Modification of the Inverted Internal Limiting Membrane Flap Technique for the Treatment of Chronic and Large Macular Holes

Andrew, Nicholas H; Chan, Weng Onn; Tan, Mei Hong; Ebneter, Andreas; Gilhotra, Jagjit S

doi:10.1097/iae.0000000000000931

Cited by 64 publications

(60 citation statements)

References 8 publications

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“…Several authors have reported a higher anatomical and functional success rate with this technique and its certain modifications. 8,[15][16][17][18][19] Andrew et al used a fragment of ILM, described as "ILM hinge" attached to the hole margin, which is then folded in the hole and allowed to settle at base of the hole. Michalewska et al developed a modification of the original inverted ILM flap technique, peeling only the area temporal to MH…”

Section: Inverted Ilm Flapmentioning

confidence: 99%

Current Management of Macular Hole

Singh¹,

Narayanan²

2019

Ophthalmic Surg Lasers Imaging Retina

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In this issue's Practical Retina column, Sumit Randhir Singh, MD, and Raja Narayanan, MD, MBA, from the LV Prasad Eye Institute in Hyderabad, India, discuss the current therapeutic options for repairing macular holes (MHs). We are all aware that there is great discussion and wide variability in thinking among our colleagues regarding approaches to close a MH. Common controversies include when and if internal limiting membrane peeling is necessary, as well as what to do with it after it is peeled (fully or partially to create a flap). Other discussions include choice of tamponade, duration of positioning, and use of retinal grafts. Choice of adjuvants have also been discussed and will be addressed in this article. Drs. Singh and Narayanan tackle this topic in a concise and logical manner. They will provide a thorough review of the literature and provide opinions based on the strength of the evidence in the literature. I am certain that their insights will be very valuable for maximizing outcomes in patients with MHs.

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Section: Inverted Ilm Flapmentioning

confidence: 99%

Current Management of Macular Hole

Singh¹,

Narayanan²

2019

Ophthalmic Surg Lasers Imaging Retina

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“…It was regarded as an untreatable disease in poor prognosis until the first describtion of vitrectomy to treat MH by Kelly and Wendel [1] in 1991. The success rate of MH surgery increased to 98% [2][3][4] of cases with the introduction of internal limiting membrane (ILM) peeling by Eckardt et al [5], which was thought to be one of the most effective surgical procedures [6]. However, the anatomical success rate of MH that are larger than 400 μm is less likely to close and has been as low as 40% [7,8], regardless of whether the ILM has been removed or not during vitrectomy.…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis

et al. 2020

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Background: The purpose of this study was to compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique and internal limiting membrane peeling in large macular holes (MH).Methods: Related studies were reviewed by searching electronic databases of Pubmed, Embase, Cochrane Library. We searched for articles that compared inverted ILM flap technique with ILM peeling for large MH (> 400 μm). Double-arm meta-analysis was performed for the primary end point that was the rate of MH closure, and the secondary end point was postoperative visual acuity (VA). Heterogeneity, publication bias, sensitivity analysis and subgroup analysis were conducted to guarantee the statistical power.Results: This review included eight studies involving 593 eyes, 4 randomized control trials and 4 retrospective studies. After sensitivity analysis for eliminating the heterogeneity of primary outcome, the pooled data showed the rate of MH closure with inverted ILM flap technique group was statistically significantly higher than ILM peeling group (odds ratio (OR) = 3.95, 95% confidence interval (CI) = 1.89 to 8.27; P = 0.0003). At the follow-up duration of 3 months, postoperative VA was significantly better in the group of inverted ILM flap than ILM peeling (mean difference (MD) = − 0.16, 95% CI = − 0.23 to 0.09; P < 0.00001). However, there was no difference in visual outcomes between the two groups of different surgical treatments at relatively long-term follow-up over 6 months (MD = 0.01, 95% CI = − 0.12 to 0.15; P = 0.86).Conclusion: Vitrectomy with inverted ILM flap technique had a better anatomical outcome than ILM peeling. Flap technique also had a signifcant visual gain in the short term, but the limitations in visual recovery at a longer follow-up was found.

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“…All abstracts, studies and citations were reviewed and assessed. The inclusion criteria for eligibility were as follows: (1) double-arm studies; (2) studies included cases among patients with MH larger than 400 μm who had been treated with the inverted ILM flap technique or ILM peeling; (3) anatomical hole closure rate and visual acuity (VA) were observed after the treatments; (4) the relevant statistics were provided, such as age, gender, duration of disease, hole size, and follow-up time; (5) prospective randomized control trial or retrospective case series. Exclusion criteria were as follows: (1) non -controlled study; (2) patients with macular retinoschisis, age-related macular degeneration, retinal detachment, or proliferative diabetic retinopathy; (3) treatments with modified inverted ILM flap techniques; (4) short -term follow-up that less than three months; (5) reviews or case reports.…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis

Shen

Lin

Zhang

et al. 2019

Preprint

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Background: The purpose of this study was to compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique and internal limiting membrane peeling in large macular holes (MH). Methods: Related studies were reviewed by searching electronic databases of Pubmed, Embase, Cochrane Library. We searched for articles that compared inverted ILM flap technique with ILM peeling for large MH (> 400 μm). Double-arm meta-analysis was performed for the primary end point that was the rate of MH closure, and the secondary end point was postoperative visual acuity (VA). Heterogeneity, publication bias, sensitivity analysis and subgroup analysis were conducted to guarantee the statistical power. Results: This review included eight studies involving 593 eyes, 4 randomized control trials and 4 retrospective studies. After sensitivity analysis for eliminating the heterogeneity of primary outcome, the pooled data showed the rate of MH closure with inverted ILM flap technique group was statistically significantly higher than ILM peeling group (odds ratio (OR) = 3.95, 95% confidence interval (CI) = 1.89 to 8.27; P = 0.0003). At the follow-up duration of 3 months, postoperative VA was significantly better in the group of inverted ILM flap than ILM peeling (mean difference (MD) = -0.16, 95% CI = -0.23 to 0.09; P ＜ 0.00001). However, there was no difference in visual outcomes between the two groups of different surgical treatments at relatively long-term follow-up over 6 months (MD = 0.01, 95% CI = -0.12 to 0.15; P = 0.86). Conclusion: Vitrectomy with inverted ILM flap technique had a better anatomical outcome than ILM peeling. Flap technique also had a signifcant visual gain in the short term, but the limitations in visual recovery at a longer follow-up was found. Keywords: Inverted internal limiting membrane flap technique, Internal limiting membrane peeling, Large macular hole, Meta-analysis

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Modification of the Inverted Internal Limiting Membrane Flap Technique for the Treatment of Chronic and Large Macular Holes

Cited by 64 publications

References 8 publications

Current Management of Macular Hole

Current Management of Macular Hole

Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis

Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis

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