Abstract
Purpose
To compare the anatomic and functional outcome of two variants of the inverted internal limiting membrane (I-ILM) flap technique for idiopathic macular holes (IMH) larger than 400 µm.
Methods
Twenty-seven consecutive patients undergoing PPV for IMH were randomly assigned to different variants of I-ILM technique: the Cover group included 14 patients in which the I-ILM was folded upside-down over the MH as a single layer while the Fill group enrolled 13 patients in which the I-ILM was folded within the MH in multiple layers.
Results
MH closed in 12/14 Cover and in 13/13 Fill eyes (84.6 vs. 100%, p = 0.14; n.s.). Vision at 1 month was Snellen 0.44 ± 0.17 vs. 0.28 ± 0.21 (p = 0.05) and 0.48 ± 0.20 vs. 0.37 ± 0.25 (n.s.) at 3 months. IS/OS line interruption width was 463 ± 385 vs. 602 ± 210 µm, respectively, at 1 month (n.s.) and 602 ± 210 vs. 563 ± 209 µm at 3 months (n.s.). The Cover group showed outer retina cystic changes more often (p < 0.01). MH over 700 µm closed in 0/2 and in 2/2 cases, respectively, in the Cover and Fill groups (0.045).
Conclusions
Cover and Fill I-ILM techniques allowed similar closure rates and post-operative vision at 3 months. The Cover group showed better anatomical restoration and vision at 1 month while the Fill technique might be more efficient in closing larger MHs.
Similar content being viewed by others
References
Kelly NE, Wendel RT (1991) Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol 109(5):654–9
Madi HA, Masri I, Steel DH (2016) Optimal management of idiopathic macular holes. Clin Ophthalmol 10:97–116
Michalewska Z, Michalewski J, Adelman RA, Nawrocki J (2010) Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology 117:2018–25
Kuriyama S, Hayashi H, Jingami Y, Kuramoto N, Akita J, Matsumoto M (2013) Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia. Am J Ophthalmol 156:125–131
Michalewska Z, Nawrocki J (2013) Macular hole surgery in a patient who cannot maintain facedown positioning. Case Rep Ophthalmol 4:1–6
Michalewska Z, Michalewski J, Dulczewska-Cichecka K, Adelman RA, Nawrocki J (2015) Temporal inverted internal limiting membrane flap technique versus classic inverted internal limiting membrane flap technique: a comparative study. Retina 35:1844–50
Lai CC, Chen YP, Wang NK, Chuang LH, Liu L, Chen KJ, Hwang YS, Wu WC, Chen TL (2015) Vitrectomy with internal limiting membrane repositioning and autologous blood for macular hole retinal detachment in highly myopic eyes. Ophthalmology 122:1889–98
Song Z, Li M, Liu J, Hu X, Hu Z, Chen D (2016) Viscoat-assisted inverted internal limiting membrane flap technique for large macular holes associated with high myopia. J Ophthalmol 6:8283062. doi:10.1155/2016/8283062
Chen Z, Zhao C, Ye JJ, Wang XQ, Sui RF (2016) Inverted internal limiting membrane flap technique for repair of large macular holes: a short-term follow-up of anatomical and functional outcomes. Chin Med J (Engl) 129:511–7
Gekka T, Watanabe A, Ohkuma Y, Arai K, Watanabe T, Tsuzuki A, Tsuneoka H (2015) Pedicle internal limiting membrane transposition flap technique for refractory macular hole. Ophthalmic Surg Lasers Imaging Retina 46:1045–6
Michalewska Z, Michalewski J, Cisiecki S, Adelman R, Nawrocki J (2008) Correlation between foveal structure and visual outcome following macular hole surgery: a spectral optical coherence tomography study. Graefes Arch Clin Exp Ophthalmol 246:823–30
Hayashi H, Kuriyama S (2014) Foveal microstructure in macular holes surgically closed by inverted internal limiting membrane flap technique. Retina 34:2444–50
Wakabayashi T, Fujiwara M, Sakaguchi H, Kusaka S, Oshima Y (2010) Foveal microstructure and visual acuity in surgically closed macular holes: spectral-domain optical coherence tomographic analysis. Ophthalmology 117:1815–24. doi:10.1016/j.ophtha.2010.01.017
Villate N, Lee JE, Venkatraman A, Smiddy WE (2005) Photoreceptor layer features in eyes with closed macular holes: optical coherence tomography findings and correlation with visual outcomes. Am J Ophthalmol 139:280–9
Imai H, Azumi A (2014) The expansion of RPE atrophy after the inverted ILM flap technique for a chronic large macular hole. Case Rep Ophthalmol 5:83–6
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
No funding was received for this research.
Conflict of interest
All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Financial disclosure
None of the other authors has any financial interest in the subject matter. The research for this paper was financially supported in part by the Ministry of Health and “Fondazione
Rights and permissions
About this article
Cite this article
Rossi, T., Gelso, A., Costagliola, C. et al. Macular hole closure patterns associated with different internal limiting membrane flap techniques. Graefes Arch Clin Exp Ophthalmol 255, 1073–1078 (2017). https://doi.org/10.1007/s00417-017-3598-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-017-3598-9