scholarly journals Inverted internal limiting membrane flap technique versus complete internal limiting membrane peeling in large macular hole surgery: a comparative study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Prithvi Ramtohul ◽  
Eric Parrat ◽  
Danièle Denis ◽  
Umberto Lorenzi
Keyword(s):  
Optical Coherence Tomography ◽  
Functional Outcomes ◽  
Internal Limiting Membrane ◽  
External Limiting Membrane ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Flap Technique ◽  
Stage 4 ◽  
Group 2 ◽  
Group 1

Abstract Background To compare the anatomical and functional outcomes of the inverted internal limiting membrane (ILM) flap technique and the complete ILM removal in the treatment of large stage 4 macular hole (MH) > 400 μm and to evaluate reconstructive anatomical changes in foveal microstructure using spectral-domain optical coherence tomography. Methods This is a retrospective, consecutive, nonrandomized comparative study of patients affected by idiopathic, myopic or traumatic stage 4 MH (minimum diameter > 400 μm) treated with 25-gauge pars-plana vitrectomy with either complete ILM peeling (n = 23, Group 1) or inverted ILM flap technique (n = 23, Group 2), between August 2016 and August 2018. Main outcomes measured were the MH closure rate assessed by spectral-domain optical coherence tomography and the best-corrected visual acuity (BCVA) at six months. Foveal microstructure reconstructive changes were evaluated using SD-OCT to determine predictive factors of postoperative BCVA. Results Closure of MH was achieved in 16/23 cases of Group 1 (70%) and in 22/23 cases of the Group 2 (96%). Surgical failure was reported in 6 cases of Group 1 and 1 case of Group 2. The MH closure rate was significantly higher with the inverted ILM flap technique (P-value = 0.02). Average BCVA (LogMAR) changed from 1.04 ± 0.32 to 0.70 ± 0.31 in Group 1 and from 0.98 ± 0.22 to 0.45 ± 0.25 in Group 2 (P-value = 0.005) at 6 months. Improvement in BCVA (> 0.3 LogMAR units) was statistically higher in the Group 2 (P-value = 0.03). Restoration of foveal microstructure was significantly higher in the Group 2 at 6 months (52% vs 9%, P-value < 0.01). In Group 2, the integrity of the external limiting membrane at 3 months postoperatively was the only significant feature correlated with postoperative BCVA at 6 months (r = 0.562; P-Value = 0.01, forward stepwise regression analysis). Conclusion Inverted ILM flap technique is more effective than the classic ILM peeling for the closure of large stage 4 MHs > 400 μm, improving both anatomical and functional outcomes. Early recovery of the external limiting membrane at 3 months is a positive predictive value of postoperative BCVA 6 months after inverted ILM flap technique.

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.

scholarly journals Effect of inverted internal limiting membrane flap technique on small-medium size macular holes

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Kanako Yamada ◽  
Akio Oishi ◽  
Mao Kusano ◽  
Hirofumi Kinoshita ◽  
Eiko Tsuiki ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Internal Limiting Membrane ◽  
Medium Size ◽  
External Limiting Membrane ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Postoperative Visual Acuity ◽  
Flap Technique ◽  
Macular Holes ◽  
Significant Difference

AbstractInverted internal limiting membrane (ILM) flap technique was developed to achieve macular hole (MH) closure in large MH and refractory cases. In this study, we evaluate the effect of the technique for small-medium size MH. We recruited patients who underwent vitrectomy for small-medium size (< 400 μm) MH with either inverted ILM flap technique (flap group) or with conventional ILM peeling (peeling group). Using propensity score, 21 eyes of 21 patients in the peeling group were matched against 21 eyes of 21 patients in the flap group. We compared MH closure rate, postoperative visual acuity, and recovery of the external limiting membrane (ELM) and ellipsoid zone (EZ). The MH closure rate was not different between the two groups (flap vs peeling: 90% vs 100%, P = 0.49). Whereas there was no significant difference in visual acuity improvement between the two groups, the flap group showed more disruption of the ELM 3 months after surgery and of the EZ at 3 and 6 months after surgery (P = 0.02, P = 0.03, and P = 0.04, respectively). The result suggested that inverted ILM flap technique does not have additional benefits for small-medium size MHs and may delay recovery of retinal integrity.

scholarly journals Effect of Inverted Internal Limiting Membrane Flap Technique on Normal Size Macular Holes

2021 ◽  
Author(s):  
Kanako Yamada ◽  
Akio Oishi ◽  
Mao Kusano ◽  
Hirofumi Kinoshita ◽  
Eiko Tsuiki ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Propensity Score ◽  
Internal Limiting Membrane ◽  
External Limiting Membrane ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Postoperative Visual Acuity ◽  
Flap Technique ◽  
Macular Holes ◽  
Significant Difference

