Inverted internal limiting membrane flap technique as a useful procedure for macular hole-associated retinal detachment in highly myopic eyes

Abstract

PurposeTo determine whether the inverted internal limiting membrane (ILM) flap technique contributes to high reattachment and closure rates in patients with macular hole-associated retinal detachment (MHRD).Patients and methodsIn all, 15 eyes of 15 patients with MHRD undergoing 25-gauge pars plana vitrectomy with the inverted ILM flap technique or ILM peeling. The patients were divided into the inverted ILM flap technique group (6 eyes) and ILM peeling group (9 eyes). The logarithm of minimal angle of resolution best-corrected visual acuity (BCVA) and retinal attachment and macular hole closure rates were compared between the two groups before and after surgery.ResultsNo significant differences were found in the pre- and postoperative BCVA at 1 and 3 months after surgery in either group (inverted ILM flap technique group, preoperatively 1.04±0.55, 1 month 0.95±0.30, 3 months 0.83±0.22; ILM peeling group, preoperatively 1.00±0.44, 1 month 1.05±0.38, 3 months 1.06±0.49; P>0.05, respectively). The postoperative BCVA at 6 months after surgery was significantly better in the inverted ILM flap technique group than in the ILM peeling group (inverted ILM flap technique group, 0.62±0.35; ILM peeling group, 1.02±0.41, P=0.045). The improvement in BCVA was significantly better in the inverted ILM flap technique group than in the ILM peeling group (inverted ILM flap technique group, –0.41±0.29; ILM peeling group, 0.02±0.36; P=0.021). The primary macular hole closure rates were 100% in the inverted ILM flap technique group and 55.5% in the ILM peeling group. The primary reattachment rates were 100% in the inverted ILM flap technique group and 55.5% in the ILM peeling group. The primary macular hole closure and reattachment rates were not significantly different in both groups (P=0.056, respectively).ConclusionThe inverted ILM flap technique is a useful procedure for MHRD in highly myopic eyes.

Vitrectomy with internal limiting membrane peeling versus inverted internal limiting membrane flap technique for macular hole-induced retinal detachment: a systematic review of literature and meta-analysis

“…The shortest follow-up duration was 6 months in 3 studies [ 23 – 25 ], the follow-up duration was 12 months in 1 study [ 22 ]. 25-gauge vitrectomy was performed in 3 studies [ 22 – 24 ], 23-gauge vitrectomy was performed in 1 study [ 25 ]. To visualize ILM, brilliant blue G was used in 3 studies [ 22 – 24 ], indocyanine green (ICG) was used in 1 study [ 25 ].…”

“…25-gauge vitrectomy was performed in 3 studies [ 22 – 24 ], 23-gauge vitrectomy was performed in 1 study [ 25 ]. To visualize ILM, brilliant blue G was used in 3 studies [ 22 – 24 ], indocyanine green (ICG) was used in 1 study [ 25 ]. C 3 F 8 gas tamponade was applied in 4 studies, SF 6 gas tamponade was used in 2 studies [ 22 , 24 ], Silicone oil tamponade was used in 1 study [ 22 ].…”

“…To visualize ILM, brilliant blue G was used in 3 studies [ 22 – 24 ], indocyanine green (ICG) was used in 1 study [ 25 ]. C 3 F 8 gas tamponade was applied in 4 studies, SF 6 gas tamponade was used in 2 studies [ 22 , 24 ], Silicone oil tamponade was used in 1 study [ 22 ]. In order to minimize the effect of Lens status on the postoperative BCVA.…”

ILM peeling in macular hole retinal detachment: insert or not?

“…The concept was confirmed firstly by Michalewska et al in larger macular hole (MH) to facilitate the healing process and now has been extended for use in treating MHRD [2]. However, vitreoretinal surgeons are still asking, BIs the inverted ILM flap technique still a preferable option for MHRD?^Previous direct comparison studies have suggested contradictory results [3][4][5][6]. On this issue, Wakabayashi et al reported that the inverted ILM insertion technique seems to improve the anatomical results in terms of MH closure rate rather than the functional results of MHRD despite there being a tendency for better postoperative visual acuity in the inverted ILM insertion group.…”

The management of macular hole retinal detachment and macular retinoschisis in pathological myopia; a UK collaborative study

“…EMB have also been used in the management of MRS with a number of studies recommending a combination of macular buckling and vitrectomy in order to address both inner traction and the posterior staphyloma [57][58][59]. Recent published data, however, using a variation on ILM peeling have demonstrated macular hole closure rates of 80-100% and retinal reattachment rates of 100% using the inverted ILM flap technique, compared to 36-55% and 55-91%, respectively, using standard ILM peeling in cases with MHRD [60,61].…”