Analysis of results of inverted internal limiting membrane flap technique using 3D visualization for surgical treatment of macular holes

2021 ◽  
pp. 31-35
Author(s):  
A.V. Egorov ◽  
◽  
O.V. Kolenko ◽  
A.Y. Khudyakov ◽  
V.V. Egorov ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
High Efficiency ◽  
Silicone Oil ◽  
3D Visualization ◽  
Internal Limiting Membrane ◽  
Visualization System ◽  
Flap Technique ◽  
Macular Holes ◽  
Analysis Of Results

Purpose. Analysis of results of inverted internal limiting membrane (ILM) flap technique using 3D visualization for surgical treatment of macular holes (MH). Material and methods. 21 people with stage 3 or 4 MH. Visometry and optical coherence tomography (OCT) were performed before surgery, on the 3rd day and 1 month after surgery. All patients underwent a three-port 27G vitrectomy with using NGENUITY 3D visualization system (Alcon, USA). After vitrectomy and ILM staining, the ILM flap was formed in the form of single monoblock with wide base, which was turned over and placed on the MH area. The operation was completed by fluid/air exchange. Results. MH closure on the 3rd day after surgery was observed in 19 (90.5%) of 21 patients. In 2 patients, MH closure was absent; in these cases, a second operation was performed with silicone oil tamponade. One month after the operation, according to OCT datas, complete MH closure was noted in all patients. The average value of the best corrected visual acuity by this observation period was 0.3, which was 6 times higher than the initial (0.05) visual acuity. The use of 3D visualization system allowed us to reduce the level of endoillumination by up to 15% and to reduce the exposure time of the endovitreal dye to 15 seconds to reduce the risks of retinal phototoxicity. Conclusion. The proposed inverted ILM flap technique made it possible to achieve MH closure in 90.5% of cases. The experience of using NGENUITY 3D visualization system has shown high efficiency and safety by reducing the risk of iatrogenic phototoxicity. Key words: macular hole, inverted flap, internal limiting membrane, 3D visualization, NGENUITY.

Results surgical treatment of rhegmatogenous retinal detachment and macular hole

2021 ◽  
pp. 97-99
Author(s):  
A.V. Zhigulin ◽  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Surgical Treatment ◽  
Retinal Detachment ◽  
Macular Hole ◽  
Silicone Oil ◽  
Internal Limiting Membrane ◽  
Optical Coherence ◽  
Primary Surgery ◽  
Analysis Of Results

Purpose. Analysis of functional and anatomical results surgical treatment of retinal detachment and macular hole (RDMH) with internal limiting membrane (ILM) peeling and silicone tamponade. Material and methods. Analysis of results surgical treatment of 17 patients (17 eyes) with RDMH was carried out. Disease duration ranged from 2 weeks to 3 months. Visual acuity before surgical treatment ranged from no light perception to 0.05 (on average 0.01±0.02). All patients underwent endovitreal surgery with ILM removal. Then retinal holes were localized at periphery with further endolaser coagulation or cryocoagulation and silicone oil (5700 cSt) tamponade. Results. Retinal adhesion was noted in all eyes after primary surgery. Closure of hole was successful in 16 patients. After operation, visual acuity improved in all patients, averaging 0.11±0.09. Conclusion. Vitrectomy with IPM removal and silicone oil (5700 cSt) tamponade in treatment of RDMH made it possible to achieve reattachment of retina in 17 patients, complete closure of macular hole in 16 of 17 patients. One patient, according to optical coherence tomography, showed decrease diameter of macular hole after 12 months. Positive functional effect was achieved in increase visual acuity to average of 0.15±0.15 after 12 months. Key words: retinal detachment, macular hole, vitrectomy, internal limiting membrane removal, silicone oil tamponade, visometry, optical coherence tomography.

scholarly journals Inverted Internal Limiting Membrane Flap Technique for Extra Large Macular Holes

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 ◽  
Internal Limiting Membrane ◽  
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.

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

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.

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

2020 ◽  
Author(s):  
Nisa Silva ◽  
Natália Ferreira ◽  
Bernardete Pessoa ◽  
Nuno Correia ◽  
João Melo Beirão ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Internal Limiting Membrane ◽  
Flap Technique ◽  
Macular Holes

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

2019 ◽  
Vol 57 (217) ◽  
Author(s):  
Kiran Shakya ◽  
Ram Prasad Pokhrel ◽  
Om Krishna Malla
Keyword(s):  
Visual Acuity ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Internal Limiting Membrane ◽  
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.

