Internal Limiting Membrane Peeling Versus Inverted Flap Technique for Treatment of Full-Thickness Macular Holes

Rizzo, Stanislao; Tartaro, Ruggero; Barca, Francesco; Caporossi, Tomaso; Bacherini, Daniela; Giansanti, Fabrizio

doi:10.1097/iae.0000000000001985

Cited by 150 publications

(153 citation statements)

References 12 publications

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“…Indeed, the flap should provide an environment to instruct the photoreceptors in order to assume correct position during the reconstruction process and finally to improve visual acuity [2]. In line with previous papers [2][3][4][5]7,15,40,41], in both groups of this study, mean visual acuity improved after ILM-flap inversion. In particular, as we previously observed, a significant improvement of functional parameters as visual acuity, retinal sensitivity, and fixation was achieved as early as one month after surgery [15], so we considered that time point as baseline in this study.…”

Section: Discussionsupporting

confidence: 86%

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Microperimetric Biofeedback Training After Successful Inverted Flap Technique for Large Macular Hole

Sborgia

Niro

Tritto

et al. 2020

JCM

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Background: Despite the high closure rate of large macular hole (LMH) after surgery, visual recovery is often worse than expected. Microperimetric biofeedback can improve visual function in macular pathologies. We evaluated the efficacy of biofeedback on macular function after successful inverted flap technique for LMH. Methods: In this prospective comparative study, 26 patients after LMH surgical closure were enrolled. The whole sample was equally divided into two groups. In Group 1 (trained), patients underwent a double cycle of microperimetric biofeedback, using structured light stimulus plus acoustic tone; in Group 2 (control), patients underwent scheduled visits. We analyzed visual acuity, retinal sensitivity at central 12° (macular sensitivity, MS) and 4° (central macular sensitivity, CMS), and fixation stability over twelve months. Results: Visual acuity improved mainly in the trained group, without any significant differences between the groups (p > 0.05). Only after training did MS significantly improve (p = 0.01). CMS more significantly improved in the trained (p < 0.001) than the control group (p < 0.01) (Group 1 vs. 2, p = 0.004). Only in the trained group did fixation significantly improve (3 months, p ≤ 0.03; 12 months, p ≤ 0.01). An equality test on matched data confirmed a greater significant improvement of CMS (p ≤ 0.02) at all follow-up and fixation (p ≤ 0.02) at last follow-up after training. Conclusions: Microperimetric biofeedback consolidates and increases the improvement of retinal sensitivity and fixation gained after successful inverted flap technique.

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Section: Discussionsupporting

confidence: 86%

“…The inverted inner limiting membrane (ILM)-flap technique has become one of the most effective procedures, with more than 90% of closure rate of LMH [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Microperimetric Biofeedback Training After Successful Inverted Flap Technique for Large Macular Hole

Sborgia

Niro

Tritto

et al. 2020

JCM

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“…Several authors have reported a higher anatomical and functional success rate with this technique and its certain modifications. 8,[15][16][17][18][19] Andrew et al used a fragment of ILM, described as "ILM hinge" attached to the hole margin, which is then folded in the hole and allowed to settle at base of the hole. Michalewska et al developed a modification of the original inverted ILM flap technique, peeling only the area temporal to MH…”

Section: Inverted Ilm Flapmentioning

confidence: 99%

Current Management of Macular Hole

Singh¹,

Narayanan²

2019

Ophthalmic Surg Lasers Imaging Retina

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In this issue's Practical Retina column, Sumit Randhir Singh, MD, and Raja Narayanan, MD, MBA, from the LV Prasad Eye Institute in Hyderabad, India, discuss the current therapeutic options for repairing macular holes (MHs). We are all aware that there is great discussion and wide variability in thinking among our colleagues regarding approaches to close a MH. Common controversies include when and if internal limiting membrane peeling is necessary, as well as what to do with it after it is peeled (fully or partially to create a flap). Other discussions include choice of tamponade, duration of positioning, and use of retinal grafts. Choice of adjuvants have also been discussed and will be addressed in this article. Drs. Singh and Narayanan tackle this topic in a concise and logical manner. They will provide a thorough review of the literature and provide opinions based on the strength of the evidence in the literature. I am certain that their insights will be very valuable for maximizing outcomes in patients with MHs.

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“…In 2010, Michalewska et al introduced the inverted ILM flap technique, improving both visual acuity and closure success of large idiopathic MHs and myopic MHs [6]. More recently, Rizzo et al found out, in a large comparative study, a 95.6% and a 88.4% closure rate respectively in idiopathic MHs > 400 μm and myopic MHs with the inverted ILM flap procedure [7].…”

Section: Introductionmentioning

confidence: 99%

Inverted internal limiting membrane flap technique versus complete internal limiting membrane peeling in large macular hole surgery: a comparative study

et al. 2020

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Background: To compare the anatomical and functional outcomes of the inverted internal limiting membrane (ILM) flap technique and the complete ILM removal in the treatment of large stage 4 macular hole (MH) > 400 μm and to evaluate reconstructive anatomical changes in foveal microstructure using spectral-domain optical coherence tomography. Methods: This is a retrospective, consecutive, nonrandomized comparative study of patients affected by idiopathic, myopic or traumatic stage 4 MH (minimum diameter > 400 μm) treated with 25-gauge pars-plana vitrectomy with either complete ILM peeling (n = 23, Group 1) or inverted ILM flap technique (n = 23, Group 2), between August 2016 and August 2018. Main outcomes measured were the MH closure rate assessed by spectral-domain optical coherence tomography and the best-corrected visual acuity (BCVA) at six months. Foveal microstructure reconstructive changes were evaluated using SD-OCT to determine predictive factors of postoperative BCVA. Results: Closure of MH was achieved in 16/23 cases of Group 1 (70%) and in 22/23 cases of the Group 2 (96%). Surgical failure was reported in 6 cases of Group 1 and 1 case of Group 2. The MH closure rate was significantly higher with the inverted ILM flap technique (P-value = 0.02). Average BCVA (LogMAR) changed from 1.04 ± 0.32 to 0.70 ± 0.31 in Group 1 and from 0.98 ± 0.22 to 0.45 ± 0.25 in Group 2 (P-value = 0.005) at 6 months. Improvement in BCVA (> 0.3 LogMAR units) was statistically higher in the Group 2 (P-value = 0.03). Restoration of foveal microstructure was significantly higher in the Group 2 at 6 months (52% vs 9%, P-value < 0.01). In Group 2, the integrity of the external limiting membrane at 3 months postoperatively was the only significant feature correlated with postoperative BCVA at 6 months (r = 0.562; P-Value = 0.01, forward stepwise regression analysis). Conclusion: Inverted ILM flap technique is more effective than the classic ILM peeling for the closure of large stage 4 MHs > 400 μm, improving both anatomical and functional outcomes. Early recovery of the external limiting membrane at 3 months is a positive predictive value of postoperative BCVA 6 months after inverted ILM flap technique.

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Internal Limiting Membrane Peeling Versus Inverted Flap Technique for Treatment of Full-Thickness Macular Holes

Abstract: Vitrectomy associated with the inverted ILM flap technique seems to be effective surgery for idiopathic and myopic large MHs, improving both functional and anatomical outcomes.

Cited by 150 publications

References 12 publications

Microperimetric Biofeedback Training After Successful Inverted Flap Technique for Large Macular Hole

Microperimetric Biofeedback Training After Successful Inverted Flap Technique for Large Macular Hole

Current Management of Macular Hole

Inverted internal limiting membrane flap technique versus complete internal limiting membrane peeling in large macular hole surgery: a comparative study

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