Clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane flap covering technique for complicated macular hole

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Objective To observe the clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane (ILM) flap covering technique for complicated macular hole (MH). Methods This is a retrospective case series. Twenty-one eyes of 20 patients who underwent vitrectomy combined with modified inverted ILM flap covering technique were enrolled in this study. Among these eyes, 9 eyes were idiopathic MH (IMH), with the mean basal diameter of (1 188.3±155.1) μm, minimum diameter of (626.9±86.2) μm, logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) of 1.1±0.3; 2 eyes were MH with high myopia, with the mean basal diameter of (696.5±232.6) μm, minimum diameter of (259.0±69.3) μm, logMAR BCVA of 1.3; 5 eyes were high myopia MH with retinal detachment (RD), with the mean BCVA of 1.5±0.1; 3 eyes were rhegmatogenous RD (RRD) with MH, with the mean logMAR BCVA of 1.6; 2 eyes were MH after vitrectomy for RRD, with the mean basal diameter of (1 606.0±69.3) μm, minimum diameter of (909.0±387.5) μm, logMAR BCVA of 1.6. All patients received 23G or 25G vitrectomy after removal of posterior vitreous cortex intraoperatively. Indocyanine green staining assisted circle-wise ILM peeling was performed. ILM of diameter 1.5 disc-diameters around fovea was residual and loosened; perfluoronoctane assisted inverting superior or temporal residual ILM covering on macular hole. C3F8, gas or silicone oil tamponade was performed at the end. BCVA and hole closure were followed up for 1-4 months. C3F8, gas or silicone oil was tamponaded at the end. BCVA and hole closure were followed up for 1-4 months. Results MH of 21 eyes were closed after surgery. Nine IMH were closed at typeⅠ, with U shape closure in 7 eyes, V shape closure in 2 eyes. Two eyes of MH with high myopia, 3 eyes of RRD with MH, 2 eyes of MH after vitrectomy for RRD were closed at typeⅠ of U shape. Five eyes of high myopia MHRD including MH closure at typeⅠ of U shape 3 eyes, typeⅡ of W shape 2 eyes. The mean logMAR BCVA of IMH, MH with high myopia, high myopia MHRD, RRD with MH, MH after vitrectomy for RRD eyes were 0.8±0.3, 0.9±0.2, 1.4±0.1, 0.7±0.3, 0.9±0.2, respectively. The mean postoperative logMAR BCVA in IMH eyes was improved compared preoperative one (P=0.02). There was no obvious change of pre-and postoperative logMAR BCVA in MH with high myopia, high myopia MHRD, RRD with MH, MH after vitrectomy for RRD eyes (P=0.18, 0.10, 0.11, 0.18). Conclusion Vitrectomy combined with inverted ILM flap covering technique for complicated MH is an effective method to improve the success rate of MH closure and the visual function. Key words: Retinal Perforations/surgery; Vitrectomy