Combination of Inverted ILM Flap Technique and Subretinal Fluid Application Technique for Treatment of Chronic, Persistent and Large Macular Holes

Controlled Trials ◽

Ilm Peeling ◽

Closure Rate ◽

Flap Technique ◽

Randomized Controlled ◽

Background: Vitrectomy with internal limiting membrane (ILM) peeling is an effective surgical procedure for the treatment of macular holes (MHs). However, there is a possibility of poor postoperative anatomical closure with conventional ILM peeling for MHs larger than 400 μm. Therefore, a novel inverted ILM flap technique was developed for such cases. Objectives: This meta-analysis study was performed to evaluate and compare the anatomical and visual outcomes of the inverted ILM flap technique and ILM peeling in large MHs. Methods: The Cochrane Library, PubMed, and Embase databases were searched to identify randomized controlled trials (RCTs). The trial eligibility and risk of bias were assessed according to Cochrane review methods. The primary outcome measures included MH closure rate and postoperative visual acuity (VA). Subgroup analysis of postoperative VA based on follow-up time was also conducted. Pooled odds ratios (ORs), weighted mean difference (WMD), and 95% confidence intervals (CIs) were calculated. Statistical analysis was performed using RevMan 5.3 software. Results: Five RCTs with a total of 155 eyes in the inverted ILM flap group and 161 eyes in the ILM peeling group were included in this meta-analysis. Statistical meta-analysis revealed that the overall MH closure rate in the inverted ILM flap group was significantly higher than that in the ILM peeling group (OR, 3.10; 95% CI, 1.25 to 7.66; P = 0.01). The postoperative VA was significantly better in the inverted ILM flap group than ILM peeling group (WMD, -0.14; 95% CI, -0.21 to -0.07; P = 0.0002). The subgroup meta-analysis indicated that the postoperative VA was significantly better in the inverted ILM flap group than ILM peeling group (WMD, -0.17; 95% CI, -0.26 to -0.08; P = 0.0004) at the 3-month follow-up. However, no significant difference was observed between the two groups at the 6-month follow-up (WMD, -0.09; 95% CI, -0.20 to 0.02; P = 0.10). Conclusions: Vitrectomy with inverted ILM flap technique showed a higher anatomical closure rate as well as visual gain—although only in the short-term as no difference in visual recovery was found at the 6-month follow-up—than did ILM peeling in large MHs. The inverted ILM flap technique should be considered as a preferred and routine procedure for the treatment of patients with MHs larger than 400 µm.

Optical Coherence Tomography Findings in Idiopathic Macular Holes

Journal of Ophthalmology ◽

10.1155/2011/928205 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Lynn L. Huang ◽

David H. Levinson ◽

Jonathan P. Levine ◽

Umar Mian ◽

Irena Tsui

Keyword(s):

Optical Coherence Tomography ◽

Macular Hole ◽

Clinical Assessment ◽

Chart Review ◽

Subretinal Fluid ◽

Optical Coherence ◽

Cross Sectional ◽

Macular Holes ◽

Idiopathic Macular Holes ◽

Intraretinal Cysts

Purpose. To describe the characteristics of idiopathic macular holes (MH) on optical coherence tomography (OCT) and correlate OCT with clinical assessment.Design. Cross-sectional chart review and OCT assessment.Participants. Sixty-seven eyes with a clinically diagnosed idiopathic MH with available OCT data.Methods. A retrospective chart review and OCT assessment.Results. Based on OCT grading, 40 eyes had a full-thickness macular hole (FTMH) and 21 eyes had a lamellar macular hole (LMH). Clinical exam and OCT assessment agreed in 53 (87%) eyes when assessing the extent of MH. Six eyes (14.6%) in the FTMH group, and 3 eyes in the LMH group (14.3%) had persistent vitreomacular traction. Thirty-seven eyes (92.5%) in the FTMH group and 11 eyes (52.4%) in the LMH group had associated intraretinal cysts. Two eyes (5.0%) in the FTMH group and zero eyes in the LMH group had subretinal fluid. Intraretinal cysts were found to be more frequently associated with FTMH than with LMH (P<0.001).Conclusion. This paper described OCT findings in a group of patients with clinically diagnosed MH. A high level of correlation between clinical assessment and OCT findings of LMH and FTMH was observed, and intraretinal cysts were often present in FTMH.

