Viscoat Assisted Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes Associated with High Myopia

Abstract

Purpose. To investigate the surgical outcomes of Viscoat® assisted inverted internal limiting membrane (ILM) flap technique for large macular holes (MHs) associated with high myopia. Design. Prospective, interventional case series. Methods. Fifteen eyes of 15 patients with high myopia underwent vitrectomy and Viscoat assisted inverted ILM flap technique to treat MH without RD. Patients were followed up over 6 months. The main outcome measures were MH closure evaluated by optical coherence tomography (OCT) and best-corrected visual acuities (BCVAs). Result. MH closure was observed in all eyes (100%) following the initial surgery. Type 1 closure was observed in 13 eyes (86.7%); type 2 closure was observed in the remaining 2 eyes (13.3%). Compared to the preoperative baseline, the mean BCVA (logarithm of the minimum angle of resolution) improved significantly at 3 months and 6 months after surgery (P = 0.025, 0.019, resp.). The final BCVA improved in 10 eyes (66.7%), remained unchanged in 3 eyes (20.0%), and worsened in 2 eyes (13.3%). Conclusion. Vitrectomy combined with Viscoat assisted inverted ILM flap technique is an effective treatment for large MHs in highly myopic eyes. It may increase the success rate of the initial surgery and enhance the anatomical and functional outcomes.

Efficacy of the Perfluoro-N-Octane-Assisted Single-Layered Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes

“…The ILM around the MH was left to cover the hole and showed a better anatomical closure rate and visual outcome than ILM peeling for large MHs. Since then, several modifications were reported for the treatment of the aforementioned challenging situations [9][10][11][12] . Our group has reported a modified technique to cover a MH with a single-layered ILM flap that would be more physiologic and provide a more regular structure for glial proliferation [10] .…”

Sub-perfluoro-n-octane injection of ocular viscoelastic device assisted inverted internal limiting membrane flap for macular hole retinal detachment surgery: a novel technique

“…This fluid, combined with the movement of the globe, could produce turbulence, which may dislocate the ILM flap from the MH after surgery. Thus, retinal glue such as OVD to stabilize the ILM flap has been used to resolve the problem [5,7,11,12]. However, OVD application onto MH or ILM is challenging in a fluid-filled eye.…”

Internal Limiting Membrane Peeling in Macular Hole Surgery; Why, When, and How?

“…This is typically trimmed to shorten the length of the frill to ~0.5-1mm in length, and then inverted into the hole using forceps. 94 [96][97][98][99][100][101][102][103][104][105] The technique is thought to work by both a scaffold effect and the presence of Muller cell fragments on the peeled ILM acting to stimulate a glial cell response aiding closure. 93 Although closure rates are improved, the question arises as to whether visual prognosis is affected in any way by the presence of the non-neural retinal sheet in the hole.…”

“…Heavy liquids can be used to hold the flap in place during a fluid air exchange before gas exchange and face down positioning for a few days. [108][109][110][111][112][113][114]…”