Single-Layer Inverted Internal Limiting Membrane Flap Versus Conventional Peel for Small- or Medium-Sized Full-Thickness Macular Holes

Purpose: To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small-to-medium idiopathic macular hole.Methods: Eyes with #400 mm idiopathic macular holes were randomized into the conventional ILM peeling group (25 eyes) and inverted flap group (25 eyes). A 12-month followup was considered. Macular sensitivity (MS) change detected with MP-1 microperimetry was the primary outcome. Secondary outcomes included best-corrected visual acuity change, closure rate, anatomical findings on optical coherence tomography such as Ushape foveal contour, restoration of external limiting membrane, and ellipsoid zone.Results: In both groups, MS improved throughout the follow-up. Final MS was greater in the conventional ILM peeling group compared with the inverted flap group, being 16.6 6 2.3 dB versus 14.9 6 2.9 dB, respectively (P = 0.026). In both groups best-corrected visual acuity improved throughout the follow-up, with a final best-corrected visual acuity of 0.19 6 0.14 logMar (20/31 Snellen) in the conventional ILM group and 0.22 6 0.11 logMar (20/33 Snellen) in the inverted flap group (P = 0.398). Anatomical hole closure was achieved in all cases. No difference in optical coherence tomography findings was shown between the two groups.Conclusion: A better final MS was found in eyes undergoing conventional ILM peeling. Inverted flap technique has disadvantages compared with conventional peeling for the treatment of small-to-medium idiopathic macular holes.

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“… 14 Perfluorcarbon liquids and viscoelastic devices have been also used to stabilize and flatten this single-layered flap. 14 , 16 , 17 …”

Section: Discussionmentioning

confidence: 99%

“…Evidence on the use of the inverted flap technique for the treatment of small- and medium-size FTMHs is quite limited, 16 , 18 with no randomized trials comparing this technique with conventional ILM peeling.…”

Section: Discussionmentioning

confidence: 99%

Conventional Internal Limiting Membrane Peeling Versus Inverted Flap for Small-to-Medium Idiopathic Macular Hole

Ventre

Fallico

Longo

et al. 2022

Retina

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“…To our knowledge, there are two recent publications comparing ILM peeling and ILM flap techniques for small and medium MHs retrospectively [ 22 , 23 ]. While Baumann et al.…”

Section: Discussionmentioning

confidence: 99%

“…reported no significant differences between groups [ 22 ], Chou et al. found better results for the ILM flap group in the earlier postsurgical period (up to 6 months after surgery), but not afterwards [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

ILM peeling with ILM flap transposition vs. classic ILM peeling for small and medium macula holes—a prospective randomized trial

Leisser

Ruiß

Pilwachs

et al. 2022

Spektrum Augenheilkd.

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Background The aim of the present study was to compare macular hole closure rates of patients with small and medium-sized macular holes who underwent vitrectomy with internal limiting membrane (ILM) peeling combined with ILM flap transposition over the macular hole, compared with classic ILM peeling. Methods This prospective randomized trial was designed as a pilot study with two groups: ILM peeling with ILM flap transposition over the macular hole vs. classic ILM peeling. Results Among 20 patients recruited, complete analysis could be performed for 16 patients. The macular hole closure rates were 100% in both groups, without significant differences with respect to postsurgical subfoveal hyporeflective zones ( p = 1.0, Fisher’s exact test), postsurgical visual acuity ( p = 0.7, t -test), and postsurgical irregularities of the ellipsoid zone ( p = 1.0, Fisher’s exact test). Conclusion Vitrectomy with ILM peeling combined with ILM flap transposition over the macular hole and classic ILM peeling are both successful methods for the repair of macular holes of small and medium size and are associated with comparable outcomes.

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“…The method has been successfully used for large macular holes [ 2 , 3 ] and macular holes with high myopia [ 4 , 5 ]. It seems to have gained significant attention among vitreoretinal surgeons in recent years and has also been used successfully in macular holes <400 µm with high closure rates [ 6 , 7 , 8 ]. We wanted to explore the question of how a persistent macular hole after vitrectomy with the inverted flap technique can be closed and to what extent this might partly explain the closure mechanism.…”

Section: Introductionmentioning

confidence: 99%

ILM Flap Repositioning for Persistent Macular Hole

Kastl¹,

Heidenkummer

2022

Case Rep Ophthalmol

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We present a case of a persistent macular hole which was initially treated by pars plana vitrectomy with the inverted ILM flap technique. In a second procedure, the internal limiting membrane (ILM) flap was mobilized from its perifoveal adherence to the retina and peeled back to its adherence at the foveal ring. The eye was filled with 25% C2F6 gas. Three weeks after the second procedure, closure of the hole was observed. Best corrected visual acuity increased from 20/400 to 20/50. We assume that contractile elements within the ILM may cause perifoveal adhesion and centrifugal effects preventing macular hole closure. If macular hole closure does not occur after surgery with an inverted ILM flap, it is worth to peel back the existing flap again towards the foveal edge in order to induce hole closure and preserve the benefits of flap surgery. If the flap is only attached to the foveal ring, centripetal contraction could lead to annular closure of the macular hole. If the flap is lost, alternative surgical methods for refractory MHs should be considered.

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Single-Layer Inverted Internal Limiting Membrane Flap Versus Conventional Peel for Small- or Medium-Sized Full-Thickness Macular Holes

Cited by 29 publications

References 32 publications

Conventional Internal Limiting Membrane Peeling Versus Inverted Flap for Small-to-Medium Idiopathic Macular Hole

Conventional Internal Limiting Membrane Peeling Versus Inverted Flap for Small-to-Medium Idiopathic Macular Hole

ILM peeling with ILM flap transposition vs. classic ILM peeling for small and medium macula holes—a prospective randomized trial

ILM Flap Repositioning for Persistent Macular Hole

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