Inverted Internal Limiting Membrane Flap Technique for Treatment of Macular Hole Retinal Detachment in Highly Myopic Eyes

Takahashi, Hiroyuki; Inoue, Makoto; Koto, Takashi; Itoh, Yuji; Hirota, Kazunari; Hirakata, Akito

doi:10.1097/iae.0000000000001898

Cited by 52 publications

(38 citation statements)

References 27 publications

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“…Kumar and Yadav [23] considered that the tissue pillars could be composed of redundant retinal tissue, subclinical epiretinal membranes, or small residual pieces of the ILM attached to the edges of the hole. They suggested that the mechanism of closure could be similar to the inverted ILM flap surgical approach in which the pillars provide mechanical support to bridge the gap and more quickly cover up the defects in the inner retina [24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

Macular hole edge morphology predicts restoration of postoperative retinal microstructure and functional outcome

et al. 2020

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Background: To investigate the ability of intraoperative optical coherence tomography (iOCT) during macular hole (MH) surgery to image different hole edge configurations and predict the restoration of retinal microstructure and visual outcomes. Methods: This retrospective case series study included 53 MH patients. One eye each was assessed with iOCT during vitrectomy after internal limiting membrane (ILM) peeling. The MHs were categorized into three groups according to the morphology of the hole edge. The Hole-Door group had vertical pillars of tissue that projected into the vitreous cavity after ILM peeling. The Foveal Flap group had a preoperative foveal flap that adhered to the hole edge after ILM peeling, and the Negative group had neither a hole-door nor a foveal flap. At 6 months after surgery, the retinal microstructure restoration and visual outcomes were compared among the groups. Results: All eyes had MH closure, and the postoperative best corrected visual acuity (BCVA) was significantly improved compared with the preoperative BCVA (P < 0.001). The Hole-Door group (n = 15) and Foveal Flap group (n = 14) had significantly better final visual acuity and postoperative restoration of the external limiting membrane (ELM) than the Negative group (n = 24) (P = 0.002, P = 0.012). For the group in which the MH diameter (MHD) was ≤400 μm (n = 25), there were no significant differences in ELM restoration, ellipsoid zone (EZ) restoration, or BCVA among the three groups (P = 0.516, P = 0.179, and P = 0.179 respectively). For the MHD > 400-μm group (n = 28, the Hole-Door group and Foveal Flap group had significantly better final visual acuity and restoration of ELM than the Negative group (P = 0.013, P = 0.005). Conclusions: The novel use of iOCT during MH surgery confirmed the presence of hole edges configured as doorholes, foveal flaps, or neither. The data acquired by iOCT can provide useful predictive information for postoperative restoration of the retinal microstructure and visual outcome of MH, especially large ones.

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Section: Discussionmentioning

confidence: 99%

Macular hole edge morphology predicts restoration of postoperative retinal microstructure and functional outcome

et al. 2020

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“…Moreover, the heterogeneity was low. is may be attributed to the study of Takahashi et al [29], who reported a lower postoperative retinal reattachment rate for the inverted ILM flap group.…”

Section: Discussionmentioning

confidence: 92%

“…However, there was a significant intergroup difference in the postoperative BCVA at 12 months after surgery, with no heterogeneity. is could be attributed to the use of BBG for ILM staining in all three included studies [28][29][30]. Glial cell proliferation induced by the inverted ILM flap, as proposed by Michalewska, produces an environment for photoreceptors to assume new positions in direct proximity to the fovea, thus resulting in improved postoperative visual acuity [16].…”

Section: Discussionmentioning

confidence: 93%

“…e full text of the remaining 13 studies was evaluated; two studies had unqualified data, two did not meet the inclusion criteria, one was contextually irrelevant, and one contained data that could not be extracted. Eventually, seven studies [19,20,[26][27][28][29][30] with a total of 198 eyes (84 in the inverted ILM flap group and 114 in the ILM peeling group) were included in our meta-analysis. e characteristics of the seven studies are depicted in Table 1, and the results of their quality assessment are reported in Supplementary Table 1.…”

Section: Search Resultsmentioning

confidence: 99%

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Inverted Internal Limiting Membrane Flap Technique versus Internal Limiting Membrane Peeling for Vitrectomy in Highly Myopic Eyes with Macular Hole-Induced Retinal Detachment: An Updated Meta-Analysis

