Inverted Internal Limiting Membrane Flap vs Complete Internal Limiting Membrane Peeling for Large Macular Holes in Nonposturing Surgery

2021 ◽  
pp. 247412642110222
Author(s):  
Rubina Rahman ◽  
Mohammad Waseem Sarfraz ◽  
Mohamad El-Wardani
Keyword(s):  
Visual Acuity ◽  
Functional Outcomes ◽  
Internal Limiting Membrane ◽  
Full Thickness ◽  
Ilm Peeling ◽  
Minimum Diameter ◽  
Internal Limiting Membrane Peeling ◽  
Surgical Success ◽  
Macular Holes ◽  
Hole Closure

Purpose: This study compared anatomical and functional outcomes of the inverted internal limiting membrane flap (ILMF) technique with complete ILM peeling (ILMP) in nonposturing surgery for large, full-thickness macular holes (MHs). Methods: This was a retrospective, comparative, single-surgeon study. Eyes with idiopathic large full-thickness MHs (minimum diameter > 400 μm) were included. A total of 46 patients including 22 ILMF cases and 24 ILMP cases were analyzed. No positioning instructions were advised postoperatively. Results: Primary hole closure was achieved in all patients (100%) in both groups. Mean logMAR visual acuity (VA) improved significantly in both groups compared with the preoperative values (ILMF: 0.60 [SD, 0.26] postoperatively, vs 0.93 [SD, 0.3] preoperatively, P = .032; ILMP: 0.43 [SD, 0.22] postoperatively vs 0.83 [SD, 0.16] preoperatively, P < .01). However, ILMP showed a statistically significant improvement in VA compared with ILMF ( P = .02). Conclusions: All MHs in both groups closed after surgery (100%). There was a statistically significant improvement of VA in the ILMP group compared with the ILMF group ( P = .02). Not posturing after surgery did not compromise surgical success in both groups.

scholarly journals Conventional Internal Limiting Membrane Peeling Versus Temporal Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes: A Comparative Study

2021 ◽  
Author(s):  
Nurullah Koçak ◽  
Volkan Yeter ◽  
Hakkı Birinci
Keyword(s):  
Functional Outcomes ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Internal Limiting Membrane Peeling ◽  
Flap Technique ◽  
Macular Holes ◽  
Group 2 ◽  
Hole Closure ◽  
Group 1

Abstract Purpose: To compare the anatomical, morphological, and functional outcomes of the conventional internal limiting membrane (ILM) peeling versus temporal inverted internal limiting membrane flap technique for large full-thickness macular holes (FTMHs). Subjects and Methods: Forty-six eyes of 44 patients with a minimum base diameter > 600 µm were included in this retrospective interventional study. The patients were divided into Group 1 (conventional ILM peeling) and Group 2 (temporal inverted ILM flap). The hole closure rate, best-corrected visual acuity (BCVA), ellipsoid zone (EZ), and external limiting membrane (ELM) defects were analyzed at baseline and 6 months after surgery.Results: Hole closure was achieved in 17/25 (68%) cases of Group 1 and 20/21 (95.2%) cases of Group 2. The hole closure rate was significantly higher in the temporal inverted ILM flap group (p = 0.022). The mean BCVA (logMAR) changed from 1.12 ± 0.43 to 0.72 ± 0.31 in Group 1 and from 1.07 ± 0.34 to 0.51 ± 0.26 in Group 2 at six months (p < 0.001 in both cases). U-shaped closure was observed in 3 (12%) eyes in Group 1 and 15 (71.4%) eyes in Group 2 (p < 0.001). The total restoration rates of ELM and EZ were significantly higher in the temporal inverted ILM flap group (p = 0.009, p = 0.001, respectively).Conclusion: The temporal inverted ILM flap technique is more effective than conventional ILM peeling for larger than 600 µm macular holes and improves anatomical, morphological, and functional outcomes.

Internal limiting membrane peeling without vitrectomy for laser-induced macular holes in two children

2021 ◽  
pp. 112067212199063
Author(s):  
Nan Chen ◽  
Kunkun Zheng
Keyword(s):  
Visual Acuity ◽  
Surgical Procedure ◽  
Pediatric Patients ◽  
Internal Limiting Membrane ◽  
Optical Coherence ◽  
Slit Lamp ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Before And After

Purpose: To describe a technique of internal limiting membrane (ILM) peeling without vitrectomy for the treatment of laser-induced macular holes in two children. Methods: ILM peeling was performed under the vitreous hyaloid, and the vitreous was retained. Slit lamp and optical coherence tomographic examinations were performed before and after surgery. Results: Macular holes were closed with different patterns at different time in the two patients, while visual acuity improved significantly in both of them eventually. Conclusion: The technique of ILM peeling in the absence of vitrectomy can promote the closure of laser-induced macular holes and minimize the surgical procedure, with few vitrectomy complications in pediatric patients. The closure pattern may vary on account of different injury sources and extents.

