Vitrectomy With Internal Limiting Membrane Transplants in the Closure of 2 Adjacent Macular Holes

2021 ◽  
pp. 247412642110183
Author(s):  
Gregg T. Kokame ◽  
Kevin Card
Keyword(s):  
Case Report ◽  
Gas Exchange ◽  
Clinical Presentation ◽  
Internal Limiting Membrane ◽  
Management Problem ◽  
Ilm Peeling ◽  
Tissue Proliferation ◽  
Macular Holes

Purpose: Two adjacent macular holes (MHs), which were noted in the highly myopic left eye of an 85-year-old woman, is an uncommon clinical presentation. This case report presents the successful closure of the 2 adjacent MHs using internal limiting membrane (ILM) transplants during vitrectomy that included. Methods: ILM transplants were placed within both MHs during vitrectomy that included ILM peeling and fluid gas exchange with 18% perfluoropropane (C3F8) and postoperative facedown positioning for 1 week. Results: Both MHs were successfully closed following surgery with improvement in vision and decrease in metamorphopsia. Conclusions: This case suggested that relief of traction by ILM peeling and placement of ILM transplants within both MHs to provide a scaffold and stimulate glial tissue proliferation may have facilitated closure of the 2 adjacent MHs, which is a difficult management problem to manage and not previously reported to the best of our knowledge.

scholarly journals Inverted internal limiting membrane flap technique versus internal limiting membrane peeling for large macular holes: A meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Ji-Guo Yu ◽  
Jing Wang ◽  
Yi Xiang
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Internal Limiting Membrane ◽  
Controlled Trials ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Flap Technique ◽  
Randomized Controlled ◽  
Macular Holes

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.

Method of surgical treatment of small and medium diameter macular holes with the foveal-sparing internal limiting membrane peeling

2021 ◽  
pp. 213-216
Author(s):  
A.A. Shpak ◽  
◽  
A.I. Kolesnik ◽  
F.A. Avakyan ◽  
V.A. Pismenskaya ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Developed Countries ◽  
Clear Understanding ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Air Tamponade ◽  
Medium Diameter

Introduction and purpose. Idiopathic macular hole (IMH) is an urgent medical and social problem of the population of developed countries. It is known that microinvasive 3-port vitrectomy with gas-air tamponade is a generally accepted method of surgical treatment of IMH. There is still no clear understanding of the reasons for incomplete functional success in this category of patients, despite the anatomical success.Thus, there is a need to develop and implement in clinical practice a modification of the ILM peeling technique for the treatment of small and medium-diameter of IMH, which would not be inferior in anatomical effectiveness to existing methods and would be accompanied by a less damaging effect on the structures of the retina. Material and methods. The study included 10 patients with a diagnosis of IMH, who underwent a 3-port microinvasive 25G vitrectomy with the preservation of foveal ILM. Results. The analysis of the clinical and functional results of surgical treatment of IMH with the foveal fragment left revealed the complete closure of the macular tear, the absence of gross defects of the ellipsoid zone, an increase in the values of the average visual acuity and microperimetry from the 1st month of dynamic observation. Conclusion. The proposed low-traumatic method of fovea - sparing ILM peeling provides stable anatomical and functional result, the restoration of both morphological and functional parameters, and minimizes the mechanical impact on the retina in the fovea. Key words: macular rupture, internal limiting membrane, fovea-sparing ILM peeling.

scholarly journals Comparison of Anatomical and Visual Outcomes between Idiopathic and Myopic Macular Holes Using the Internal Limiting Membrane or Inverted Internal Limiting Membrane Flap Technique

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Federico Peralta Iturburu ◽  
Claudia Garcia-Arumi ◽  
Maria Bové Alvarez ◽  
Jose Garcia-Arumi
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Small Sample Size ◽  
Internal Limiting Membrane ◽  
Small Sample ◽  
Ilm Peeling ◽  
Visual Outcomes ◽  
Macular Holes ◽  
Idiopathic Macular Holes

