Internal Limiting Membrane Inverted Flap Technique for Lamellar Macular Hole – Case Report

The consensus of lamellar macular hole repair generally entails vitrectomy with internal limiting membrane with/without epiretinal membrane peeling with gas tamponade, although the risk of a full thickness macular hole remains. In this case report, we investigate the role of the regenerative properties of autologous platelets in the repair of a lamellar macular hole with pars plana vitrectomy, an autologous platelet plug, and 12% C3F8 without prone posturing. All three patients in this case report experienced visual improvement along with anatomic closure of the lamellar macular hole. Further randomized studies with larger sample sizes will contribute to the existing data regarding this procedure and its outcomes.

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Embedding of lamellar hole-associated epiretinal proliferation combined with internal limiting membrane inversion for the treatment of lamellar macular hole: a case report

BMC Ophthalmology ◽

10.1186/s12886-018-0926-8 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 4

Author(s):

Yusuke Shiode ◽

Yuki Morizane ◽

Kosuke Takahashi ◽

Shuhei Kimura ◽

Mio Hosokawa ◽

...

Keyword(s):

Case Report ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Lamellar Macular Hole ◽

Lamellar Hole

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Case report: successful closure of a large macular hole secondary to uveitis using the inverted internal limiting membrane flap technique

BMC Ophthalmology ◽

10.1186/s12886-015-0072-5 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 16

Author(s):

Masayuki Hirano ◽

Yuki Morizane ◽

Tetsuhiro Kawata ◽

Shuhei Kimura ◽

Mio Hosokawa ◽

...

Keyword(s):

Case Report ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Flap Technique ◽

Large Macular Hole

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Macular hole treated by the inverted internal limiting membrane flap technique: case report

Spektrum der Augenheilkunde ◽

10.1007/s00717-016-0298-5 ◽

2016 ◽

Vol 30 (3) ◽

pp. 138-141

Author(s):

Karolína Skorkovská ◽

Susanne Binder

Keyword(s):

Case Report ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Flap Technique

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Clinical and histological evaluation of large macular hole surgery using the inverted internal limiting membrane flap technique

Clinical Ophthalmology ◽

10.2147/opth.s119762 ◽

2016 ◽

Vol Volume 11 ◽

pp. 9-14 ◽

Cited By ~ 22

Author(s):

Satoru Kase ◽

Wataru Saito ◽

Shohei Mori ◽

Michiyuki Saito ◽

Ryo Ando ◽

...

Keyword(s):

Macular Hole ◽

Internal Limiting Membrane ◽

Histological Evaluation ◽

Macular Hole Surgery ◽

Flap Technique ◽

Large Macular Hole

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

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313311 ◽

2018 ◽

Vol 103 (10) ◽

pp. 1495-1502 ◽

Cited By ~ 4

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.

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Answer to the Letter to the Editor relating: Lytvynchuk LM, Falkner-Radler CI, Krepler K, Glittenberg CG, Ahmed D et al. “Dynamic intraoperative optical coherence tomography for inverted internal limiting membrane flap technique in large macular hole surgery” Graefe’s Arch Clin Exp Ophthalmol 2019 May 29; https://doi.org/10.1007/s00417-019-04364-5 written by Michalewska Z. and Nawrocki J.

Graefe s Archive for Clinical and Experimental Ophthalmology ◽

10.1007/s00417-019-04472-2 ◽

2019 ◽

Vol 257 (11) ◽

pp. 2589-2589

Author(s):

Lyubomyr M. Lytvynchuk ◽

Susanne Binder

Keyword(s):

Optical Coherence Tomography ◽

Macular Hole ◽

Internal Limiting Membrane ◽

Optical Coherence ◽

Macular Hole Surgery ◽

Flap Technique ◽

Letter To The Editor ◽

Intraoperative Optical Coherence Tomography ◽

Large Macular Hole

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Long-Term Outcome of Vitrectomy with Suitable Internal Limiting Membrane Peeling and Air Tamponade for Highly Myopic Foveoschisis-Associated Lamellar Macular Hole

Journal of Ophthalmology ◽

10.1155/2020/2074037 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Jia-lin Wang ◽

Yan-ling Wang

Keyword(s):

Macular Hole ◽

Internal Limiting Membrane ◽

Lamellar Macular Hole ◽

Ilm Peeling ◽

Long Term Outcome ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Myopic Foveoschisis ◽

Air Tamponade

Purpose. To investigate the outcome of pars plana vitrectomy (PPV) with suitable internal limiting membrane peeling (ILM) and air tamponade for patients with highly myopic foveoschisis-associated lamellar macular hole (MH). Methods. This retrospective interventional case series included 11 patients with highly myopic foveoschisis-associated lamellar MH who underwent PPV and indocyanine green-aided ILM peeling up to the temporal vascular arcades. Following air tamponade after surgery, all patients were instructed to maintain a face-down position. The patients were followed up for over 1 year and evaluated for MH closure and the best-corrected visual acuity before and after surgery. Results. The mean ± standard deviation values of patient age, axial length, and follow-up duration were 67.82 ± 6.54 years, 29.21 ± 1.95 mm, and 24.27 ± 8.11 months, respectively. After surgery, the lamellar MH closed in all eyes, and 10 eyes showed vision improvement at the 1-month, 3-month, and final follow-up evaluations. One patient showed decreased vision at 2 years after surgery, with patchy chorioretinal atrophy in the macular region. Myopic foveoschisis showed resolution in three eyes and alleviation in eight. Ten patients underwent cataract surgery during PPV. Conclusion. Extension of ILM peeling up to the temporal vascular arcades and air tamponade after PPV may improve the visual function and rate of MH closure for patients with highly myopic foveoschisis-associated lamellar MH.

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