Evaluation of secondary surgery to enlarge the peeling of the internal limiting membrane following the failed surgery of idiopathic macular holes

Abstract

The aim of the present study was to evaluate the clinical results of pars plana vitrectomy (PPV) combined with the surgical enlargement of internal limiting membrane (ILM) peeling in patients who had previously undergone failed idiopathic macular hole (IMH) surgery. In the study, 134 eyes from 130 IMH patients who had received PPV combined with ILM peeling surgery (2 disk diameters) were analyzed. Within this cohort, 14 eyes had IMHs that were not closed, of which 13 eyes underwent a second surgery involving enlargement of the ILM peeling. The extent of the ILM peeling was increased to the vascular arcades of the posterior fundus in the secondary surgery. Of the 13 eyes that underwent secondary surgery, five were in stage III and nine were in stage IV. The second surgery successfully achieved IMH closure in 61.5% (8/13) of the eyes. The IMH was completely closed following surgery and the logMAR vision increased from 0.98 to 0.84 (P=0.013) in the 8 successfully treated cases. The surgical enlargement of ILM peeling closed the IMHs and improved vision in the majority of patients. In addition, the procedures were safe. Therefore, the results of the present study indicate that enlargement of ILM peeling may be an effective therapy for patients who have previously undergone the failed surgical correction of an IMH.

Outcomes of light silicone oil tamponade for failed idiopathic macular hole surgery

“…Table 3 summarizes the visual and anatomical outcomes of persistent MH management in different studies. [ 14 15 16 17 18 19 20 21 22 23 24 25 26 27 ] According to the data presented in this table, a second procedure for management of persistent MH using various techniques led to anatomical success in 60-100% of eyes. In addition, significant visual improvement was reported in almost all mentioned studies, paralleling anatomical success.…”

Internal limiting membrane translocation for refractory macular holes

“…This might be partly due to the fact that there is little else to do when the posterior hyaloid has been detached and the ILM removed. Several different techniques have been described as adjunctive procedures to attempt closure when reoperating these patients, such as pneumatic retinopexy and repeat fluid–gas exchange,14 PPV with enlargement of previous ILM peel,15 endotamponade with silicone oil16 17 or long-lasting gas,7 radial relaxing retinotomies on the margin of the hole18 and laser photocoagulation,19 among others.…”

Refractory macular hole repaired by autologous retinal graft and blood clot

“…Various surgical strategies have been introduced as adjunctive procedures to attempt closure of the refractory MH; these include enlargement of the previous ILM peel [ 6 ], use of heavy silicone oil for tamponade [ 7 ], pedicle ILM flap technique [ 8 ], lens capsular flap transplantation [ 9 ], autologous free ILM flap [ 10 – 12 ], and autologous neurosensory retinal free flap [ 13 ].…”