Inverted Internal Limiting Membrane Flap Technique for Extra Large Macular Holes

Current Trends in Ophthalmology ◽

10.18314/ctoy.v1i1.371 ◽

2018 ◽

Vol 1 (1) ◽

pp. 07-13

Author(s):

Ogugua Ndubuisi Okonkwo ◽

Adekunle Olubola Hassan ◽

Olufemi Oderinlo

Keyword(s):

Visual Acuity ◽

Case Series ◽

Functional Results ◽

Vital Role ◽

Symptom Duration ◽

Flap Technique ◽

Macular Holes ◽

Snellen Visual Acuity ◽

Sd Oct

Aim: To investigate the outcome of the inverted Internal Limiting Membrane (ILM) flap technique for extra large idiopathic macular holes (MHs).Methods: A retrospective non-comparative surgical case series of seven eyes of 7 patients with MHs (base diameter of at least 1000 ?m) was conducted. All the MHs were treated using pars plana vitrectomy and brilliant blue G (BBG)-assisted inverted ILM flap technique. Spectral Domain- Optical Coherence Tomography (SD-OCT) images were used to assess the anatomical outcomes of surgery including the macular microstructure, while Best Corrected Snellen Visual Acuity (BCSVA) was used to evaluate the functional outcomes.Results: The average MH size was 1241microns and average symptom duration was nineteen months. All eyes achieved successful anatomical closure and there was no occurrence of a flat open type closure. SD-OCT microstructural study revealed a reconstruction of the Ellispod Zone (EZ) and External Limiting Membrane (ELM), in only 3 eyes. There was an improvement in visual acuity in 5 eyes, while 2 eyes maintained the same as pre operative vision. The largest increase in post operative visual acuity gain was a 4-line improvement in Best Corrected Snellen Visual Acuity (BCSVA) noted in one of the 3 eyes with reconstructed EZ and ELM. The 3 months symptom duration in this patient was the shortest in this series.Conclusion: Inverted ILM flap technique is a safe and effective approach for the management of extra large chronic idiopathic MHs with demonstrably good anatomical and limited functional results in a majority of cases. Postoperative reconstruction of the microstructure is however seen only in a minority of eyes. Despite an absence of the outer retina (EZ and ELM), some eyes still experience an improvement in vision. The symptom duration may play a vital role in functional outcome in this subset of extra large chronic MHs.

Surgical Repair of Traumatic Macular Holes With Extreme Macular Pathology Using an Internal Limiting Membrane Flap Technique

Ophthalmic Surgery Lasers and Imaging Retina ◽

10.3928/23258160-20181002-17 ◽

2018 ◽

Vol 49 (10) ◽

pp. e143-e146

Author(s):

Andrew W. Browne ◽

Felipe F. Conti ◽

Peter K. Kaiser ◽

Rishi P. Singh

Keyword(s):

Surgical Repair ◽

Flap Technique ◽

A Female Case of X-Linked Retinoschisis with Macular Hole Bilaterally

Case Reports in Ophthalmological Medicine ◽

10.1155/2020/8824995 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

A. Altun

Keyword(s):

Visual Acuity ◽

Macular Hole ◽

Pars Plana Vitrectomy ◽

Silicone Oil ◽

Surgical Experience ◽

Flap Technique ◽

Macular Holes ◽

Female Case ◽

Pars Plana

Purpose. We aimed at reminding that X-linked retinoschisis may also be seen in female patients and share our vitreoretinal surgical experience. Methods. The patient underwent pars plana vitrectomy including the closure of the macular holes with inverted ILM flap technique bilaterally. Lens extractions were performed by phacoemulsification during the removal of silicone oil endotamponade. Patient. An 18-year-old girl with X-linked retinoschisis and large macular holes in both eyes presented to the clinic of ophthalmology. It was confirmed that the patient had RS1 mutation Results. Nine-month-follow-up was uneventful for retinal findings. Significant improvement in visual acuity was achieved, and macular holes were remained closed. Conclusion. In cases with large macular holes due to XLR, an inverted ILM flap technique might be safe and effective. Four-month-silicone-endotamponade might be sufficient.

Clinical outcomes with large macular holes using the tiled transplantation internal limiting membrane pedicle flap technique

International Journal of Ophthalmology ◽

10.18240/ijo.2019.02.10 ◽

2019 ◽

Cited By ~ 1

Keyword(s):

Clinical Outcomes ◽

Pedicle Flap ◽

Flap Technique ◽

The Role of Single-Layered Flap in Temporal Inverted Internal Limiting Membrane Flap Technique for Macular Holes: Pros and Cons

Journal of Ophthalmology ◽

10.1155/2019/5737083 ◽

2019 ◽

Vol 2019 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Yasuyuki Takai ◽

Masaki Tanito ◽

Kazunobu Sugihara ◽

Akihiro Ohira

Keyword(s):

