Broad internal limiting membrane peeling with adjunctive plasma–thrombin for repair of large macular holes

2020 ◽  
pp. 112067212092021
Author(s):  
Kyle A Bolo ◽  
Stanley Chang
Keyword(s):  
Case Series ◽  
Internal Limiting Membrane ◽  
Adjunctive Treatment ◽  
Retinal Layer ◽  
Retrospective Case ◽  
Closure Rate ◽  
Autologous Plasma ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
Macular Holes

Purpose To assess the potential efficacy of broad internal limiting membrane peeling with adjunctive plasma–thrombin instillation to treat large macular holes and to make qualitative comparisons to internal limiting membrane peeling without adjunctive treatment and internal limiting membrane peeling with inverted and free internal limiting membrane flaps. Methods A systematic literature review and a retrospective case series. Participants in the case series (N = 39) had idiopathic macular holes larger than 400 µm as measured on spectral-domain optical coherence tomography and underwent pars plana vitrectomy, internal limiting membrane peeling, placement of autologous plasma and bovine thrombin over the hole, and gas tamponade. Repeat imaging and clinical data were collected from 1, 2, 3, 6, and 12 months postoperatively. Results Macular hole closure rate was 97%; 82% had U-type closures. At 12 months, 11% had defects in the external limiting membrane and 22% in the ellipsoid zone. This closure rate is similar to prior studies of internal limiting membrane flaps, while the U-type closure rate and retinal layer restoration compare favorably to those reported for internal limiting membrane peeling alone and internal limiting membrane flaps; 75% experienced a three-line improvement in visual acuity by 6 months, which exceeds results by either method. Conclusion Plasma–thrombin instillation over macular holes may be a less-complicated alternative adjunct to internal limiting membrane flaps that can achieve similar outcomes when combined with internal limiting membrane peeling.

Autologous internal limiting membrane transplant for recurrent idiopathic macular holes

2020 ◽  
pp. 112067212090639 ◽  
Author(s):  
Tommaso Rossi ◽  
Carlandrea Trillo ◽  
Guido Ripandelli
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Outer Segment ◽  
Internal Limiting Membrane ◽  
Control Group ◽  
Closure Rate ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
Macular Holes ◽  
Idiopathic Macular Holes

Purpose: To report a series of recurrent idiopathic macular holes treated by means of a free autologous internal limiting membrane flap and compare visual and anatomic results to a control group undergoing further internal limiting membrane peeling and novel gas tamponade. Methods: Retrospective surgical series of 15 consecutive patients receiving autologous internal limiting membrane flap compared to 14 patients operated on for internal limiting membrane peeling enlargement. Autologous internal limiting membrane flap was created after brilliant blue G staining, internal limiting membrane lifting, perfluorocarbon bubble injection and creation of a wide internal limiting membrane free flap translocated underneath perfluorocarbon liquid, to the macular hole bed. Both groups were tamponated with 20% SF6 and positioned face down for 4 h a day for 3 days. Results: Macular hole closed in 14/15 (93.3%) patients of the autologous internal limiting membrane group and 9/14 (64.2%) controls (p < 0.05). Visual acuity increased from 0.05 ± 0.03 to 0.23 ± 0.13 Snellen in the autologous internal limiting membrane group and from 0.05 ± 0.03 to 0.14 ± 0.10 Snellen of controls (p < 0.05 for both). Vision of the autologous internal limiting membrane group improved more than controls at 1 month (p = 0.043) and 3 months (p = 0.045). Inner segment/outer segment interruption at 3 months was smaller in the autologous internal limiting membrane group than controls, reducing from 1230 ± 288 µm at baseline to 611 ± 245 and 547 ± 204 µm at 3 months versus 1196 ± 362, 745 ± 222 and 705 ± 223 µm, respectively (p < 0.05). Conclusion: Autologous internal limiting membrane flap can effectively close recurrent idiopathic macular holes with a higher closure rate, smaller residual inner segment/outer segment line interruption and higher visual acuity at 3 months than previous standard of care.

