Vitrektomie mit iOCT-assistierter invertierter ILM-Flap-Technik bei großen Makulaforamina

Abstract

Vitrectomy with BP and iOCT-assisted ILM peeling using the inverted ILM flap technique in patients with large FTMH is a very controlled and safe microsurgical strategy and shows good functional and anatomical results. The morphology of the FTMH, the ILM flap and the position of the inverted ILM flap under air was well visualized by IOCT. The microstructural integrity of the outer retinal layers is displayed in detail on SD-OCT and represents an important predictive parameter for BCVA after macular hole surgery.

Inverted internal limiting membrane flap technique in eyes with large idiopathic full-thickness macular hole: long-term functional and morphological outcomes

“…Several studies found an association between the microstructural regeneration of retinal layers and the improvement of BCVA [29,34,46,51,[54][55][56]. Especially, the complete reintegration of the ELM was identified to be a prognostic factor for the improvement of BCVA [30,34,46,55,57,58]. The microstructural regeneration of retinal layers can endure up to 2 years.…”

“…iSD-OCT is a useful tool that provides valuable real-time information during surgery allowing to individualize surgical treatment for each patient [63]. The usage of iSD-OCT allows a safe and controlled performance of the I-ILM flap technique [11,17,[44][45][46][47]. iSD-OCT helped us to confirm the correct positioning of the ILM flap at the very end of surgery.…”

“…For dynamic intraoperative imaging, the microscope-integrated iSD-OCT system Rescan 700 (Carl Zeiss Meditec AG, Oberkochen, Germany) was used. The patients were advised to maintain a face-down position for 3 days postoperatively [ 46 ]. The I-ILM flap technique used in our study differed from the original I-ILM flap technique.…”

“…The I-ILM flap technique used in our study differed from the original I-ILM flap technique. Instead of creating a single I-ILM flap, a radial I-ILM flap, resembling a rosette, was peeled and inverted over the MH [ 21 , 46 ].

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“…The development of intraoperative spectral-domain optical coherence tomography (iSD-OCT; Spectralis HRA Oct; Heidelberg Engineering, Heidelberg, Germany) further improved MH surgery, providing real-time information about the vitreous body, retinal layers, and its manipulation during vitreoretinal surgery. iSD-OCT proved to be an efficient tool in performing the I-ILM flap technique allowing a controlled ILM peeling and proper positioning of the ILM flap [43][44][45][46][47]. However, despite promising functional and anatomical results for large MH, some vitreoretinal surgeons are still reserved in performing this new technique because of concerns regarding the long-term outcomes.…”