Vitrectomy with the inverted internal limiting membrane flap technique in eyes with full-thickness macular hole and dry age-related macular degeneration

2020 ◽  
pp. 112067212092137
Author(s):  
Zofia Michalewska ◽  
Jerzy Nawrocki
Keyword(s):  
Visual Acuity ◽  
Macular Degeneration ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Age Related Macular Degeneration ◽  
Full Thickness ◽  
Flap Technique ◽  
Age Related ◽  
Macular Holes ◽  
Full Thickness Macular Hole

Purpose To present effects of the inverted internal limiting membrane flap technique in full-thickness macular holes coexisting with dry age-related macular degeneration. Methods Our database was retrospectively reviewed in order to spot patients with the simultaneous diagnosis of dry age-related macular degeneration and full-thickness macular hole. Vitrectomy with the inverted internal limiting membrane flap technique was performed. Inclusion criteria were full-thickness macular hole, drusen, vitrectomy performed, and spectral domain optical coherence tomography (Copernicus HR, Optopol, Poland) or swept source optical coherence tomography (Triton, Topcon, Japan) before surgery, then 1 week (±3 days), 1 month (±1 week), 3 months (±1 month), 6 months (±1 month), 12 months (±2 months), and 18 months to 12 years after surgery. Main outcome measures Closure of macular hole and visual acuity at the final control. Results A total of 18 eyes of 12 patients (mean age: 68 years) were included. Mean minimum macular hole diameter was 493 μm. Mean maximum macular hole diameter was 1072 μm. Macular hole was closed in 16 eyes after first surgery and in all eyes after second surgery. Improvement of visual acuity was statistically significant ( P = 0.05), but there was no statistical significant correlation observed between initial macular hole diameters and final visual acuity ( P > 0.1). Conclusion The inverted internal limiting membrane flap technique improves anatomical and functional results in eyes with coexisting dry age-related macular degeneration and full-thickness macular holes. Final development of choroidal neovascularization or geographic atrophy is possible in rare cases.

scholarly journals Pedicle internal limiting membrane flap technique for very large macular holes: a preliminary report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
José Edísio da Silva Tavares Neto ◽  
Igor Neves Coelho ◽  
Rodrigo Jorge ◽  
David Leonardo Cruvinel Isaac ◽  
Marcos Pereira de Ávila
Keyword(s):  
Visual Acuity ◽  
Macular Hole ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Sao Paulo ◽  
Functional Improvement ◽  
São Paulo ◽  
Flap Technique ◽  
Macular Holes ◽  
Linear Diameter

Abstract Background Conventional vitrectomy technique for macular hole surgery has a good outcome in small and medium macular holes, but for very large macular holes (minimum linear diameter higher than 700 μm) other techniques were developed aiming to achieve greater rates of closure and visual acuity gain. The purpose of this article is to report the anatomical and functional outcomes of four very large macular hole (MH) cases which have undergone vitrectomy with the pedicle internal limiting membrane (ILM) flap technique. Methods This is a retrospective series of four patients with large MH who were treated with vitrectomy and the pedicle ILM flap technique. Comprehensive ophthalmologic evaluation was performed before surgery and included ETDRS best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT) for MH measures: height, minimum linear diameter (MLD) and external base diameter. The particular detail of this technique is related to ILM flap creation. During the peeling, the ILM was not removed completely from the retina but was left attached to the edges of the macular hole and subsequently trimmed with the vitrectomy probe using the scissors mode. Results Four patients with very large MH underwent PPV and the pedicle ILM flap technique was used to pursue macular closure. Median preoperative BCVA was 20/400 (range: 20/320 to 20/400) and median postoperative BCVA was 20/200 (range: 20/320 to 20/200). Of the 4 cases reported, 3 obtained anatomical closure (75%), and also presented BCVA improvement after surgery, considering the last follow-up visit of each case. No additional procedures were performed in either case. One patient demonstrated no anatomic and functional improvement. Conclusion The present study describes the first Brazilian case series of very large MH treated by the inverted pedicle ILM flap technique. This technique was associated with anatomic and visual improvement in most cases, and represents an alternative therapeutic approach for large macular holes. Trial Registration Project registered in Plataforma Brasil with CAAE number 30163520.0.0000.5440 and approved in ethics committee   from  Ribeirão Preto Medical School Clinics Hospital, University of São Paulo—Ribeirão Preto, São Paulo, Brazil (appreciation number 3.948.426 gave the approval).

