To describe the efficacy of a modification of the superior inverted flap technique, with maculorrhexis, in vitrectomy for full-thickness macular hole (MH) surgery compared to internal limiting membrane peeling (ILM).
Methods
Retrospective and comparative study of patients with MH. In group A, a superior ILM flap is created to cover the macular hole, and in group B conventional ILM peeling was performed.
Results
A total of 80 eyes were included (44 group A and 36 group B). MH closure occurred in 100% in group A and 91.67% in group B (p = 0.0869). There were more U-type closures in group A(90.91%) than in group B(58.33%), p = 0.0017. Both groups showed Best corrected visual acuity (BCVA) improvement at 3 and 6 months. At 3 months BCVA in group A was significantly better but at 6 months results were similar. Ellipsoid layer (EZ) recovery at 6 months was achieved in 81.82% patients in group A and 52.78% in B (p = 0.005), and external limiting membrane in 81.82% in group A and 69.44% in B (p = 0.1957).
Conclusions
The superior inverted flap maculorrhexis technique is suitable for idiopathic MH treatment, with better anatomical and non-inferior functional results than the classic ILM peeling. It achieves functional recoveries earlier, better BCVA and greater gains at 3 months compared to the classic ILM peeling. It also obtains a higher number of U-shaped closures and higher EZ restorations.
DuanH-TChenSWangY-X, et al.Visual function and vision-related quality of life after vitrectomy for idiopathic macular hole: a 12mo follow-up study. Int J Ophthalmol2015; 8: 764–769.
2.
CaMJlENnD,et al.Population-based incidence of macular holes. Ophthalmology2009; 116:1366–9.
3.
WilliamsonTHLeeE. Idiopathic macular hole: analysis of visual outcomes and the use of indocyanine green or brilliant blue for internal limiting membrane peel. Graefes Arch Clin Exp Ophthalmol2014; 252: 395–400.
4.
KaseSSaitoWMoriS,et al.Clinical and histological evaluation of large macular hole surgery using the inverted internal limiting membrane flap technique. Clinical Ophthalmology2016; 11: 9–14.
5.
MichalewskaZMichalewskiJAdelmanRA. Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology2010; 117: 2018–2025.
6.
MichalewskaZMichalewskiJNawrockiJ. Continuous changes in macular morphology after macular hole closure visualized with spectral optical coherence tomography. Graefes Arch Clin Exp Ophthalmol2010; 248: 1249–1255.
7.
MichalewskaZMichalewskiJDulczewska-CicheckaK,et al.Inverted internal limiting membrane flap technique for surgical repair of myopic macular holes. Retina2014; 34: 664–669.
8.
ManasaSKakkarPKumarA,et al.Comparative evaluation of standard ILM peel with inverted ILM flap technique in large macular holes: a prospective, randomized study. Ophthalmic Surg Lasers Imaging Retina2018; 49: 236–240.
9.
KannanNBKohliPParidaH, et al.Comparative study of inverted internal limiting membrane (ILM) flap and ILM peeling technique in large macular holes: a randomized-control trial. BMC Ophthalmol2018:177.
10.
YamashitaTSakamotoTTerasakiH, et al.Best surgical technique and outcomes for large macular holes: retrospective multicentre study in Japan. Acta Ophthalmol2018; 96: e904–e910.
11.
RossiTGelsoACostagliolaC,et al.Macular hole closure patterns associated with different internal limiting membrane flap techniques. Graefe’s Archive for Clinical and Experimental Ophthalmology2017; 255: 1073–1078.
12.
CasiniGMuraMFigusM, et al.Inverted internal limiting membrane flap technique for macular hole surgery without extra manipulation of the flap. Retina2017; 37: 2138–2144.
13.
HayashiHKuriyamaS. Foveal microstructure in macular holes surgically closed by inverted internal limiting membrane flap technique. Retina2014; 34: 2444–2450.
14.
MichalewskaZMichalewskiJDulczewska-CicheckaK, et al.Temporal inverted internal limiting membrane flap technique versus classic inverted internal limiting membrane flap technique: a comparative study. Retina2015; 35: 1844–1850.
15.
ChenGTzekovRJiangF, et al.Inverted ILM flap technique versus conventional ILM peeling for idiopathic large macular holes: A meta-analysis of randomized controlled trials. PLoS One2020; 15(7):e0236431.
16.
ChenS-N. Large semicircular inverted internal limiting membrane flap in the treatment of macular hole in high myopia. Graefe’s Archive for Clinical and Experimental Ophthalmology2017; 255: 2337–2345.
17.
TakahashiHInoueMKotoT,et al.Inverted internal limiting membrane flap technique for treatment of macular hole retinal detachment in highly myopic eyes. Retina2018; 38: 2317–2326.
18.
ItoYTerasakiHTakahashiA,et al.Dissociated optic nerve fiber layer appearance after internal limiting membrane peeling for idiopathic macular holes. Ophthalmology2005; 112: 1415–1420.
19.
TerasakiH, et al.Focal macular ERGs in eyes after removal of macular ILM during macular hole surgery. Invest Ophthalmol Vis Sci2001; 42: 229–234.
20.
DukerJSKaiserPKBinderS, et al.The international vitreomacular traction study group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology2013; 120: 2611–2619.
21.
ImaiMIijimaHGotohT,et al.Optical coherence tomography of successfully repaired idiopathic macular holes. Am J Ophthalmol1999; 128: 621–627.
22.
ParkJHLeeSMParkSW, et al.Comparative analysis of large macular hole surgery using an internal limiting membrane insertion versus inverted flap technique. Br J Ophthalmol2019; 103: 245–250.
