The Role of Internal Limiting Membrane Flap for Highly Myopic Macular Hole Retinal Detachment: Improving the Closure Rate but Leading to Excessive Gliosis

Chen, Yiqi; Wang, Jun; Ye, Xin; Yu, Jiafeng; Tao, Jiwei; Lin, Lei; Wu, Sulan; Qu, Jia; Shen, Lijun

doi:10.3389/fmed.2021.812693

Cited by 10 publications

(13 citation statements)

References 36 publications

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“…However, the BCVA between closed MH and unclosed MH was not significantly different, which was in line with other studies. [13,21,25] Previous studies have shown that ELM and EZ restoration was associated with improvement of postsurgical BCVA [26]. However, the outer retinal layer was difficult to identify in our study due to chorioretinal atrophy, indicating that irreversible damage had occurred in the photoreceptor layer.…”

Section: Discussionmentioning

confidence: 60%

Macular buckling alone versus combined inverted ILM flap on macular hole-associated macular detachment in patients with high myopia

Zhao

Song

Tanumiharjo

et al. 2023

Eye

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Purpose To compare the efficacy of macular buckling (MB) alone against a combined internal limiting membrane (ILM) inversion flap for full-thickness macular hole (FTMH)-associated macular detachment (MD) in patients with high myopia. Methods This was a prospective interventional case series of patients with high myopia surgically treated with MB alone or combined with an inverted ILM flap for FTMH- associated MD. Best-corrected visual acuity (BCVA) at the 24-month postoperative follow-up, rate of initial retinal reattachment and macular hole closure were measured. Results A total of 62 eyes from 62 participants (33 in the MB group, 29 in the combination group) were studied. Postoperative BCVA improved significantly in both the combination group (P < 0.001) and the MB group (P = 0.027). The postoperative BCVA at 12 months (P = 0.021) and 24 months (P = 0.041) was significantly better in the combination group than in the MB group. The postoperative BCVA was not significantly different between the eyes with closed and unclosed MH at each follow-up time point (P > 0.05). In the combination group, we observed earlier retinal reattachment and closure of the MH as well as a higher rate of MH closure (82.8% vs. 66.7%) than in the MB group, although this difference was insignificant (P = 0.248). Conclusion MB combined with the ILM flap inversion technique achieved better postoperative BCVA and a higher success rate of MH closure than MB alone. We believe that combination surgery should be preferentially recommended.

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Section: Discussionmentioning

confidence: 60%

Macular buckling alone versus combined inverted ILM flap on macular hole-associated macular detachment in patients with high myopia

Zhao

Song

Tanumiharjo

et al. 2023

Eye

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“…Moreover, retraction of the outer layer of Mu¨ller cells that envelops the photoreceptor cells can lead to centrifugal displacement of photoreceptor cells. 33 In the temporal inverted ILM flap technique, a large monolayer ILM flap provides a more stable structure for glial cell proliferation. As glial cells present and adhere to the ILM flap, sticking to the retinal surface due to ILM turnover and being unable to migrate to the fully sealed MH space, the proliferation of glial cells within the MH wall also has an important role in MH closure.…”

Section: Discussionmentioning

confidence: 99%

Temporal inverted internal limiting membrane flap technique for myopic macular hole retinal detachment reconstruction

Teng,

Zhang

2024

J Int Med Res

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Objective To examine the effects of the temporal inverted internal limiting membrane (ILM) flap technique for foveal reconstruction in patients with highly myopic macular hole-associated retinal detachment (MHRD). Methods A retrospective case series analysis of four patients (four eyes) with MHRD was conducted. The foveal optical coherence tomography changes following treatment using the temporal inverted ILM flap technique were evaluated. Results In Patient 1, the ILM bridged the macular hole and residual subretinal fluid on postoperative day 6, and complete retinal reattachment was achieved at 19 months. Patient 2 exhibited reduced retinal detachment, with visible ILM inversion and macular hole closure after 14 days. In Patient 3, macular hole closure and fovea formation had occurred by day 25, and the ILM flap was visible. At 2 months, the outer collagenous layer connection in the central fovea and recovery of the external limiting membrane and ellipsoid zone were observed. Patient 4 had a “white hole” MHRD, with macular hole closure achieved on postoperative day 20, albeit with a suboptimal foveal shape. Conclusion The temporal inverted ILM flap technique in conjunction with vitrectomy facilitates foveal reconstruction in patients with successful treatment of MHRD, and this reconstruction process can be observed by optical coherence tomography.

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“…However, a proliferative response has also been observed after the classic inverted ILM flap technique. Chen et al 13 described a series of 45 eyes with myopic MH and RD. Twenty-four eyes were treated with ILM peeling, and 21 eyes were treated with the inverted ILM flap technique.…”

Section: Discussionmentioning

confidence: 99%

Visual Improvement Despite Macular Pucker After Inverted Internal Limiting Membrane Flap Technique for Idiopathic Macular Hole

Buckle,

Jawaheer,

Keller

2024

Journal of VitreoRetinal Diseases

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Purpose: To report a case of a macular pucker forming after macular hole (MH) repair with the inverted internal limiting membrane (ILM) flap technique, with resolution after secondary inverted ILM flap peeling. Methods: A single case was evaluated. Results: A 76-year-old woman presented with reduced central vision (28 letters) in the right eye. Optical coherence tomography (OCT) identified an idiopathic full-thickness MH measuring 629 µm in diameter. The patient had pars plana vitrectomy with inverted ILM flap formation. One month postoperatively, the visual acuity (VA) in the right eye was 47 letters and OCT confirmed MH closure. However, the patient developed deterioration in the central vision 10 months postoperatively. A macular pucker in the inverted ILM flap region was found on OCT. Repeat vitrectomy with inverted ILM flap peeling was performed. Postoperatively, the VA in the right eye improved to 60 letters and OCT showed resolution of the macular pucker. Conclusions: A complication of the inverted ILM flap technique for MH is formation of a macular pucker in the region of the inverted ILM flap. Secondary inverted ILM flap peeling results in resolution of the macular pucker.

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The Role of Internal Limiting Membrane Flap for Highly Myopic Macular Hole Retinal Detachment: Improving the Closure Rate but Leading to Excessive Gliosis

Cited by 10 publications

References 36 publications

Macular buckling alone versus combined inverted ILM flap on macular hole-associated macular detachment in patients with high myopia

Macular buckling alone versus combined inverted ILM flap on macular hole-associated macular detachment in patients with high myopia

Temporal inverted internal limiting membrane flap technique for myopic macular hole retinal detachment reconstruction

Visual Improvement Despite Macular Pucker After Inverted Internal Limiting Membrane Flap Technique for Idiopathic Macular Hole

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