scholarly journals Inverted ILM Flap Technique in Idiopathic Full-Thickness Macular Hole Surgery: Functional Outcomes and Their Correlation with Morphologic Findings

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Paolo Carpineto ◽  
Enrico Borrelli ◽  
Luca Cerino ◽  
Daniele Guarini ◽  
Agbeanda Aharrh-Gnama ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Functional Outcomes ◽  
Internal Limiting Membrane ◽  
Full Thickness ◽  
Flap Technique ◽  
Macular Holes ◽  
Full Thickness Macular Hole ◽  
Effective Option ◽  
The Mean

Objectives. The inverted internal limiting membrane (ILM) flap technique has been shown to increase the success rate in large full-thickness macular holes (FTMHs) and in FTMHs associated with high myopia. The aim of our study was to confirm the efficacy and safety of inverted ILM flap technique in idiopathic FTMHs independent of their dimensions and to assess functional outcomes and their correlation to morphologic findings. Methods. Sixteen consecutive patients affected by idiopathic FTMH were enrolled in this prospective study. The preoperative mean (±SD) diameter of the FTMH was 422 (±106) µm. All patients underwent vitrectomy and ILM peeling with inverted ILM flap. At 1-, 3-, and 6-month postoperative visits, visual acuity measurement, indirect ophthalmoscopy, and microperimetry were performed, and the foveal contour and the integrity of the ellipsoid zone (EZ) and external limiting membrane (ELM) were investigated using spectral domain optical coherence tomography (SD-OCT). Results. At six months postoperatively, 15 out of 16 (93.75%) patients obtained FTMH closure. The mean best corrected visual acuity (BCVA) improved from 1.1 LogMAR to 0.3 LogMAR, and the mean retinal sensitivity (MS) improved from 7.2 to 23.4 dB. ELM defects were evident in 1 out of 16 (6.25%) eyes, and EZ defects were detected in 2 out of 16 (12,50%) eyes. A statistically significant relationship was observed between BCVA, MS, and EZ reconstitution at each follow-up visit. Conclusions. Results confirm that the inverted ILM flap technique is a safe and effective option for FTMH treatment and show a strong correlation between higher BCVAs and MSs and EZ reconstitution after surgery.

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.

Comparative analysis of large macular hole surgery using an internal limiting membrane insertion versus inverted flap technique

2018 ◽  
Vol 103 (2) ◽  
pp. 245-250 ◽  
Author(s):  
Jong Ho Park ◽  
Seung Min Lee ◽  
Sung Who Park ◽  
Ji Eun Lee ◽  
Ik Soo Byon
Keyword(s):  
Visual Acuity ◽  
Complete Resolution ◽  
Internal Limiting Membrane ◽  
Insertion Technique ◽  
Closure Rate ◽  
Swept Source ◽  
Minimum Diameter ◽  
Flap Technique ◽  
Comparative Clinical Study ◽  
Hole Closure

BackgroundTo determine whether the internal limiting membrane (ILM) insertion technique is as effective as the inverted ILM flap technique for the initial surgical treatment of eyes with large idiopathic macular holes (MHs).MethodsThis retrospective, non-randomised, comparative clinical study included 41 eyes with large MHs (minimum diameter >500 µm) that were treated using the ILM insertion technique or the inverted ILM flap technique. The hole closure rate, postoperative best corrected visual acuity (BCVA) and swept source optical coherence tomography findings were analysed at 6 months after surgery.ResultsThere were 15 and 26 eyes in the insertion and inverted flap groups, respectively. Hole closure was achieved in all eyes. The mean final BCVA was better in the inverted flap group than in the insertion group (0.527 vs 0.773, p=0.006), although significant postoperative improvements were observed in both groups (p<0.001). Postoperative foveal discolouration was more common in the insertion group than in the inverted flap group (86.7% vs 7.7%, p<0.001). Complete resolution of ellipsoid zone and external limiting membrane defects was observed in 7 and 18 eyes, respectively, in the inverted flap group; in contrast, complete resolution was not observed in any of the eyes in the insertion group (p=0.035 and p<0.001, respectively).ConclusionThe ILM insertion technique may be as effective as the inverted ILM flap technique for the closure of large MHs. However, the latter technique results in better recovery of photoreceptor layers and, consequently, better postoperative visual acuity.

scholarly journals The outcome of vitrectomy with internal limiting membrane peeling for chronic macular hole at Biratnagar eye hospital: A tertiary eye care center in Nepal

2016 ◽  
Vol 7 (6) ◽  
pp. 43-46
Author(s):  
Lalit Agarwal ◽  
Nisha Agrawal ◽  
Pratap Karki ◽  
Abhishek Anand
Keyword(s):  
Macular Hole ◽  
Pars Plana Vitrectomy ◽  
Internal Limiting Membrane ◽  
Internal Limiting Membrane Peeling ◽  
Chronic Stage ◽  
Visual Improvement ◽  
Macular Holes ◽  
Pars Plana ◽  
Hole Closure

