Swept-Source Optical Coherence Tomography to Determine the Recovery of Retinal Layers After Inverted Internal Limiting Membrane Flap Technique for Macular Hole

Bektasoglu

et al. 2023

Klin Monbl Augenheilkd

Purpose We aimed to report our surgical experience with repeat surgery as the next step after an unsuccessful hole closure with the primary single-layered temporal inverted flap technique (IFT). Methods We identified cases with persistent macular holes by reviewing the records of eyes that underwent IFT between October 2018 and October 2021. These cases were evaluated for hole features, anatomical closure, and visual improvement before and after the first and second surgeries. In addition, the technique applied in repeat surgery was recorded. Optical coherence tomography (OCT) images at follow-up were used to evaluate the flap position. Results A persistent hole was identified in 11 (6.4%) of 172 patients who underwent IFT. An inferotemporal displacement was observed in seven eyes, while no flap could be identified in the OCT images of the other four eyes. In the second surgery, the old flap was reinverted in one eye, and a new flap was created from the superior region in five eyes and the nasal region in the other five eyes and was stabilized under perfluorocarbon liquid. A gas tamponade (C3F8/SF6) was used in all patients at the end of surgery. The minimum hole diameter was > 400 µm in all eyes and 100% closure was achieved after the second surgery. Visual acuity gain of ≥ 3 lines was observed in 9 of the 11 eyes (81.8%). The mean visual acuity increase at the last follow-up was significant (p = 0.008). Conclusion With single-layer temporal IFT in the primary surgery of macular holes, unsuccessful results may be observed due to the flap displacement in the early period. In our series, IFT was applied again with the use of the old flap or the creation of a new flap in the second surgery of the persistent holes, and successful results were obtained.

Section: Discussionmentioning

confidence: 99%

Repeat Surgery following Temporal Inverted ILM Flap Technique: Next Step after Primary Failure

Bektasoglu

et al. 2023

Klin Monbl Augenheilkd

“…Morawski et al 29 ) emphasized that BCVA was signi cantly related to the integrity of EZ band after operative. In this review, we analyzed the correlation between BCVA and ELM defect and between BCVA and EZ defect after operation, which were proved to be signi cant (P 0.05) (Table 4).…”

Section: Discussionmentioning

confidence: 99%

Recovery of idiopathic macular hole at different stages after surgery: A Systematic Review and Meta-analysis

Liao

Shen

et al. 2023

Preprint

Background A systematic review and meta-analysis was conducted to assess the visual function and microstructure recovery of idiopathic macular hole (IMH) at different stages after surgery and its relationship. Methods We systematically searched electronic database from PubMed, Embase and Cochrane Library before June 2022. The primary outcome parameter was the best corrected visual acuity (BCVA) at different time periods after surgery, while the secondary outcome parameter was the percentage or length of recovery of external limiting membrane (ELM) and ellipsoid zone (EZ) at different periods. Results This meta-analysis included 328 eyes from 10 studies. The pooled BCVA significantly improved at every stage (P < 0.05). At the same time, ELM and EZ defects repaired significantly in 1–3 months and 3–6 months after surgery (P < 0.05), which confirmed that 1–6 months were the key time for the rearrangement of the outer layer of the retina. Moreover, EZ layer continued to recover (P < 0.05) during six months after operation. Moreover, there was a significant positive correlation between ELM and EZ (P < 0.0001). Conclusions Recovery of visual function was significantly correlated with ELM layer and EZ layer. The repair of ELM is always prior to that of EZ, and the rearrangement of layers often occurs in 1–6 months. Patients’ vision continued to improved after operation.

“…A recent trend in postoperative outcomes assessment following macula hole repair has focused on analysis of foveal microstructure and integrity of retinal layers on optical coherence tomography (OCT) as a correlate for function. In particular, recovery of the external limiting membrane (ELM) and ellipsoid zone (EZ) line has been correlated with postoperative BCVA [100,101]. For the analysis of functional outcomes by the ''cover'' versus ''fill'' technique of inverted flap, for example, in patients with holes greater than 400 um and follow up longer than 12 months, 86% and 58% of eyes had regeneration of the ELM and EZ respectively in the ''cover'' group, while no cases had regeneration of either in the insertion group [97], which supported their finding that the ''cover'' group had better final BCVA.…”

Section: Inverted Ilm Flapmentioning

confidence: 99%

Current Trends in Macular Hole Repair

2021

Purpose To describe and detail the current surgical trends in the repair of macular holes so that retinal surgeons may have access to the most up to date advances in macular hole repair technology. Recent findings The inverted ILM flap and various iterations of the technique have been the dominant surgical trends for repair of both routine macular holes and those with a higher risk of non-closure when using standard surgical techniques. Additional surgical techniques include use of other acellular scaffolds such as lens capsule flaps or human amniotic membrane, autologous retinal transplantation, application of autologous blood products, and macular detachment with retinal incisions. Summary Surgical innovation in the last decade has focused on techniques to address core concepts of pathology that lead to macular hole formation or retard its repair, namely: novel ways to promote organized cell proliferation, release tractional forces on the retina, and increase retinal ''compliance'' to cover the foveal defect.