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Macular hole closure patterns associated with different internal limiting membrane flap techniques

  • Retinal Disorders
  • Published:
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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.

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References

  1. Kelly NE, Wendel RT (1991) Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol 109(5):654–9

    Article  CAS  PubMed  Google Scholar 

  2. Madi HA, Masri I, Steel DH (2016) Optimal management of idiopathic macular holes. Clin Ophthalmol 10:97–116

    PubMed  PubMed Central  Google Scholar 

  3. Michalewska Z, Michalewski J, Adelman RA, Nawrocki J (2010) Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology 117:2018–25

    Article  PubMed  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. Michalewska Z, Nawrocki J (2013) Macular hole surgery in a patient who cannot maintain facedown positioning. Case Rep Ophthalmol 4:1–6

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Google Scholar 

  9. 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

    Article  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. 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

    Article  PubMed  Google Scholar 

  12. Hayashi H, Kuriyama S (2014) Foveal microstructure in macular holes surgically closed by inverted internal limiting membrane flap technique. Retina 34:2444–50

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Tommaso Rossi.

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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.

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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

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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

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  • DOI: https://doi.org/10.1007/s00417-017-3598-9

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