Purpose. To compare the results of vitrectomy with those of internal limiting membrane (ILM) peeling or inverted ILM flap for treating myopic or idiopathic macular hole. Methods. Thirty-nine eyes of 39 patients undergoing vitrectomy with ILM peeling for macular hole (25 idiopathic and 14 myopic) and 27 eyes of 27 patients undergoing vitrectomy with inverted ILM flap (15 idiopathic and 12 myopic) were included. Outcome measures were macular hole closure by optical coherence tomography and visual acuity at 6 months. Results. Closure was achieved in 25 (100%) idiopathic and 12 (86%) myopic macular holes in the ILM peeling group and in 14 (93%) idiopathic and 11 (91.77%) macular holes in the inverted ILM flap group. There were no statistically significant differences in restoration of the external limiting membrane and ellipsoid zone between the groups. Median best-corrected visual acuity (logarithm of minimal angle of resolution) at the end of follow-up was 0.22 (20/32 Snellen) in idiopathic and 0.4 (20/50) in myopic (P=0.042) patients in the ILM peeling group and 0.4 (20/50) in idiopathic and 0.4 (20/50) in myopic (P=0.652) patients in the inverted ILM flap group. Conclusion. Both techniques were associated with high closure rates in myopic and idiopathic macular holes, with somewhat better visual outcomes in idiopathic cases. The small sample size may have provided insufficient power to support the superiority of one technique over the other in the two groups.

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.

scholarly journals Effect of internal limiting membrane peeling on normal retinal function evaluated by microperimetry-3

2020 ◽  
Author(s):  
Yue Qi ◽  
Zengyi Wang ◽  
Shi-Ming Li ◽  
Qisheng You ◽  
Xida Liang ◽  
...  
Keyword(s):  
Internal Limiting Membrane ◽  
Retinal Function ◽  
Fundus Photography ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Pars Plana ◽  
Air Tamponade ◽  
23 Gauge

Abstract Background To evaluate the effect of internal limiting membrane (ILM) peeling surrounding macular holes (MH) for the function of retina by microperimetry-3(MP-3). Methods This is a prospective, cohort study which included patients with MHs who were treated by 23-gauge 3-port pars plana vitrectomy and ILM peeling with air tamponade. Color fundus photography, retinal optical coherence tomography and MP-3 were performed 1 week before, 1 and 4 months after the operation. In MP-3 examination, a customized follow-up pattern with 45 spots in the central 8° visual field was used. The spots corresponding to the retina surrounding macular holes were selected for comparison of pre- and post-operative function. Results We incuded 44 eyes of 44 patients with best corrected visual acuity (BCVA) of 1.06±0.40 (logMAR). All eyes achieved an anatomical success at 4 months. BCVA significantly improved at 1 month (0.53±0.30, P<0.01) and 4 months (0.31±0.24, P<0.01), respectively. Mean retinal sensitivity (MRS, dB) of the retina surrounding macular hole was 23.46±3.01 dB at baseline, and significantly increased at 1 month (26.25±2.31 dB, u=-4.88, P<0.01) and 4 months(27.14±2.45 dB, t=-6.29, P<0.01). Patients with increased MRS are significantly younger than those with deceased MRS (59.72±3.22 years vs. 65.60±8.19 years, P<0.01). After ILM peeling, the increasing extent of MRS was significantly higher in inferior and nasal retina than in superior and temporal retina at 1 and 4 months (P<0.05). Conclusion ILM peeling in normal retina will not decrease the retinal function in a short-term after surgery.

scholarly journals The effect of internal limiting membrane peeling to normal retinal function evaluated by microperimetry-3

2019 ◽  
Author(s):  
Yue Qi ◽  
Zengyi Wang ◽  
Qisheng You ◽  
Xida Liang ◽  
Yanping Yu ◽  
...  
Keyword(s):  
Internal Limiting Membrane ◽  
Retinal Function ◽  
Fundus Photography ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Pars Plana ◽  
Air Tamponade ◽  
23 Gauge

Abstract Background To evaluate the effect of internal limiting membrane (ILM) peeling to the function of retina surrounding macular holes (MH) by microperimetry-3(MP-3). Methods This is a prospective, cohort study which included 44 eyes of 44 patients with MHs who were treated by 23-gauge 3-port pars plana vitrectomy and ILM peeling with air tamponade. Color fundus photography, retinal optical coherence tomography and MP-3 were used 1 week before and 1, 4 months after operation. In MP-3 examination, a customized follow-up pattern with 45 spots in the central 8° visual field was used. The spots corresponding to the retina surrounding macular holes were selected for comparison of pre- and post-operative function. Results All eyes had achieved an anatomical success at the last follow-up. BCVA (logMAR) significantly improved both in 1 and 4 months after surgery (1.06±0.40 versus 0.53±0.30 and 0.31±0.24, P<0.01). The mean retinal sensitivity (MRS) (in dB) of the retina surrounding macular hole significantly increased 1 and 4 months after ILM peeling: pre-operative 23.46±3.01 dB versus post-operative 26.25±2.31 dB (u=-4.88, P<0.01) in 1 month and 27.14±2.45 dB (t=-6.29, P<0.01) in 4 months. Patients with increased MRS are significantly younger than patients with deceased MRS (59.72±3.22 years versus 65.60±8.19 years, P<0.01). After ILM peeling, the increasing extent of MRS was significantly higher in inferior and nasal retina than that in superior and temporal retina both in 1 and 4 months (P<0.05). Conclusion ILM peeling in normal retina will not decrease the retinal function in a short-term after surgery.