scholarly journals Surgical Treatment of Previously Unclosed Macular Holes

2020 ◽  
Vol 17 (3) ◽  
pp. 368-374
Author(s):  
R. R. Faizrakhmanov ◽  
E. A. Larina ◽  
O. A. Pavlovskii
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Macular Hole ◽  
Free Flap ◽  
Inverse Correlation ◽  
Functional Results ◽  
Internal Limiting Membrane ◽  
Morphological Parameters ◽  
Photoreceptor Layer ◽  
Macular Holes

Macular holes are the most often pathology leading to reduced vision among persons after 60 years. The macular hole is the acquired disease which is a defect of a foveola part of retina on all thickness from an internal limiting membrane to an external segment of a photoreceptor layer. The standard method of treatment is surgery method: a microinvasive vitrectomy with membrane peeling in macular area. There is a number of the techniques increasing efficiency of operative intervention. Even in case of successful surgical intervention macular holes are not always closed.The purpose: development and assessment of morphological parameters of the central retina with a new surgical method of closing earlier operated macula hole using a free flap.Material and methods. 40 patients (40 eyes, 28 women and 12 men) had participated in this study. All patients were operated about macular hole with negative anatomic result. By technology which were used earlier, patients were divided into 3 studied groups (with PRP mass using, with introverted flap using, with mechanical matching of edges of a hole). The main method of research was the optical coherent tomography. All patients were operated by an original technique. It’s purpose was a closing of earlier operated rigid macular hole using a free flap.Results. The defect of a photoreceptor component was closed with an additional expansion of earlier created macular rexis in patients of the 1st and 3rd groups at reoperation. The earlier created flap of an internal limiting membrane was used in patients of the 2nd group. In the analysis of dependence of change of visual acuity from morphological parameters of a macular hole after primary surgical treatment the inverse correlation relation from diameter of a macular hole on small and big radiuses is revealed. The highest visual acuity after a reoperation was reached at patients of the second group.Conclusions. It is necessary to consider the technique which was used earlier, diameter of a macular hole on small and big radiuses, postoperative edema in a parafovea zone for planning the surgical treatment and a forecast of functional results. 

The use of autologous conditioned plasma (ACP) in the surgical treatment of full-thikness macular holes

2021 ◽  
pp. 102-105
Author(s):  
I.V. Laskova ◽  
◽  
A.A. Kravchenko ◽  
D.I. Uskov ◽  
E.V. Lopina ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Macular Hole ◽  
High Efficiency ◽  
Silicone Oil ◽  
Pigment Epithelium ◽  
Subretinal Fluid ◽  
Ophthalmological Examination ◽  
Ophthalmic Surgery ◽  
Macular Holes ◽  
Number Of Patients

Increasingly, the use of autologous conditioned plasma in ophthalmic surgery in recent years has been given more preference than other blood products with similar effects. Surgical treatment of full-thikness macular hole is no exception. Domestic and foreign studies of recent years show that the use of ACP as an adhesive component in the treatment of this pathology is considered the most acceptable. However, in addition to the effective "gluing" of the macular hole, the convergence of its edges plays an important role in the postoperative anatomy of the foveolar zone. Objective: to study the effectiveness of the use of autologous conditioned plasma in the surgical treatment of full-thikness macular hole. Materials and methods of research. Patients who underwent surgery for a full-thikness macular hole with a diameter of more than 400 microns were prospectively observed. The study included 51 patients. The follow-up period ranged from 2 months to 1 year. All patients in the preoperative and postoperative periods underwent a comprehensive ophthalmological examination. Surgical technique: after a standard three-port vitrectomy (25Ga), the posterior hyaloid membrane was removed, and the ILM was peeled. With the help of a saline solution, a circular separation of the bonds between the edges of the gap and the pigment epithelium was achieved. After the subretinal fluid was removed and the induced local central retinal detachment was attached, the tear area was irrigated by ACP. After that, the air was replaced with silicone oil, which was removed after 1.5 months. Nodal sutures were applied to the sclerotomy (vicryl 8-0). Results. In 49 operated patients, anatomical restoration of the foveolar zone was achieved, which accounted for 96% of the total number of patients. Visual functions were evaluated after 1.5 months (after removal of silicone oil). Corrected visual acuity in 96% of patients ranged from 0.2 to 0.5. Conclusion. The high efficiency of the use of autologous conditioned plasma in the treatment of full-thikness macular holes allows us to achieve high anatomical and functional results. Key words: macular rupture, autologous conditioned plasma, silicone tamponade.

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.

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