ShiodeYMorizaneYMatobaR, et al.The role of inverted internal limiting membrane flap in macular hole closure. Investigative Opthalmology & Visual Science2017; 58: 4847.
25.
RizzoS, et al.Internal limiting membrane peeling versus inverted flap technique for treatment of full-thickness macular holes: a comparative study in A large series of patients. Retina2018; 38: S73–S78.
26.
GhassemiFKhojastehHKhodabandeA, et al.Comparison of three different techniques of inverted internal limiting membrane flap in treatment of large idiopathic full-thickness macular hole. Clin Ophthalmol2019; 13: 2599–2606.
27.
GhassemiFMirshahiRBazvandF,et al.The quantitative measurements of foveal avascular zone using optical coherence tomography angiography in normal volunteers. Journal of Current Ophthalmology2017; 29: 293–299.
28.
TakaiYTanitoMSugiharaK, et al.Temporal inverted internal limiting membrane flap technique for A macular hole patient unable to maintain postoperative prone positioning. Retin Cases Brief Rep2016; 10: 323–326.
29.
MaierM, et al.Vitrectomy and iOCT-assisted inverted ILM flap technique in patients with full thickness macular holes. Der Ophthalmologe : Zeitschrift der Deutschen Ophthalmologischen Gesellschaft2019; 116(7):617-624.
30.
ShinMKParkKHParkSW, et al.Perfluoro-n-Octane–Assisted single-layered inverted internal limiting membrane flap technique for macular hole surgery. Retina2014; 34: 1905–1910.
31.
MichalewskaZNawrockiJ. Macular hole surgery in a patient who cannot maintain facedown positioning. Case Rep Ophthalmol2013; 4: 1–6.
32.
TadayoniRVicautEDevinF, et al.A randomized controlled trial of alleviated positioning after small macular hole surgery. Ophthalmology2011; 118: 150–155.
33.
ShenYLinXZhangL,et al.Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis. BMC Ophthalmol2020; 20: 14.
34.
YanYZhaoTSunC, et al.Anatomical and functional outcomes in eyes with idiopathic macular holes that underwent surgery using the inverted internal limiting membrane (ILM) flap technique versus the conventional ILM peeling technique. Adv Ther2021; 38: 1931–1945.
35.
MorizaneYShiragaFKimuraS, et al.Autologous transplantation of the internal limiting membrane for refractory macular holes. Am J Ophthalmol2014; 157: 861–869.e1.
36.
CarpinetoP, et al.Inverted ILM flap technique in idiopathic full-thickness macular hole surgery: functional outcomes and their correlation with morphologic findings. J Ophthalmol2021; 2021: 1–7.
37.
Da ChouHLiuLWangC-T, et al.Single-layer inverted internal limiting membrane flap versus conventional peel for small- or Medium-sized full-thickness macular holes. Am J Ophthalmol2021; S0002939421004396: 111–119. doi:10.1016/j.ajo.2021.08.016
38.
AvciRMavi YildizAYilmazS. Conventional internal limiting membrane peeling versus temporal inverted internal limiting membrane flap for large macular holes. Eur J Ophthalmol2021; 31(2):679-687. doi:10.1177/1120672119892427
39.
MichalewskaZMichalewskiJCisieckiS,et al.Correlation between foveal structure and visual outcome following macular hole surgery: a spectral optical coherence tomography study. Graefe’s Archive for Clinical and Experimental Ophthalmology2008; 246: 823–830.
40.
GeenenCMurphyDCSandinhaMT, et al.Significance of preoperative external limiting membrane height on visual prognosis in patients undergoing macular hole surgery. Retina2019; 39: 1392–1398.
41.
BottoniFAngelisSDLuccarelliS, et al.The dynamic healing process of idiopathic macular holes after surgical repair: a spectral-domain optical coherence tomography study. Invest. Ophthalmol. Vis. Sci2011; 52: 4439–4446.
42.
TadayoniR, et al.Dissociated optic nerve fiber layer appearance of the fundus after idiopathic epiretinal membrane removala aThe authors have no financial interest in the material used in this work. Ophthalmology2001; 108: 2279–2283.
43.
MitamuraYOhtsukaK. Relationship of dissociated optic nerve fiber layer appearance to internal limiting membrane peeling. Ophthalmology2005; 112: 1766–1770.
44.
MitamuraYSuzukiTKinoshitaT, et al.Optical coherence tomographic findings of dissociated optic nerve fiber layer appearance. Am J Ophthalmol2004; 137: 1155–1156.
45.
NukadaKHangaiMOotoS, et al.Tomographic features of macula after successful macular hole surgery. Invest Ophthalmol Vis Sci2013; 54: 2417–2428.
46.
AlkabesMSalinasCVitaleL, et al.En face optical coherence tomography of inner retinal defects after internal limiting membrane peeling for idiopathic macular hole. Invest Ophthalmol Vis Sci2011; 52: 8349–8355.
47.
AvciRMavi YildizAYilmazS. Evaluation of inner retinal dimples and internal limiting membrane flap configuration after temporal inverted ILM flap technique. Eur J Ophthalmol2020; 31: 649–655. doi:10.1177/1120672120940980
48.
ImaiHOhtaK. Microperimetric determination of retinal sensitivity in areas of dissociated optic nerve fiber layer following internal limiting membrane peeling. Jpn J Ophthalmol2010; 54: 435–440.
49.
LeonardRESmiddyWEFlynnHW,et al.Long-term visual outcomes in patients with successful macular hole surgery. Ophthalmology1997; 104: 1648–1652.