scholarly journals Effect of internal limiting membrane peeling on normal retinal function evaluated by microperimetry-3

2020 ◽  
Author(s):  
Yue Qi ◽  
Zengyi Wang ◽  
Shi-Ming Li ◽  
Qisheng You ◽  
Xida Liang ◽  
...  
Keyword(s):  
Internal Limiting Membrane ◽  
Retinal Function ◽  
Fundus Photography ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Pars Plana ◽  
Air Tamponade ◽  
23 Gauge

Abstract Introduction To evaluate the effect of internal limiting membrane (ILM) peeling surrounding macular holes (MH) for the function of retina by microperimetry-3(MP-3). Materials and Methods This is a prospective, cohort study which included patients with MHs who were treated by 23-gauge 3-port pars plana vitrectomy and ILM peeling with air tamponade. Color fundus photography, retinal optical coherence tomography and MP-3 were performed 1 week before, 1 and 4 months after the operation. In MP-3 examination, a customized follow-up pattern with 45 spots in the central 8° visual field was used. The spots corresponding to the retina surrounding macular holes were selected for comparison of pre- and post-operative function. Results We included 44 eyes of 44 patients with best corrected visual acuity (BCVA) of 1.06±0.40 (logMAR). All eyes achieved an anatomical success at 4 months. BCVA significantly improved at 1 month (0.53±0.30, P<0.01) and 4 months (0.31±0.24, P<0.01), respectively. Mean retinal sensitivity (MRS, dB) of the retina surrounding macular hole was 23.46±3.01 dB at baseline, and significantly increased at 1 month (26.25±2.31 dB, u=-4.88, P<0.01) and 4 months(27.14±2.45 dB, t=-6.29, P<0.01). Patients with increased MRS are significantly younger than those with deceased MRS (59.72±3.22 years vs. 65.60±8.19 years, P<0.01). After ILM peeling, the increasing extent of MRS was significantly higher in inferior and nasal retina than in superior and temporal retina at 1 and 4 months (P<0.05). Conclusion ILM peeling in normal retina will not decrease the retinal function in a short-term after surgery.

scholarly journals Vitrectomy with Internal Limiting Membrane Peeling and Gas Tamponade for Myopic Foveoschisis

2021 ◽  
Author(s):  
Jingyi Zhang ◽  
Yanping Yu ◽  
Dongshu Dai ◽  
Wu Liu
Keyword(s):  
Randomized Study ◽  
Significant Risk ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Foveal Thickness ◽  
Myopic Foveoschisis ◽  
Gas Tamponade ◽  
Central Foveal Thickness ◽  
Macular Holes ◽  
Air Tamponade

Abstract Background We evaluated the effect of vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade for myopic foveoschisis (MF),and analysed prognosis with different gas tamponade. Methods Retrospective, non-randomized study. The records of patients with MF treated by vitrectomy, were reviewed. Patients were followed up postoperatively mean 16.74 months, to record changes of Best-corrected visual acuity (BCVA) and central foveal thickness (CFT). Results 62 eyes (59 patients) were analysed in total, with mean age of 55.29 ± 10.34 years, 49 females (83.1%). Foveoschisis completely resolved in all eyes at least 6 months post vitrectomy, except for two postoperative full-thickness macular holes (FTMH). Final BCVA improved significantly from 0.69 ± 0.39 to 0.44 ± 0.42 logMAR, and CFT from 502.47 ± 164.78 to 132.67 ± 52.26 µm. Patients were subdivided into three subgroups based on the different endotamponades used (C3F8, C2F6, and air). Baseline BCVA, baseline CFT and foveal detachment (FD) were not significantly different among the three groups. Eyes treated with air tamponade had better visual outcomes than eyes with C3F8 tamponade (P = 0.009). Baseline BCVA and FD were significant risk factors for postoperative BCVA (P<0.001 and P = 0.013, respectively). Conclusions Vitrectomy with ILM peeling and gas tamponade results in good functional and anatomic outcomes in the treatment of MF. Good vision and no-FD pre-surgery are related with good visual prognosis. Air tamponade can provide faster visual recovery and reduce postoperative complications, compared with expansive gas.

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