Temporal Inverted Internal Limiting Membrane Flap Technique Versus Classic Inverted Internal Limiting Membrane Flap Technique

Michalewska, Zofia; Michalewski, Janusz; Dulczewska-Cichecka, Karolina; Adelman, Ron A.; Nawrocki, Jerzy

doi:10.1097/iae.0000000000000555

Cited by 222 publications

(249 citation statements)

References 16 publications

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“…One theory is that the ILM may act as a scaffold for glial proliferation. Another theory is that the ILM flap forms a compartment that blocks entry of fluid from the vitreous cavity to the MH [9] . Using our modified technique, there were 4 cases of delayed closure showing resolution of the neurosensory defect under the ILM flap during follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Hole diameter, hole configuration, and status of the outer retina were assessed on a B-scan image obtained using OCT by a masked investigator (KYP). Hole configuration was characterized into U-shape, V-shape, W-shape (irregular), flat open, and "flap closure" [5,9] . U-shape was defined as a contour similar to that of a healthy fovea, and V-shape was defined as a steep contour.…”

Section: Methodsmentioning

confidence: 99%

“…W-shape was a closed but irregular contour that could not be defined as U-or V-shape. Flap closure was recognized as a thin ILM flap covering the MH without approximation of retinal tissue [9] ( Fig. 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…The ILM around the MH was left to cover the hole and showed a better anatomical closure rate and visual outcome than ILM peeling for large MHs. Since then, several modifications were reported for the treatment of the aforementioned challenging situations [9][10][11][12] . Our group has reported a modified technique to cover a MH with a single-layered ILM flap that would be more physiologic and provide a more regular structure for glial proliferation [10] .…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, a flat/open shape is observed postoperatively in 19-39% of all MHs, and this configuration is related to a worse visual acuity [4,5] . Various surgical strategies have been introduced to improve postoperative outcomes for these cases [6][7][8][9] . Michalewska et al [7] have reported an inverted ILM flap technique for large MHs.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of the Perfluoro-N-Octane-Assisted Single-Layered Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes

Pak

Park

et al. 2017

Ophthalmologica

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Purpose: The aim of this study was to evaluate the efficacy of the perfluoro-n-octane-assisted single-layered inverted internal limiting membrane (ILM) flap for large macular holes (MHs). Methods: We reviewed idiopathic MHs >400 μm. The patients were divided into ILM peeling (group P, 51 eyes) and ILM flap (group F, 41 eyes). Closure of MHs, best-corrected visual acuity (BCVA), and postoperative optical coherence tomography findings were analyzed. Results: MH closure was achieved in 88.2% in group P and in 100% in group F (p = 0.032). SF₆ and air was used most frequently in groups P and F, respectively. Both had a significant improvement in BCVA, which was better in group F until 3 months, but not at 6 months. At 6 months, the ellipsoid zone and external limiting membrane were restored with no significant difference. Conclusion: The single-layered inverted ILM flap was better for the closure of large MHs than ILM peeling, without using long-acting gas that prevents early rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of the Perfluoro-N-Octane-Assisted Single-Layered Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes

Pak

Park

et al. 2017

Ophthalmologica

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Features Involved in the Healing Process of Macular Holes

2017

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The mechanism of closure of a macular hole (MH) is not yet fully understood. Spontaneous closure in nontraumatic cases is possible, but quite rare. 1 Alternatively, vitrectomy and gas tamponade, with or without internal limiting membrane (ILM) peeling, achieve anatomic success in 80% to 95% of cases. During recent years, different techniques have been attempted to improve the closure rate of MH and bring it closer to 100%.The addition of autologous serum does not appear to alter the prognosis of surgery, 1 while the addition of platelet-rich plasma seems to work better, 2 even in challenging cases, such as myopic MH. More recently, the ILM flap technique was introduced for cases of MH that pose a high risk of persistence, such as myopic, chronic, or large holes. Initially, many surgeons thought that it would be necessary to put the ILM inside the hole to create a kind of plug. Subsequently, the pioneers of this technique stated that it would be sufficient to cover the hole with a single ILM layer, and they proposed performing the peeling only on the temporal side. 3 An MH can be considered a small laceration in the weakest point of the retina, the fovea. The formation of a blood clot is the first step in the repair of a skin wound, which creates a closed environment, within which the repair mechanisms can act. Similarly, there is some evidence that anything that covers the MH and can separate the vitreous cavity from the intraretinal and subretinal space could facilitate its closure. This might explain why a single layer of ILM covering a myopic MH makes such a significant difference in the rate of closure of myopic MH. 4 Moreover, the ILM flap was found to be displaced or not present in all MHs that failed to close. For the same reason, platelet-rich plasma is likely to work better than autologous serum that does not stick at the edges of the MH.We could even speculate that the main role of a tamponade might be the formation of a cover over the MH that can promote the maintenance of the homeostatic conditions necessary for the healing process. Silicone oil has been found to be an effective tamponade for the treatment of MH. This is surprising, as it is a lasting, but weaker, tamponade compared with gas. A possible explanation for its positive effect in promoting MH closure is that it creates a kind of bursa inside the edge of the MH and, therefore, compartmentalizes chemotactic and nutrient substances that may support its closure.The ILM flap also acts as substrate for a secondary intention wound-healing mechanism. When the hole is large, the edges are stiff, or the retina is not elastic enough, the ILM plug can support the closure without complete reapposition of the edges. In some cases, this step is followed by further anatomical and functional improvements during follow-up: the plug is slowly dis-VIEWPOINT

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Pars plana vitrectomy with internal limiting membrane flap versus pars plana vitrectomy with conventional internal limiting membrane peeling for large macular hole

Ghoraba

Abdelkarem

Akhavanrezayat

et al. 2021

Cochrane Database of Systematic Reviews

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Temporal Inverted Internal Limiting Membrane Flap Technique Versus Classic Inverted Internal Limiting Membrane Flap Technique

Abstract: The study results indicate that the temporal inverted ILM flap technique is as effective as the classic inverted ILM flap technique for the repair of large Stage IV macular holes.

Cited by 222 publications

References 16 publications

Efficacy of the Perfluoro-N-Octane-Assisted Single-Layered Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes

Efficacy of the Perfluoro-N-Octane-Assisted Single-Layered Inverted Internal Limiting Membrane Flap Technique for Large Macular Holes

Features Involved in the Healing Process of Macular Holes

Pars plana vitrectomy with internal limiting membrane flap versus pars plana vitrectomy with conventional internal limiting membrane peeling for large macular hole

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