Background:  A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Pars plana vitrectomy and gas tamponade is a recognised modality of treatment for macular hole.Larger holes are more likely to remain open after repair and late reopening after an initially closed macular hole is seen in macular holes larger than 400 μm.Aims and Objective: To evaluate the anatomical and functional outcome of pars plana vitrectomy with internal limiting membrane peeling for chronic stage 3 macular hole.Materials and Methods: Records of 15 patients with stage 3 chronic macular holes operated from 1st January 2013 to 30th June 2013 and completed 1 year of follow up were retrospectively evaluated and included in the study. Preoperative best distance corrected visual acuity (BCVA), preoperative macular hole size, final BCVA and macular hole status at 1 year follow up were recorded. Macular hole closure and visual improvement was calculated. Correlation of macular hole closure and visual improvement with various macular hole parameter was estimated.Results: Eleven (73.3%) macular holes closed at 1 year follow-up. Mean BCVA improved from 1.2 ± 0.27 to 0.89 ± 0.36 logarithm of minimum angle of resolution at 1 year (p<0.001). Visual improvement was seen in only eight (53.3%) eyes. Both macular hole closure and visual improvement showed no correlation with minimum linear diameter, base diameter and hole height.Conclusion: Chronic stage 3 macular hole can be closed successfully in majority of patients with fairly good visual improvement. Macular hole parameters of stage 3 holes may not have any correlation with the anatomical and visual outcome.Asian Journal of Medical Sciences Vol.7(6) 2016 43-46

scholarly journals The Management of Lamellar Macular Holes: A Review

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Ciprian Danielescu ◽  
Horia Tudor Stanca ◽  
Florian Balta
Keyword(s):  
Surgical Intervention ◽  
Internal Limiting Membrane ◽  
First Year ◽  
Full Thickness ◽  
Internal Limiting Membrane Peeling ◽  
Macular Holes ◽  
Full Thickness Macular Hole ◽  
Phakic Eyes ◽  
Over Time

This literature review aims to provide the retina specialist with answers to patient’s questions related to the management of lamellar macular holes (LMHs). Most LMHs are stable over time, but 13–21% present an anatomic decline after 18–24 months of follow-up. Nineteen point five percent of the eyes may experience a visual acuity (VA) loss of more than 5 letters after 3 years. Many surgeons choose to perform surgery when there is significant metamorphopsia or documented decline in VA over time. The typical surgery is phacovitrectomy with the epiretinal membrane and the internal limiting membrane peeling in previously phakic eyes (41.9 to 85.3% of the eyes). In the eyes that remained phakic, cataract surgery was often necessary within the first year of follow-up (19.2 to 40% of eyes). After surgery, a VA gain was recorded in 63–94% of eyes, but some eyes (between 0 and 20%) suffered some VA loss. Progression to full-thickness macular hole may occur after surgery, and thus a second surgical intervention may be needed.

scholarly journals 25 vs. 27-gauge micro-incision vitrectomy surgery for visually significant macular membranes and full-thickness macular holes: a retrospective study

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Gordon T. Brown ◽  
Sangeethabalasri Pugazhendhi ◽  
Robert M. Beardsley ◽  
John W. Karth ◽  
Peter A. Karth ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Retrospective Study ◽  
Retrospective Analysis ◽  
Epiretinal Membrane ◽  
Internal Limiting Membrane ◽  
Full Thickness ◽  
Eligibility Criteria ◽  
Macular Holes ◽  
Corrected Distance Visual Acuity ◽  
Vitrectomy Surgery

Abstract Background To evaluate visual and safety outcomes for 25-gauge (25G) and 27-gauge (27G) micro-incision vitrectomy platforms (MIVS) for the treatment of epiretinal membrane and full-thickness macular holes. Methods Retrospective analysis of all patients who underwent internal limiting membrane (ILM) peel surgery from January 2017 through December 2018. 207 cases met the eligibility criteria for inclusion. Primary endpoint was post-operative Best-Corrected Distance Visual Acuity (BCVA) at 6 months. Results For all patients combined, mean logMAR BCVA improved from 0.57 (± 0.40) to 0.37 (± 0.36) post-operatively (p < 0.001). For 25G ERMs, logMAR BCVA improved from 0.51 (± 0.28) to 0.30 (± 0.25) post-operatively (p < 0.001). For 27G ERMs, logMAR BCVA improved from 0.33 (± 0.28) to 0.28 (± 0.27) post- operatively (p = 0.15). For 25G FTMHs, logMAR BCVA improved from 0.87 (± 0.48) to 0.51 (± 0.44) post-operatively (p < 0.001). For 27G FTMHs, logMAR BCVA changed from 0.89 (± 0.47) to 0.96 (± 0.60). Conclusion Final visual outcomes improved for both 25G and 27G ERM groups and the 25G FTMH group. Both 25G and 27G were safe and well tolerated MIVS platforms for the treatment of ERM and FTMH.

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.

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.

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