Abstract Inverted internal limiting membrane (ILM) flap technique was developed to achieve macular hole (MH) closure in large MH and refractory cases. In this study, we evaluate the effect of the technique for normal size MH. We recruited patients who underwent vitrectomy for normal size (< 400 µm) MH with either inverted ILM flap technique (flap group) or with conventional ILM peeling (peeling group). Using propensity score,21 eyes of 21 patients in the peeling group were matched against 21 eyes of 21 patients in the flap group. we compared MH closure rate, postoperative visual acuity, and recovery of the external limiting membrane (ELM) and ellipsoid zone (EZ). The MH closure rate was not different between the two groups (flap vs peeling: 90% vs 100%, P = 0.49). Whereas there was no significant difference in visual acuity improvement between the two groups, the flap group showed more disruption of the ELM 3 months after surgery and of the EZ at 3 and 6 months after surgery (P = 0.02, P = 0.03, and P = 0.04, respectively). The result suggested that inverted ILM flap technique does not have additional benefits for normal size MHs and may delay recovery of retinal integrity.

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.

Foveal microstructure and visual outcomes of myopic macular hole surgery with or without the inverted internal limiting membrane flap technique

2018 ◽  
Vol 103 (10) ◽  
pp. 1495-1502 ◽  
Author(s):  
Xu-Ting Hu ◽  
Qin-Tuo Pan ◽  
Jing-Wei Zheng ◽  
Zong-Duan Zhang
Keyword(s):  
Retinal Detachment ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Flap Technique ◽  
Hyperreflective Foci ◽  
Retinal Reattachment ◽  
Pars Plana ◽  
Myopic Macular Hole

PurposeThe aim of this study was to determine the effect of the inverted internal limiting membrane (ILM) flap technique on the macular hole (MH) closure and foveal microstructure recovery of patients with highly myopic MH.MethodsPars plana vitrectomy and gas tamponade with the inverted ILM flap technique (19 eyes) or with the ILM peeling technique (21 eyes) were performed in patients with highly myopic MH with or without retinal detachment. The rate of MH closure and retinal reattachment, the reconstructive anatomical change of the foveal microstructure and the best-corrected visual acuities (BCVA) of the two groups were compared.ResultsThe anatomic closure rate was statistically significantly higher in the inverted group (100%) than in the peeling group (66.7%; p=0.009). All eyes with MH retinal detachment had successful retinal reattachment in these two groups. However, the rate of the external limiting membrane (ELM) and ellipsoid zone (EZ) (p=0.020), as well as gliosis (p=0.049) in macular area, detected by OCT, was significantly greater in the inverted group than in the peeling group. The postoperative BCVA was significantly better in the eyes with ELM, EZ (p=0.031) and gliosis (p=0.008), but without hyperreflective foci (p=0.001).ConclusionsThese findings demonstrate that the inverted ILM flap technique has better efficacy than the ILM peeling technique for patients with myopic MH in closure rate, foveal microstructure and postoperative BCVA.

scholarly journals Reconstructing Foveola by Foveolar Internal Limiting Membrane Non-Peeling and Tissue Repositioning for Lamellar Hole-Related Epiretinal Proliferation

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Tzyy-Chang Ho ◽  
Allen Yi-Lun Ho ◽  
Muh-Shy Chen
Keyword(s):  
Visual Acuity ◽  
Clinical Characteristics ◽  
Internal Limiting Membrane ◽  
Lamellar Macular Hole ◽  
Ilm Peeling ◽  
Corrected Visual Acuity ◽  
Tangential Traction ◽  
Group 2 ◽  
Lamellar Hole ◽  
Group 1

Abstract Differences in the pathogenesis and clinical characteristics between lamellar macular hole (LMH) with and without LMH-associated epiretinal proliferation (LHEP) can have surgical implications. This study investigated the effects of treating LHEP by foveolar internal limiting membrane (ILM) non-peeling and epiretinal proliferative (EP) tissue repositioning on visual acuity and foveolar architecture. Consecutive patients with LHEP treated at our institution were enrolled. The eyes were divided into a conventional total ILM peeling group (group 1, n = 11) and a foveolar ILM non-peeling group (group 2, n = 22). In group 2, a doughnut-shaped ILM was peeled, leaving a 400-μm-diameter ILM without elevated margin over the foveola after EP tissue repositioning. The EP tissue was elevated, trimmed, and inverted into the LMH. Postoperatively, the LMH was sealed in all eyes in group 2, with significantly better best-corrected visual acuity (−0.26 vs −0.10 logMAR; p = 0.002). A smaller retinal defect (p = 0.003), a more restored ellipsoid zone (p = 0.002), and a more smooth foveal depression (p < 0.001) were achieved in group 2. Foveolar ILM non-peeling and EP tissue repositioning sealed the LMH, released the tangential traction, and achieved better visual acuity. The presumed foveolar architecture may be reconstructed surgically. LMH with LHEP could have a combined degenerative and tractional mechanism.

