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

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 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.

The Role of Internal Limiting Membrane Flap for Highly Myopic Macular Hole Retinal Detachment: Improving the Closure Rate but Leading to Excessive Gliosis

Purpose: To investigate the surgical outcomes of the inverted internal limiting membrane (ILM) flap technique for macular hole retinal detachment (MHRD) in high myopia.Methods: This was a retrospective interventional study on 45 highly myopic eyes with MHRD after ILM peeling (n = 24, peeling group) or the inverted ILM flap technique (n = 21, inverted group). The inverted group was consisted of autologous blood (AB) subgroup (n = 10) and perfluorocarbon liquid (PFCL) subgroup (n = 11). MH closure, best-corrected visual acuity (BCVA), foveal microstructures, and excessive gliosis were analyzed during a follow-up of over 12 months.Results: The inverted group achieved a higher MH closure rate (95.24%) than the peeling group (41.67%; p &lt; 0.001). No significant difference was found in postoperative BCVA between the two groups (p = 0.98) or between the closed MH with or without excessive gliosis (p = 0.60). Excessive gliosis was identified in 9 eyes in the inverted group, and there was no difference in the incidence of excessive gliosis between the AB subgroup (4 in 10 eyes, 40%) and the PFCL subgroup (5 in 11 eyes, 45.45%) (p &gt; 0.999).Conclusion: The inverted ILM flap technique was effective in MH closure but had no advantage in postoperative BCVA and microstructural restoration. Excessive gliosis was only detected in the inverted group but did not affect the postoperative BCVA. Additionally, the incidence of excessive gliosis was not affected by adjuvants.

Boari flap urinary tract reconstruction for rectosigmoid cancer with ureteral invasion: Report of a case

Introduction: The Boari flap technique is a unique urinary tract reconstruction procedure performed after resection of the urinary tract. However, few previous reports have described the application of this technique to gastrointestinal cancer. Moreover, we have not found any papers describing the long-term prognosis. We report a case of right ureteral tract resection followed by Boari flap reconstruction for rectosigmoid carcinoma, with survival for 108 months without any urological complications. Case presentation: A woman in her 50s was diagnosed with rectosigmoid caner by local physician and referred to our institution. Computed tomography revealed right hydronephrosis due to rectosigmoid cancer invasion at the lower two-thirds of the right ureter. During laparotomy, massive lymphatic infiltration from the primary lesion to right ureter was observed. After primary tumor resection with lower ureter excision, the Boari flap procedure was performed to reconstruct the ureteral deficit. Postoperative course was uneventful, and she was discharged on postoperative day 20. The patient has been followed every 4 months for 9 years with no recurrence or unpleasant symptoms. Discussion: This technique is usually performed to manage specific conditions such as ureteral stenosis caused by ureteral calculi, retroperitoneal fibrosis, and gynecological disorders. This procedure should be reconsidered as a possible option for gastrointestinal malignant cases instead of nephrostomy or cutaneous ureterostomy, given the low rate of complications and high patient satisfaction. Conclusion: The Boari flap technique is particularly useful for bridging between the ureter and bladder in cases of colorectal malignancy with combined resection of the lower urinary tract.