Ling

Liu

et al. 2020

Journal of Ophthalmology

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Background. The aim of this meta-analysis was to compare morphological and functional outcomes between vitrectomy with the inverted internal limiting membrane (ILM) flap technique and vitrectomy with internal limiting membrane peeling in highly myopic eyes with macular hole- (MH-) induced retinal detachment (MHRD). Methods. The PubMed, Web of Science, Embase, and Cochrane Library databases were comprehensively searched from inception to November 10, 2019, for published studies comparing the two techniques for the treatment of MHRD. The outcomes in the collected articles included the postoperative MH closure rate, retinal reattachment rate, and best-corrected visual acuity (BCVA). Review Manager (version 5.3) was used for analyses. Results. In total, seven retrospective studies comparing the inverted ILM flap technique with ILM peeling for the treatment of MHRD were included. The MH closure rate was significantly higher in the inverted ILM flap group than in the ILM peeling group at 6 and 12 months after initial surgery (OR = 15.39; 95% CI: 6.68 to 35.43;P<0.00001 and OR = 12.58, 95% CI: 3.51 to 45.08; P=0.0001), while the retinal reattachment rate was similar in both groups at 6 months after initial surgery (OR = 2.40; 95% CI: 0.89 to 6.50; P=0.08). Besides, the postoperative BCVA was significantly better in the inverted ILM flap group than in the ILM peeling group at 12 months after initial surgery (MD = −0.35; 95% CI: −0.52 to −0.18; P<0.0001). Conclusions. Thus, the MH closure rate and postoperative BCVA may be better with the inverted ILM flap technique than with ILM peeling for myopic MHRD, while the postoperative retinal reattachment rate appears to be similar with both techniques. Therefore, in the future, vitrectomy with the inverted ILM flap technique should be preferred over standard ILM peeling technique for the treatment of MHRD in highly myopic eyes.

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“…They suggested that the mechanism of closure could be similar to the inverted ILM flap surgical approach in which the pillars provide mechanical support to bridge the gap and more quickly cover up the defects in the inner retina. [24][25][26][27] Visual recovery after MH closure may depend on the recovery of the retinal microstructure in the fovea, particularly the outer retina. [5][6][7][8] The authors reported that the restoration of the ELM and the EZ lines over the closed MH was associated with better BCVAs.…”

Section: Discussionmentioning

confidence: 99%

Macular hole edge morphology predicts restoration of postoperative retinal microstructure and functional outcome

Tao

Chen

Zhu

et al. 2020

Preprint

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Background: To investigate the association between iOCT feature in macular hole (MH) surgery and the restoration of the retina microstructure and visual outcomes. Methods: This was a case series study including fifty-three eyes of 53 patients with macular hole were recruited. According to the morphological characteristics of the hole edge as imaged by iOCT after ILM peeling, all patients were divided into three groups: fovel flap group, hole-door group, and negative group. The restoration of the retina microstructure and postoperative visual outcomes of the MH surgery were compared between these groups. Results: All of the eyes had MH closure after vitrectomy. The postoperative BCVA was significantly improved compared with the preoperative BCVA (P<0.001). Based on the features of the hole edge as reveal by iOCT, the negative group included 24 eyes, the fovea flap group included 14 eyes, and the hole-door group included 15 eyes. The hole-door group and foveal flap group had significantly better final visual acuity and postoperative restoration of the ELM than the negative group (P=0.002, P=0.012). For the group in which the MHD was ≤400 μm, there were no significant differences in ELM restoration, EZ restoration, or BCVA among the three groups (P=0.516 and P=0.179 respectively). For the MHD >400-μm group, the hole-door group and fovea flap group had significantly better final visual acuity and restoration of ELM than the negative group (P=0.013, P=0.005). Conclusion: This study describes a novel intraoperative sign using iOCT. This sign can provide useful predictive information for postoperative restoration of the retinal microstructure and visual outcomes of MHs, especially large ones

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Inverted Internal Limiting Membrane Flap Technique for Treatment of Macular Hole Retinal Detachment in Highly Myopic Eyes

Abstract: The inverted ILM flap technique with the presence of bridging tissue over the MH is effective in closing the MH and improving the postoperative best-corrected visual acuity in eyes with MH retinal detachment by bridging tissue over the MH.

Cited by 52 publications

References 27 publications

Macular hole edge morphology predicts restoration of postoperative retinal microstructure and functional outcome

Macular hole edge morphology predicts restoration of postoperative retinal microstructure and functional outcome

Inverted Internal Limiting Membrane Flap Technique versus Internal Limiting Membrane Peeling for Vitrectomy in Highly Myopic Eyes with Macular Hole-Induced Retinal Detachment: An Updated Meta-Analysis

Macular hole edge morphology predicts restoration of postoperative retinal microstructure and functional outcome

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