Conventional internal limiting membrane peeling versus temporal inverted internal limiting membrane flap for large macular holes

2019 ◽  
pp. 112067211989242 ◽  
Author(s):  
Remzi Avci ◽  
Aysegul Mavi Yildiz ◽  
Sami Yilmaz
Keyword(s):  
Case Series ◽  
Internal Limiting Membrane ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
Flap Technique ◽  
Macular Holes ◽  
Complete Restoration ◽  
Group 2 ◽  
Papillomacular Bundle ◽  
Group 1

Purpose: To compare the functional, anatomical, and morphological results of conventional internal limiting membrane peeling versus temporal inverted internal limiting membrane flap technique for the treatment of macular holes larger than 400 μm. Design: Retrospective, comparative case series. Methods: A total of 33 patients were included, of whom 18 were treated with internal limiting membrane peeling (Group 1) and 15 were treated with temporal inverted internal limiting membrane flap technique (Group 2). Complete ophthalmic examination, such as microperimetry and optical coherence tomography, was performed preoperatively and at 12 months after surgery. Results: The closure rates accomplished in Groups 1 and 2 were 72.2% and 100%, respectively (p = 0.036). The mean improvement in best-corrected visual acuity was logMAR 0.49 ± 0.17 in Group 1 and logMAR 0.91 ± 0.15 in Group 2 (p = 0.037). U-shaped closure was achieved in one eye in Group 1 and 12 eyes in Group 2 (p < 0.001). Complete restoration of external limiting membrane and ellipsoid zone rates were significantly higher in Group 2 (p = 0.027 and p = 0.001, respectively). Conclusion: The single-layered temporal inverted internal limiting membrane flap technique improves not only anatomical and morphological but also functional outcomes of surgery for large macular holes. Furthermore, this technique seems to minimize the risk of iatrogenic trauma to the nasal part of the fovea and the corresponding papillomacular bundle fibers.

FOVEA-SPARING VERSUS COMPLETE INTERNAL LIMITING MEMBRANE PEELING IN VITRECTOMY FOR THE TREATMENT OF MACULAR HOLES

Retina ◽  
2020 ◽  
Vol 40 (7) ◽  
pp. 1306-1314 ◽  
Author(s):  
Francesco Morescalchi ◽  
Andrea Russo ◽  
Hassan Bahja ◽  
Elena Gambicorti ◽  
Anna Cancarini ◽  
...  
Keyword(s):  
Internal Limiting Membrane ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
Macular Holes

scholarly journals Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yu Shen ◽  
Xiaoqin Lin ◽  
Luyi Zhang ◽  
Miaoqin Wu
Keyword(s):  
Sensitivity Analysis ◽  
Meta Analysis ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
Visual Outcomes ◽  
Flap Technique ◽  
Macular Holes

Abstract Background The purpose of this study was to compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique and internal limiting membrane peeling in large macular holes (MH). Methods Related studies were reviewed by searching electronic databases of Pubmed, Embase, Cochrane Library. We searched for articles that compared inverted ILM flap technique with ILM peeling for large MH (> 400 μm). Double-arm meta-analysis was performed for the primary end point that was the rate of MH closure, and the secondary end point was postoperative visual acuity (VA). Heterogeneity, publication bias, sensitivity analysis and subgroup analysis were conducted to guarantee the statistical power. Results This review included eight studies involving 593 eyes, 4 randomized control trials and 4 retrospective studies. After sensitivity analysis for eliminating the heterogeneity of primary outcome, the pooled data showed the rate of MH closure with inverted ILM flap technique group was statistically significantly higher than ILM peeling group (odds ratio (OR) = 3.95, 95% confidence interval (CI) = 1.89 to 8.27; P = 0.0003). At the follow-up duration of 3 months, postoperative VA was significantly better in the group of inverted ILM flap than ILM peeling (mean difference (MD) = − 0.16, 95% CI = − 0.23 to 0.09; P < 0.00001). However, there was no difference in visual outcomes between the two groups of different surgical treatments at relatively long-term follow-up over 6 months (MD = 0.01, 95% CI = − 0.12 to 0.15; P = 0.86). Conclusion Vitrectomy with inverted ILM flap technique had a better anatomical outcome than ILM peeling. Flap technique also had a signifcant visual gain in the short term, but the limitations in visual recovery at a longer follow-up was found.

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