Retinal and Choroidal Thicknesses Measured with Swept-Source Optical Coherence Tomography after Surgery for Idiopathic Macular Hole

2016 ◽  
Vol 27 (3) ◽  
pp. 312-318 ◽  
Author(s):  
Handan Bardak ◽  
Murat Gunay ◽  
Yavuz Bardak ◽  
Yesim Ercalik
Keyword(s):  
Optical Coherence Tomography ◽  
Layer Thickness ◽  
Healthy Controls ◽  
Idiopathic Macular Hole ◽  
Ilm Peeling ◽  
Swept Source ◽  
Group 3 ◽  
Group 2 ◽  
Fellow Eyes ◽  
Group 1

Purpose To evaluate the changes in retinal nerve fiber layer thickness (RNFLT), ganglion cell layer thickness (GCLT), retinal thickness (RT), and subfoveal choroidal thickness (SFCT) in eyes that received pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling for idiopathic macular hole (IMH) and to compare these data with data from fellow eyes and healthy controls. Methods This cross-sectional study included 49 subjects. Eighteen eyes that underwent surgery for IMH, 18 fellow eyes, and 31 eyes of the healthy controls were designated as group 1, group 2, and group 3, respectively. The RNFLT, GCLT, RT, and SFCT were measured by using the swept-source optical coherence tomography (SS-OCT) device at last postoperative visit. Results The RNFLT was significantly lower in group 1 than group 2 and group 3 (p<0.05). The GCLT was significantly reduced in all sectors in group 1 as compared to group 2 and group 3 (p<0.05). The RT was found to be significantly lower (except in central field) in group 1 than group 2 and group 3 (p<0.05). The SFCT was significantly decreased in group 1 as compared to group 2 and group 3 (p<0.05). Conclusions A reduction in the RNFLT, GCLT, RT, and SFCT was observed following PPV with ILM peeling for IMH detected by SS-OCT.

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.

scholarly journals Inverted internal limiting membrane-flap technique for large macular hole: a microperimetric study

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Giancarlo Sborgia ◽  
Alfredo Niro ◽  
Alessandra Sborgia ◽  
Valeria Albano ◽  
Tiziana Tritto ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Functional Outcomes ◽  
Internal Limiting Membrane ◽  
Closure Rate ◽  
Flap Technique ◽  
Fixation Points ◽  
Hole Closure ◽  
Large Macular Hole

Abstract Background Inverted Internal Limiting Membrane (ILM)-flap technique would seem to lead to higher closure rate and better visual acuity than traditional procedure with ILM peeling for the treatment of large macular hole (LMH). Visual acuity recovery does not reveal many other functional changes related to surgical approach. Our purpose was to evaluate macular function and morphology over a 1-year follow-up after inverted ILM-flap technique for LMH by using microperimetry in order to predict visual prognosis. Methods This study was a prospective unrandomized single-center study. 23 eyes of 22 patients with idiopathic LMH, with a minimum diameter ranging from 400 to 1000 μm, were included. All patients underwent vitrectomy with inverted ILM-flap technique and gas tamponade. We analyzed macular hole closure rate and functional outcomes including best-corrected visual acuity (BCVA), macular sensitivity (MS) at central 12° and central macular sensitivity (CMS) at central 4°, and fixation behavior as bivariate contour ellipse area (BCEA, degrees2) at 68%, 95%, and 99% of fixation points measured by microperimeter, over a follow-up of 12 months. Results The macular hole closure rate was 98%. The BCVA improved from 20/230 (Logmar, 1.06 ± 0.34) to 20/59 (logMar, 0.47 ± 0.45) at last follow-up (p < 0.001). Retinal sensitivity and BCEA significantly improved (MS, p = 0.001; CMS, p < 0.0001; BCEA: 68%, p < 0.01; 95%, p < 0.01; 99%, p = 0.001). Multiple stepwise regression analysis showed the final BCVA was significantly associated with macular hole size (β = 0.002, p = 0.03), preoperative MS (β = − 0.06, p = 0.001) and BCEA at 95% and 99% of fixation points (β = − 0.12, p = 0.01; β = 0.06, p = 0.01). Conclusions Inverted ILM-flap technique for LMH results in good morphologic and functional outcomes. Macular hole size and microperimetric parameters as preoperative MS and BCEA have a predictive role on post-surgical visual acuity.

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