<p>Comparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole</p>

Abstract

Purpose: To evaluate and compare three different techniques of inverted internal limiting membrane (ILM) flap in the treatment of large idiopathic full-thickness macular hole. Methods: In a comparative interventional case series, 72 eyes from 72 patients with large (> 400 µm) full-thickness macular hole were randomly enrolled into three different groups: group Ahemicircular ILM peel with temporally hinged inverted flap; group Bcircular ILM peel with temporally hinged inverted flap; and group Ccircular ILM peel with superior inverted flap. Best-corrected visual acuity (BCVA), anatomical closure rate, and ellipsoid zone (EZ) or external limiting membrane (ELM) defects were evaluated preoperatively, at week 1, and months 1, 3 and 6 after surgery. Results: There were 24 eyes in group A, 23 in group B, and 25 in group C. In all three groups, larger diameter macular hole was associated with worse preoperative visual acuity (r=0.625, P<0.001). Mean BCVA improved significantly in all three groups 6 months after surgery (0.91vs 0.55, p<0.001). 6 months after surgery, mean BCVA improved from 0.91 logMAR to 0.52±0.06 in group A, 0.90 to 0.53±0.06 in group B, and 0.91 to 0.55±0.11 in group C. In group A vs. B vs. C, improvement of BCVA was 0.380±0.04 vs. 0.383±0.04 vs. 0.368±0.11 logMAR, with no statistically significant difference between groups (P=0.660). The rate of successful hole closure was 87.5% vs. 91.3% vs. 100%. Although the closure rate was 100% in Group C (circular ILM peel with superiorly hinged inverted flap), this difference was not statistically significant (P=0.115). Conclusion: ILM peel with an inverted flap is a highly effective procedure for the treatment of large, full-thickness macular hole. Different flap techniques have comparable results, indicating that the technique can be chosen based on surgeon preference.

Inverted internal limiting membrane flap technique in eyes with large idiopathic full-thickness macular hole: long-term functional and morphological outcomes

“…Over the last years, several modifications of the original I-ILM flap technique have been developed, e.g., variations of the size, shape, number, and manner in which the flaps are put on the MHs as well as the usage of perfluoro-n-octane (PFO), different dyes, autologous blood, and adhesive viscoelastics [36][37][38][39][40][41][42]. These various modifications with their concomitant risks and benefits need to be further explored.…”

“…Especially, the restoration of the external limiting membrane (ELM), ellipsoid zone (EZ), and outer photoreceptor segments (OS) were reported to significantly correlate with an improved postoperative best-corrected visual acuity (BCVA) [29][30][31][32][33][34][35]. Over the last 10 years, several modifications of the original I-ILM flap technique with similar favorable results have been described [36][37][38][39][40][41][42].…”

Secondary Vitrectomy with Internal Limiting Membrane Plug due to Persistent Full-Thickness Macular Hole OCT-Angiography and Microperimetry Features: Case Series

“…Surgery of persistent and recurrent FTMH remains still a challenge, and there is a number of described surgical techniques, which should be considered after failed primary vitrectomy due to FTMH. Analysis of different flap techniques showed a comparable results, so the technique can be chosen based on the surgeon preference [ 12 ]. The results of OCT-A and microperimetry in persistent FTMH closed with secondary PPV have not been published so far.…”

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

“…Also, Ghassemi et al [ 23 ] compared three different techniques of inverted ILM flap in large idiopathic FTMH surgery, hemicircular ILM peeling with temporal-inverted flap (group A), circular ILM peeling with temporal-inverted flap (group B), and superior inverted-flap technique (group C), and concluded that all the techniques have comparable, high, and effective results.…”