Visual improvement and regeneration of retinal layers in eyes with small, medium, and large idiopathic full-thickness macular holes treated with the inverted internal limiting membrane flap technique over a period of 12 months

Abstract

Purpose This study aims to compare the improvement of best-corrected visual acuity (BCVA) and the reduction in defect length of external limiting membrane (ELM) and ellipsoid zone (EZ) in small ($$<$$ < 250 μm), medium ($$\ge$$ ≥ 250 μm), and large ($$\ge$$ ≥ 400 μm) full-thickness macular holes (FTMH) treated with inverted internal limiting membrane (I-ILM) flap technique over a follow-up period of 12 months. Methods Ninety-one eyes of 87 patients were enrolled in this retrospective study. BCVA and spectral-domain optical coherence tomography (SD-OCT) were conducted preoperatively as well as after 1, 3, 6, 9, and 12 months postoperatively. The defect length of the ELM and the EZ was measured using the caliper tool at each follow-up time point. Results BCVA improved significantly in the group of small, medium, and large FTMH over the time of 12 months, whereby the improvement did not depend on FTMH size over 9 months. Only after 12 months, large FTMH showed significantly higher BCVA improvement compared to small and medium FTMH. The closure rate was 100% (91/91). The defect length of ELM and EZ reduced continuously over the period of 12 months. There was a significant correlation between defect length of ELM and EZ with postoperative BCVA. Conclusion The I-ILM flap technique has very good morphological and functional outcomes in small, medium, and large FTMH over a long-time period, indicating that it can be considered as a treatment option in small and medium FTMH. The defect length of ELM and EZ is directly connected to postoperative BCVA.

Comparison of the use of internal limiting membrane flaps versus conventional ILM peeling on post-operative anatomical and visual outcomes in large macular holes

“…It is possible that the early improvement in visual function noted by these authors arises from the superior initial closure rates, and at later time points after revision surgery in non-closed holes the effect diminishes. It has also been hypothesised that ILM flaps may mechanically obstruct the restoration of the ellipsoid zone and external limiting membrane, essential to good post-operative visual function in FTMH repair [ 29 – 32 ]. Future studies with larger cohorts and long follow-up of at least 12 months are required to evaluate whether the initial impact of increased primary closure is accompanied by any beneficial or detrimental effect on post-operative visual function.…”

Recovery of idiopathic macular hole at different stages after surgery: A Systematic Review and Meta-analysis

“…Multiple authors reported that the defects in the EZ and ELM were a major reason for unsatisfactory postoperative visual recovery 16,19,24,26 . Nevertheless, Ooka et al 17 reported that IS/OS and ELM defect changes are not related to the changes of BCVA.…”

Minimal posterior pole vitrectomy and fixing the inverted ILM flap with DisCoVisc® for macular hole: no gas or air tamponade

“…21 Therefore, it may be a wise choice to adopt a single-layer inverted ILM flap technique for large (.400 mm), medium, and small MHs in clinical practice. 22,23 A single-layer inverted ILM flap highly avoids the formation of gliotic tissue in the fovea associated with inserting the ILM into the hole, which is believed to interfere with the fovea morphologic restoration and visual function recovery. 23 According to the MH closure morphology classification by Imai et al, 24 in this study, at the last follow-up, 12 eyes (83.3%; 12/18) showed a U-type closure; five eyes (cases 2, 3, 8, 17, and 18; 5/18) showed a V-type closure; and one eye demonstrated a W-type closure (case 6; 1/18).…”