Inverted internal limiting membrane flap technique for very large macular hole

Khodani, Mitali; Bansal, Pooja; Narayanan, Raja; Chhablani, Jay

doi:10.18240/ijo.2016.08.22

Cited by 17 publications

(11 citation statements)

References 10 publications

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“…Historically, MH diameter is closely associated with a successful anatomical outcome and postoperative VA.[ 5 – 7 ] Though the impact of ILM flap inversion for MH on postoperative VA requires further study, our findings add weight to previous reports suggesting that postoperative VA significantly improves after ILM flap inversion. [ 8 , 10 , 17 , 19 ] Nevertheless, even though ILM peeling unfortunately resulted in three unsuccessful outcomes in the current study, there was no significant difference in 6 month-postoperative VA between the groups, despite previous reports on the advantages of ILM flap inversion. [ 8 ] Furthermore, multiple regression analysis showed that MH diameter was an independent factor predicting 6-month postoperative VA in both groups, suggesting that although ILM flap inversion can close even large MHs, it does not lead to better visual outcomes than ILM peeling.…”

Section: Discussioncontrasting

confidence: 59%

Surgical results of internal limiting membrane flap inversion and internal limiting membrane peeling for macular hole

et al. 2018

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PurposeThe internal limiting membrane (ILM) is a normal part of the retina, and the outcomes of ILM removal have not been fully investigated. ILM flap inversion is a recently developed technique that increases the success rate of macular hole (MH) surgery. Thus, we compared the anatomical closure rate and visual outcome in patients undergoing microincision vitrectomy surgery (MIVS) with ILM flap inversion or conventional ILM peeling for the treatment of MH.MethodsThe medical records of 90 eyes with MH were reviewed retrospectively. The patients were classified into two groups based on MIVS procedure (group 1: ILM flap inversion, 46 eyes; group 2: ILM peeling, 44 eyes).ResultsPreoperative characteristics were similar in the two groups, and there were no significant differences in 1 month- or 6 month-postoperative VA between the groups (P = 0.25 and P = 0.42, respectively). However, the surgical success rate was significantly higher in group 1 than group 2 (P = 0.04; 46/46: 100% and 41/44: 93%, respectively). Multiple regression analysis revealed that axial length and MH diameter were independent factors predicting 6-month postoperative BCVA in group 2 (P = 0.001 and P = 0.03, respectively), and that MH diameter was an independent factor predicting 6-month postoperative VA in group 1 (P = 0.03). Logistic regression analysis revealed that axial length (OR = 2.11; P = 0.02; area under the curve: 0.94; cut off score: 28.4 mm) was an independent factor indicating surgical failure in group 2.ConclusionOur results suggest that MIVS with ILM flap inversion might be best suited to treat MH, particularly in patients with high myopia.

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Section: Discussioncontrasting

confidence: 59%

Surgical results of internal limiting membrane flap inversion and internal limiting membrane peeling for macular hole

et al. 2018

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“…This technique is particularly useful in very large or myopic MHs. [ 33 34 ] The inverted ILM flap technique could be considered for primary MH surgeries with a low chance for primary closure. However, the technique could not be considered for redo surgeries where the ILM has been peeled in the previous surgery.…”

Section: Discussionmentioning

confidence: 99%

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

Nowroozzadeh¹,

Ashraf²,

Zadmehr³

et al. 2018

J Ophthalmic Vis Res

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Purpose:To study the outcomes of redo macular hole surgery using light silicone oil tamponade.Methods:In this study, medical charts of consecutive patients who underwent redo pars plana vitrectomy, extended dye-assisted internal limiting membrane peel, and light silicone oil tamponade for failed previous macular hole surgery (from January 2010 to June 2014) were retrospectively reviewed. Best spectacle corrected visual acuity and anatomical closure rates were regarded as outcome measures.Results:Overall, data from 13 patients was recorded and analyzed. The mean (±SD) age of patients was 66 ± 7 years, and four (30.7%) were male. Mean interval between the primary and redo surgeries was 3.7 ± 2.0 months (range, 1 to 8 months). During redo surgeries, 11 (84.6%) subjects underwent additional internal limiting membrane peeling. Mean interval between the redo surgery and silicone oil removal was 5.9 ± 2.1 months (range, 3 to 10 months). After silicone oil removal, patients were followed for 21.8 ± 14.2 months (range, 3 to 51 months). Mean best spectacle corrected visual acuity improved from 20/452 before redo surgery to 20/121 in the last follow-up examination (P < 0.001). Anatomical success was achieved in 11 (84.6%) patients: nine (69.2%) macular holes were closed and two (15.4%) were flat-open.Conclusions:Redo pars plana vitrectomy with light silicone oil tamponade is an effective method for restoration of macular anatomy and function in patients with persistent macular holes.

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“…Guber et al [ 7 ] reported that most patients with large MHs (diameter > 400 μ m) showed best-corrected visual acuity (BCVA) improvements of 1 to 2 lines following surgery using the inverted flap technique. Khodani et al [ 8 ] reported that visual acuity was improved in patients with very large MHs (diameter > 1000 μ m), from a baseline visual acuity of 20/120 to a final visual acuity of 20/80 following surgery using the inverted flap technique.…”

Section: The Surgical Outcomesmentioning

confidence: 99%

“…This new method was shown to significantly improve the closure rates of large MHs (>400 μ m) and to change the flat/open closures into U-shaped or V-shaped closures. Later, the authors applied this method to highly myopic, traumatic, and other refractory MHs and were again able to achieve higher closure rates and improved visual outcomes [ 7 , 8 , 25 , 28 , 64 – 71 ]. However, the mechanism of the ILM flap technique is not yet clear.…”

Section: The Surgical Techniquesmentioning

confidence: 99%

A Review of Surgical Outcomes and Advances for Macular Holes

Zhao

Wang

Liu

et al. 2018

Journal of Ophthalmology

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The surgical outcomes of macular holes (MHs) have improved greatly in recent years. The closure rate is as high as 90–100%, but the outcomes of some special types of MHs remain unsatisfactory. Internal limiting membrane (ILM) peeling dramatically improves the anatomic success rate, but recent studies have found that it could also cause mechanical and subclinical traumatic changes to the retina. Dyes are widely used, and apart from indocyanine green (ICG), the toxicities of other dyes require further research. Face-down posturing is necessary for MHs larger than 400 μm, and the duration of this posture is determined by the type of tamponade and the case. The ellipsoid zone has been shown to be highly correlated with visual outcome and recovery. New surgical methods include the inverted ILM flap technique and the ILM abrasion technique. However, they require further research to determine their effectiveness.

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Inverted internal limiting membrane flap technique for very large macular hole

Abstract: The inverted internal limiting membrane flap technique may be promising for very large macular holes with high rate of macular closure and good visual outcome.

Cited by 17 publications

References 10 publications

Surgical results of internal limiting membrane flap inversion and internal limiting membrane peeling for macular hole

Surgical results of internal limiting membrane flap inversion and internal limiting membrane peeling for macular hole

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

A Review of Surgical Outcomes and Advances for Macular Holes

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