Anatomical and Visual Outcomes of Inverted Internal Limiting Membrane Flap Technique Versus Internal Limiting Membrane Peeling in Myopic Macular Hole Without Retinal Detachment

Abstract

Purpose: To compare the results of vitrectomy with internal limiting membrane (ILM) peeling and inverted ILM flap for treating myopic macular hole without retinal detachment. Methods: Twenty-eight eyes of 28 patients undergoing vitrectomy with either ILM peeling (n = 16) or inverted ILM flap technique (n = 12) were included. Outcomes were myopic macular hole closure by optical coherence tomography and visual acuity at 6 months and at the end of follow-up. Results: Closure of myopic macular hole was achieved in 13 eyes (81.2%) of the ILM peeling group and in 11 eyes (91.7%) of the inverted ILM flap group. The median length of follow-up was 18 months in the peeling group and 10.3 in the inverted group. There were not statistically significant differences between restoration of the external limiting membrane, external limiting membrane and ellipsoid zone, and none of both layers between the two groups. The median best-corrected visual acuity (logarithm of minimal angle of resolution) at the end of follow-up was 0.25 (20/35 Snellen) in the peeling group and 0.4 (20/50) in the inverted group (P = 0.027). Conclusion: Both techniques were associated with high closure rates of myopic macular hole but the small sample size and the retrospective design prevents any claims of superiority of one technique over the other.

Comparison of Anatomical and Visual Outcomes between Idiopathic and Myopic Macular Holes Using the Internal Limiting Membrane or Inverted Internal Limiting Membrane Flap Technique

“…Other authors have reported closure rates of 83% to 100% [11]. With regard to the BCVA, the percentage of patients with a vision improvement after ILM peeling ranges from 41% to 83% [11, 12, 13, 14]. In the present study, BCVA increased in 76% of idiopathic MH and 71% of myopic MH cases (ILM peeling group), with no statistical differences.…”

Secondary macular holes – A review of current management strategies

“…High myopia over −6.0 diopters can be complicated with a secondary MH [ Figure 2]. [36,37] The pathophysiology is not fully understood. It has been suggested that the pathologic growth of the eyeball in myopic eyes may lead to posterior staphyloma, manifesting as a posterior scleral protrusion.…”

“…[41] The growing anteroposterior axial length together with the VMT can lead to foveoschisis and the formation of a FMTH. [37,41,42] Retinal detachment is a rare complication of idiopathic MH, but it is relatively more frequent in cases of MMHs. [39,43] The reported incidence of foveoschisis in high myopia is 9-34%, and approximately 50% of patients with foveoschisis will subsequently develop either a MH or retinal detachment within 2 years.…”

“…The MMH is occasionally difficult to diagnose clinically, and OCT should be used liberally in such cases. [37] Vitrectomy and macular buckling (MB) are the two main surgical approaches for this condition. [39] Pars plana vitrectomy…”

“…Another prospective comparative study evaluated the results of vitrectomy with ILM peeling versus the inverted ILM technique for MMH (aided by perfluorocarbon for flap placement). [37] Sixteen and 12 eyes were included in each group, respectively. Gas tamponade was performed in all patients who were instructed to maintain prone positioning after surgery.…”