinal reattachment. Secondary outcome measures were the best-corrected visual acuity and postoperative complications.ResultsThere was no significant difference in the rate of MH closure (53.6 vs. 72.0%, p = 0.167) and retinal reattachment (100 vs. 96%, p = 0.472) between the face-down group and adjustable group. Compared with the mean preoperative best-corrected visual acuity (BCVA), the mean postoperative BCVA at the 6-month follow-up improved significantly in both groups (p = 0, both). But there was no significant difference in the mean postoperative BCVA (p = 0.102) and mean BCVA improvement (p = 0.554) at 6 months after surgery between the two groups. There was no significant difference in the high intraocular pressure (IOP) after surgery between the two groups (53.6 vs. 44%, p = 0.487). There were no other complications that occurred during the follow-up.ConclusionAdjustable positioning after PPV with silicon oil tamponade for MHRD repair is effective and safe. Face-down positioning does not seem to be necessary for all patients with MHRD.

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

Abstract: Face-down positioning after macular hole surgical repair is common but may not be feasible for some patients. We report closure of 94% of macular holes with the inverted internal limiting membrane flap technique without postoperative face-down positioning.

Cited by 4 publications

References 17 publications

Eine Modifikation der inversen Membrana-limitans-interna-Lappentechnik ohne Einsatz schwerer Flüssigkeiten und Bauchlagerung

Eine Modifikation der inversen Membrana-limitans-interna-Lappentechnik ohne Einsatz schwerer Flüssigkeiten und Bauchlagerung

Minimal posterior pole vitrectomy and fixing the inverted ILM flap with DisCoVisc® for macular hole: no gas or air tamponade

A Comparison of Face-Down Positioning and Adjustable Positioning After Pars Plana Vitrectomy for Macular Hole Retinal Detachment in High Myopia

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