Postoperative retinal microstructure and functional outcome after inverted-flap technique associated with silicone oil tamponade in macular hole surgery

Abstract

Purpose: Our retrospective study on 27 patients with a large mean macular hole diameter (MH-D) of 480.08±78.62 μm evaluates the usefulness of combining the current internal limiting membrane (ILM) inverted-flap surgical technique with silicone oil tamponade, which has been associated with the classical technique of ILM peeling. Results: Functional results: mean visual acuity (VA) improved to 0.89±0.11 logMar (logarithm of the minimum angle of resolution, at one month), 0.67±0.03 logMar (at three months), 0.52±0.04 logMar (at six months), 0.42±0.15 logMar (at one year) postoperative (final VA), with statistical linkage between preoperative VA and final VA (two-sample t-test, p=0.007), mean MH-D and final VA (regression analysis, p=0.003). We compared the results by MH size (Group A ≤400 μm -eight eyes and Group B >400 μm -19 eyes), finding statistical variance (Bonett & Levene methods). Group A presented a final VA of 0.21±0.12 logMar, while Group B had 0.51±0.17 logMar. Successful closure was noted in 25 (92.59%) cases, with Group A having complete closure and external limiting membrane (ELM) restoration with ellipsoid zone (EZ) regeneration in six cases. Group B had successful closure in 17 (89.47%) cases with ELM restoration in 16 cases and EZ regeneration in seven (38.88%) cases, with reintervention in two cases. Restoration of the ELM was correlated [Pearson's correlation coefficient (PCC) of 0.999, p=0.022] with successful closure, with overall restoration obtained in 24 (88.88%) cases and EZ regeneration in 13 (48.14%) cases. Conclusions: ILM inverted-flap technique with silicone oil tamponade had favorable functional and anatomical outcomes. ELM restoration was associated with successful MH closure.

Optical Coherence Tomography in Preventive Surgery of Macular Holes

“…Наиболее распространенная хирургия патологии витреомакулярного интерфейса -это витрэктомия, пилинг внутренней пограничной мембраны (ВПМ) с возможной аутологичной трансплантацией остатков ВПМ и тампонадой витреальной полости [8][9][10]. Однако данная технология имеет ряд интраоперационных рисков: токсическое воздействие витальных красителей на структуры глазного яблока; механическая травма, деформирующая внутренние слои поверхности сетчатки, вплоть до формирования ятрогенного разрыва в макулярной зоне [10][11][12].…”