Clinical Observation of Anatomical and Visual Outcomes of Macular Hole after Inverted Internal Limiting Membrane Flap in Patients with Idiopathic Macular

Abstract

Objective. To investigate anatomical and visual outcomes of macular hole (MH) after inverted internal limiting membrane (ILM) flap technique for idiopathic macular hole (IMH). Methods. A total of 13 IMH cases diagnosed in Shanxi Eye Hospital between January 2015 and June 2016 were included in the study. All patients underwent vitrectomy combined with indocyanine green-assisted inverted ILM flap technique. The MH closure rate, best-corrected visual acuity (BCVA), changes of ellipsoid zone (EZ), and external limiting membrane (ELM) were examined before operation and one, three, and six months after operation. Furthermore, 488 nm fundus autofluorescence (FAF) and spectral domain optical coherence tomography (SD-OCT) were used to observe the dynamic changes in function of macular area after surgery. Results. One month after the surgery, the MH closure rate was 100% and the visual acuity (VA) was stable, with no recurrence. Additionally, the average logMAR BCVA before operation was 1.208 ± 0.158, and this value became 0.877 ± 0.105 one month after the operation, showing a significant decrease. Three months after surgery, the average logMAR BCVA was 0.792 ± 0.103, which was significantly lower than the level one month after the surgery but much higher than that six months after surgery (0.708 ± 0.131). Besides, the diameter of the EZ defect of the postoperative one month, three months, and six months was (1377.46 ± 198.65) μm, (964.62 ± 336.26) μm, and (817.08 ± 442.99) μm, respectively. In postoperative one month, three months, and six months, the diameter of the ELM defect diameter was (969.62 ± 189.92) μm, (649.92 ± 413.15) μm, and (557.62 ± 412.50) μm, respectively. The diameter of both EZ and ELM defects was significantly reduced with the passage of time after surgery. Conclusion. Inverted ILM flap technique can reconstruct macular anatomical structure and improve VA. This technique is effective for the treatment of IMH with large MH minimum diameter and base diameter.

Effect of internal limiting membrane surgical techniques on the idiopathic and refractory management of macular holes: a systematic review and meta-analysis

“…It is an effective treatment for large FTMH [ 39 ] 7 Zhang et al, 2023 (PMID:36844949) 13 China Mean age 65.769 ± 3.479 IMH 62.9% Inverted ILM flap technique VA improved from 1.208 ± 0.158 to 0.708 ± 0.131 at 6 months. This is an effective treatment and can reconstruct macular anatomical structure and improved VA [ 40 ] 8 Nowroozzadeh et al, 2018 (PMID:29719640) 10 Iran 56–78 IMH 85.2% Free ILM flap transplantation Mean VA improved from 1.35 ± 0.32 to 0.78 ± 0.37 ( p < 0.001). It resulted in high anatomic closure and improvement in EZD [ 41 ] 9 Hirata et al, 2021 (PMID:34625615) 13 China Mean age 68.3 ± 5.9 IMH 76.7% Temporal ILM flap Mean BCVA improved from 0.63 ± 0.37 to 0.18 ± 0.15 ( p < 0.001).…”