Japanese Patients ◽

Symptom Duration ◽

Prone Positioning ◽

Flap Technique ◽

Macular Holes ◽

Pros And Cons ◽

Pars Plana ◽

Minimal Diameter

Purpose. To assess the safety and effectiveness of the single-layered inverted internal limiting membrane (ILM) flap technique for treating chronic, large, or highly myopic macular holes (MHs). Methods. The medical records of 20 eyes of 20 consecutive Japanese patients with large MHs n=6 (minimal diameter, >400 μm), chronic MHs n=2 (symptom duration, >24 months), MHs in high myopia n=11 (axial length, >26 mm), and MHs in a patient unable to maintain prone positioning postoperatively n=1 were reviewed retrospectively. All patients underwent 25-gauge pars plana vitrectomy and the temporal inverted ILM flap technique. A semicircular ILM notch was made temporally two disc diameters from the MH using a 25-gauge knife, and the ILM was peeled temporally to create a semicircular ILM flap using a 25-gauge forceps. The single-layered ILM flap was inverted in a nasal direction to cover the MH. When an epiretinal membrane (ERM) was present, it was peeled before the ILM flap was inverted. Results. The MHs closed successfully in all (100%) eyes postoperatively. In the MHs associated with an ERM, after hole closure, gradual foveal deformation occurred in both the area from which the ILM was not peeled and the ILM flap inverted side. Conclusions. The single-layered inverted ILM flap technique, a simple surgery to treat MHs, provides scaffolding for retinal gliosis and may facilitate bridge formation between the walls of the MH under the flap. Considering the 100% success rate of MH closure, this technique seems to be effective and safe for treating chronic, large, or highly myopic MHs and MHs in patients unable to maintain postoperative prone positioning. In the MHs associated with ERMs, gradual foveal deformation was observed after ERM peeling. Further studies are needed to minimize surgical complications and understand the mechanism of this technique. This trial is registered with UMIN000035091.

Inverted internal limiting membrane flap technique in the surgical treatment of macular holes: 8-year experience

International Ophthalmology ◽

10.1007/s10792-020-01600-4 ◽

2020 ◽

Cited By ~ 1

Author(s):

Nisa Silva ◽

Natália Ferreira ◽

Bernardete Pessoa ◽

Nuno Correia ◽

João Melo Beirão ◽

...

Keyword(s):

Surgical Treatment ◽

Flap Technique ◽

SURGERY FOR IDIOPATHIC MACULAR HOLES ASSOCIATED WITH EXTENSIVE SUBRETINAL FLUID

Retina ◽

10.1097/00006982-200102000-00003 ◽

2001 ◽

Vol 21 (1) ◽

pp. 15-19 ◽

Cited By ~ 6

Author(s):

HOMAYOUN TABANDEH ◽

WILLIAM E. SMIDDY ◽

MOZART MELLO ◽

GEORGE ALEXANDRAKIS ◽

HARRY W. FLYNN ◽

...

Keyword(s):

Subretinal Fluid ◽

Macular Holes ◽

Idiopathic Macular Holes

Outcomes of Inverted Internal Limiting Membrane Flap Technique for Large Idiopathic Macular Holes Surgery in Patients at A Tertiary Care Hospital

Journal of Nepal Medical Association ◽

10.31729/jnma.4393 ◽

2019 ◽

Vol 57 (217) ◽

Author(s):

Kiran Shakya ◽

Ram Prasad Pokhrel ◽

Om Krishna Malla

Keyword(s):

Visual Acuity ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Base Diameter ◽

Flap Technique ◽

Macular Holes ◽

Idiopathic Macular Holes ◽

The Mean

Introduction: Large macular holes cause significant reduction in central visual acuity. The aim ofthe study is to find out short term anatomical and visual outcomes of inverted internal limitingmembrane flaps technique for large macular holes (base diameter>1000μm) surgery in patientsat a tertiary care hospital. Methods: A descriptive cross-sectional study was conducted in a tertiary care hospital fromJanuary 2018 to December 2018 after ethical clearance from the institutional review committee.The study was done in 12 patients with idiopathic macular holes (base diameter>1000μm), theywere repaired with 25 gauge pars plana vitrectomy with brilliant blue assisted large invertedinternal limiting membrane flap technique. Statistical analyses were performed using SPSS 19.0. Results: All twelve eyes had complete anatomical closure. Mean best corrected visualacuity preoperatively was 1.48 logMAR±0.246. The mean macular hole base diameter was1217.0±196.77μm. The mean age of patients was 68.75±4.97 years. Postoperatively,mean best corrected visual acuity was 0.978 logMAR±0.12. There were no postoperativecomplications. All the patients perceived decreased size of central scotoma. Conclusions: Inverted internal limiting membrane flaps for large macular holes is suitable methodfor closure of the very large hole, restoration of functional vision and decreased size of centralscotoma.