Vitrectomy with the inverted internal limiting membrane flap technique in eyes with full-thickness macular hole and dry age-related macular degeneration

Abstract

Purpose To present effects of the inverted internal limiting membrane flap technique in full-thickness macular holes coexisting with dry age-related macular degeneration. Methods Our database was retrospectively reviewed in order to spot patients with the simultaneous diagnosis of dry age-related macular degeneration and full-thickness macular hole. Vitrectomy with the inverted internal limiting membrane flap technique was performed. Inclusion criteria were full-thickness macular hole, drusen, vitrectomy performed, and spectral domain optical coherence tomography (Copernicus HR, Optopol, Poland) or swept source optical coherence tomography (Triton, Topcon, Japan) before surgery, then 1 week (±3 days), 1 month (±1 week), 3 months (±1 month), 6 months (±1 month), 12 months (±2 months), and 18 months to 12 years after surgery. Main outcome measures Closure of macular hole and visual acuity at the final control. Results A total of 18 eyes of 12 patients (mean age: 68 years) were included. Mean minimum macular hole diameter was 493 μm. Mean maximum macular hole diameter was 1072 μm. Macular hole was closed in 16 eyes after first surgery and in all eyes after second surgery. Improvement of visual acuity was statistically significant ( P = 0.05), but there was no statistical significant correlation observed between initial macular hole diameters and final visual acuity ( P > 0.1). Conclusion The inverted internal limiting membrane flap technique improves anatomical and functional results in eyes with coexisting dry age-related macular degeneration and full-thickness macular holes. Final development of choroidal neovascularization or geographic atrophy is possible in rare cases.

Surgical Treatment for a Full-Thickness Macular Hole That Developed on a Large Drusenoid Pigment Epithelial Detachment

“…We needed reoperation to close the MH in our patient. In line with this, previous studies have indicated a trend toward lower MH closure rates in eyes with drusen [ 4 - 5 , 10 ]. The degenerative RPE associated with AMD might play a role in preventing normal MH closure which is usually seen in idiopathic MH.…”

“…Several studies have reported the surgical outcomes of FTMHs in eyes with early and intermediate drusen [4][5][6]. However, therapeutic outcomes of FTMHs developed on a large drusenoid PED have not been reported to date.…”

“…In their study, the closure rate after PPV without ILM peeling was 76%, which was lower than in their idiopathic case series (89%), and the MH closure rate became lower depending on the extent of the drusen. Recently, Michalewska and Nawrocki compared the outcomes of inverted flap technique in MH surgery among 18 eyes with intermediate AMD (defined as at least one large drusen, 20 medium-sized drusen, or 65 small drusen) and those without AMD [ 5 ]. The closure rate in eyes with intermediate AMD was 88%, which was lower than for idiopathic MH (98%).…”

Vitrectomy for full thickness macular hole developed during the course of anti-VEGF treatment of type 1 neovascular AMD

“…This technique was earlier described to be successful in large and myopic macular holes. 2 Its use in eyes with coexisting dry AMD and FTMH was also validated 3 Macular hole was closed 1 week after surgery (Figure 2(c)). After successful closure of FTMH anti-VEGF injections were continued in the Treat and extend scheme.…”

Simultaneous development of full-thickness macular hole and neovascular age-related macular degeneration

“… 23 , 24 , 25 Some studies suggested that the inverted ILM flap technique is effective in MH complicated by other macular pathologies, such as type 2 idiopathic macular telangiectasia 26 and dry age-related macular degeneration. 27 The inverted ILM flap technique was selected in the current case because exudative changes due to nAMD might have hampered MH closure. A relatively good clinical course of the present case suggests the efficacy of the procedure for MH complicated by nAMD.…”