Comparative Evaluation of Standard ILM Peel With Inverted ILM Flap Technique In Large Macular Holes: A Prospective, Randomized Study

Abstract

IFT provides superior outcomes compared to SIP and, hence, could be considered as the surgical modality of choice in large MH. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:236-240.].

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

“…Activated Müller cells also produced neurotrophic factors and growth factors that may promote the survival of retinal neurons [18]. Moreover, the ILM flaps create a closed compartment enabling the RPE to pump out fluid and keep hole dry [10]. These findings explained to the better anatomical results in the inverted ILM flap technique group.…”

“…In histopathologic findings, when the margins of the ILM were left attached to the edges of the hole, it served as a gap-free natural scaffold for gliosis, and provided a basement membrane for proliferateglial glial cells to maintain anatomic structure of the foveola [9,10]. Shiode et al showed that the neurotrophic factors and basic fibroblast growth factors (bFGF) on the surface of the ILM flap promoted the proliferation and migration of the Müller cells, contributing to fill the MH and enhance closure [11].…”

“…The titles and abstracts reviewed, and the remaining 16 studies were retrieved for the next review. Finally, after reading carefully of full-texts, We included a total of 8 studies [4,[9][10][11][12][13][14][15], 4 RCTs [4, [9][10][11] and 4 case series [12][13][14][15]. Fig.…”

“…The mean duration of symptoms varied from 3.06 to 20 months, and the average minimum diameter of MH ranged from 493.8 to 803.33 μm. The shortest follow-up duration was 3 months in 3 studies [4,10,12], the follow-up duration ≥6 months in 5 studies [9,11,[13][14][15].…”

“…Michalewska et al [9] first presented a novel technique of inverted ILM flap for the treatment of large MH, contributing to a relatively high MH closure rates. Recently, a number of clinical studies have suggested that inverted ILM flap technique achieved better anatomical and visual outcomes than ILM peeling [10][11][12][13][14][15]. However because of lacking appropriate controls, uncontrollable elements, or insufficient samples in most of these studies, the reliable evidences to support such a view were limited.…”