Macular Hole Closure Over Residual Subretinal Fluid by an Inverted Internal Limiting Membrane Flap Technique in Patients With Macular Hole Retinal Detachment in High Myopia

Okuda, Tetsuhiko; Higashide, Tomomi; Kobayashi, Koh; Ikuno, Yasushi; Sugiyama, Kazuhisa

doi:10.1097/icb.0000000000000205

Cited by 19 publications

(10 citation statements)

References 10 publications

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“…The inclusion criteria were as follows: minimum MH > 400 μm, age > 18 and at least 6 months of follow-up. Exclusion criteria were the presence of a chorioretinal atrophy involving the fovea (diagnosed on SD-OCT as a [1] region of hypertransmission of at least 250 μm in diameter, [2] a zone of attenuation or disruption of the RPE of at least 250 μm in diameter, [3] evidence of overlying photoreceptor degeneration, and [4] absence of scrolled RPE or other signs of an RPE tear), previous retinal surgery, presence of choroidal neovascularization, diabetic retinopathy or other ocular conditions that could influence the BCVA, except lens opacity.…”

Section: Methodsmentioning

confidence: 99%

“…Although the MH closure rate reaches approximately 90% with the standard procedure, some cases are more challenging and display a worsened prognosis [4]. In fact, large MHs' diameters > 400 μm, chronic MHs, and secondary MHs, resulting from ocular trauma, severe myopia, retinal detachment or proliferative vitreoretinopathy, present with poor anatomical and functional outcomes [5].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Methodsmentioning

confidence: 99%

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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“…However, the foveal configurations were only partially recovered, which may be caused by the irregular margins of the inverted flap in the MH (Okuda et al. ).…”

Section: Discussionmentioning

confidence: 99%

Vitrectomy with a modified temporal inverted limiting membrane flap to reconstruct the foveolar architecture for macular hole retinal detachment in highly myopic eyes

Chen

2017

Acta Ophthalmologica

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“…Inverted internal limiting membrane (ILM) flap technique has been reported to improve the closure rates of large and persistent macular holes [51]. This technique has recently been suggested for the treatment of macular retinal detachment due to macular holes in highly myopic eyes in which macular holes are relatively difficult to close [52]. Higher rates of macular hole closure and retinal attachment, and additionally a little yet noteworthy improvement in visual acuity, were accomplished with this procedure [53].…”

Section: Macular Surgeriesmentioning

confidence: 99%

Advances in Vitreoretinal Surgery

Komur¹

2019

Frontiers in Ophthalmology and Ocular Imaging

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Vitreoretinal surgery has been radically changed over the past 10 years by the development of new techniques, smaller gauge instrumentation, and improvements in vitrectomy machines. The indications for vitrectomy have expanded dramatically, and inoperable conditions have become amenable to surgical treatment. In addition to improvements in intraocular instruments, various dyes become available and enable better visualization and a more complete removal of vitreous and membranes. In this chapter, we issued latest developments in the surgical field of retina that enable improved surgical outcomes and less complications.

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Macular Hole Closure Over Residual Subretinal Fluid by an Inverted Internal Limiting Membrane Flap Technique in Patients With Macular Hole Retinal Detachment in High Myopia

Abstract: Using the inverted internal limiting membrane flap technique, macular holes were closed over residual subretinal fluid in patients with macular hole retinal detachment. The results indicate that reattachment of the retina may not be necessary for closure of macular holes.

Cited by 19 publications

References 10 publications

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

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

Vitrectomy with a modified temporal inverted limiting membrane flap to reconstruct the foveolar architecture for macular hole retinal detachment in highly myopic eyes

Advances in Vitreoretinal Surgery

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