Non-inverted pedicle internal limiting membrane transposition for large macular holes

Hu, Zizhong; Ye, Xiaojian; Lv, Xuemei; Liang, Kang; Zhang, Weiwei; Chen, Xi; Cao, Er-Bing; Gu, Xunyi; Liu, Qing-Huai

doi:10.1038/s41433-018-0107-2

Cited by 16 publications

(11 citation statements)

References 20 publications

(27 reference statements)

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“… 4 Our previous study reported a new surgical technique of uninverted pedicle ILM transposition for treatment of eyes with large MHs. 5 Our findings indicated that transposition resulted in a high incidence of anatomic closure with good visual outcome for the treatment of large MHs. However, for patients with refractory MHs, vision-related quality of life (QoL) was not just about the closure rate of MHs: it was about visual activity and quality, such as contrast sensitivity.…”

Section: Introductionmentioning

confidence: 52%

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<p>Evaluation of Vision-Related Quality of Life after Autologous Internal Limiting–Membrane Transplantation for Refractory Macular Holes</p>

Yuan¹,

Zhang²,

Yuan³

et al. 2020

OPTH

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Purpose To evaluate the vision-related quality of life of vitrectomy combined with autologous internal limiting membrane (ILM) transplantation for refractory macular holes (MHs). Methods There were 40 eyes with refractory MHs included, and all eyes received 23 G vitrectomy and ILM peeling with autologous ILM transplantation. Preoperative and postoperative basic conditions were recorded. The Chinese version of the vision-related quality-of-life scale was used to evaluate patients after operation. Quality of life, postoperative visual acuity, and size of MHs before operation were assessed with Spearman rank correlations. Results All patients were followed up for 3 months after surgery. Mean postoperative best-corrected visual acuity had significantly improved after surgery. Vision-related quality of life of patients after surgery was closely related to the MH index, but negatively correlated with best-corrected visual acuity before and after surgery. Conclusion The anatomical structure of refractory MHs with ILM peeling combined with autologous ILM transplantation was largely reduced, and the visual acuity of patients improved significantly.

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Section: Introductionmentioning

confidence: 52%

“…All the patients received 23 G vitrectomy with ILM peeling combined with autologous ILM transplantation successfully. The surgical method 5 was three channels through pars plana corporis ciliaris being established and the vitreous body being excised. Indocyanine green staining was performed for 15 seconds.…”

Section: Methodsmentioning

confidence: 99%

<p>Evaluation of Vision-Related Quality of Life after Autologous Internal Limiting–Membrane Transplantation for Refractory Macular Holes</p>

Yuan¹,

Zhang²,

Yuan³

et al. 2020

OPTH

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“…[ 96 97 98 ] A retrospective series of 12 eyes undergoing noninverted pedicle flap for MH >400 μm showed closure rates over 90% with significant improvement in VA and macular sensitivity on mfERG. [ 99 ] However, the pedicle flap has not been widely adopted, and in our experience with its application in refractory holes, the flap tends to retract over time with reopening of the MH.…”

Section: Noninverted Internal Limiting Membrane Flapsmentioning

confidence: 99%

Current management strategies for atypical macular holes

Marlow

Mahmoud

2021

Taiwan Journal of Ophthalmology

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This review evaluates the current surgical management options for refractory and atypical macular holes (MH) and proposes a treatment paradigm for approaching complex cases. A review of literature was performed to deliver a thorough discussion of the epidemiology and pathophysiology of MH as well as the historic evolution of surgical management strategies. With this context established, an update on recent surgical advances for management of large, chronic, and highly myopic MH is provided. New small MH may be adequately treated with pars plana vitrectomy, while those ≥300 μm should undergo internal limiting membrane (ILM) peel. For MH ≥400 μm with risk factors for failure, primary intervention should involve creation of an ILM flap and various methods of flap creation are discussed. For very large MH ≥700 μm or in refractory cases, autologous retinal transplants and other recently proposed procedures should be considered. While typical MHs enjoy high initial surgical success rates, atypical and refractory MH require additional intraoperative and postoperative considerations to maximize surgical success and optimize vision. With many techniques at the surgeon's disposal, patient selection becomes critical to improving outcomes.

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“…To avoid or minimize the damage of retinal microstructure by ILM peeling, some surgeons introduced new techniques aiming to preserve the ILM for IMH [13,14]. Of note, new techniques can only be induced in clinical practice and on condition of not compromising the IMH closure rate.…”

Section: Introductionmentioning

confidence: 99%

Minimal internal limiting membrane peeling with ILM flap technique for idiopathic macular holes: a preliminary study

Qian

Fransisca

et al. 2020

BMC Ophthalmol

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Background: Internal limiting membrane (ILM) peeling increases the idiopathic macular hole (IMH) closure rate but causes the inner retina dimplings. This study is to introduce a method to minimally peel the ILM, and with the ILM flap to ensure the IMH closure. Methods: Twelve consecutive IMH eyes were treated with the minimal ILM peeling with ILM flap technique. The ILM around the MH is peeled off in an annular shape with a width of approximately 200 to 300 μm. A tongueshape ILM flap is created in the superior retina and the inferior margin of ILM is not peeled off. The ILM flap is then inverted to cover the MH, followed by fluid-air exchange and air or silicon tamponade. Spectral domain-optical coherence tomography (SD-OCT) and en face OCT for morphological assessment, best corrected visual acuity (BCVA) and multifocal electroretinogram (ERG) for functional evaluation were performed at baseline and at each postoperative follow-up. Results: All the 12 eyes achieved macular hole closure on SD-OCT after surgery (100%). At baseline, the mean preoperative BCVA was 0.83 ± 0.33 and it improved to 0.39 ± 0.28 postoperatively (p < 0.001). En face OCT showed the inner retinal dimplings were localized only in superior ILM-free retinas (7 eyes). The mERG response density in the central (R1), para-central (R2), R1/R2 ring ratios were remarkably improved at the last follow-up (p = 0.001, p = 0.033, p = 0.018, respectively). Conclusions: The minimal ILM peeling with ILM flap technique can achieve favorable MH closure with less inner retinal dimplings and has promising visual recovery for IMH eyes.

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Non-inverted pedicle internal limiting membrane transposition for large macular holes

Abstract: These findings indicate that the non-inverted pedicle ILM transposition results in a high incidence of anatomic closure with good visual outcome for the treatment of large macular hole.

Cited by 16 publications

References 20 publications

<p>Evaluation of Vision-Related Quality of Life after Autologous Internal Limiting–Membrane Transplantation for Refractory Macular Holes</p>

<p>Evaluation of Vision-Related Quality of Life after Autologous Internal Limiting–Membrane Transplantation for Refractory Macular Holes</p>

Current management strategies for atypical macular holes

Minimal internal limiting membrane peeling with ILM flap technique for idiopathic macular holes: a preliminary study

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