Abstract
BackgroundThe anatomical success rate of macular hole surgery ranges around 93–98%. However, the prognosis of large macular holes is generally poor. The study was conducted to compare the anatomical and visual outcomes of Internal Limiting Membrane (ILM) peeling vis-a-vis inverted ILM flap for the treatment of idiopathic large Full-Thickness Macular Holes (FTMH).MethodsThis was a prospective randomized control trial. The study included patients with idiopathic FTMH, with a minimum diameter ranging from 600 to 1500 μm. The patients were randomized into Group A (ILM peeling) and Group B (inverted ILM flap). The main outcome measures were anatomical and visual outcome at the end of 6 months. Anatomical success was defined as flattening of macular hole with resolution of the subretinal cuff of fluid and neurosensory retina completely covering the fovea.ResultsThere were 30 patients in each group. The mean minimum diameters in Group A and B were 759.97 ± 85.01 μm and 803.33 ± 120.65 μm respectively (p = 0.113). The mean base diameter in group A and B was 1304.50 ± 191.59 μm and 1395.17 ± 240.56 μm respectively (p = 0.112). The anatomical success rates achieved in Group A and B were 70.0 and 90.0% respectively (p = 0.125). The mean best-corrected visual acuity (BCVA) after 6 months was logMAR 0.65 ± 0.25 (Snellen equivalent, 20/89) in Group A and logMAR 0.53 ± 0.20 (Snellen equivalent, 20/68) in Group B (p = 0.060). The mean improvement in BCVA was 1.4 lines and 2.1 lines in groups A and B respectively (p = 0.353). BCVA≥20/60 was achieved by 13.3 and 20.0% in group A and B respectively (p = 0.766).ConclusionThe anatomical and functional outcome of Inverted ILM flap technique in large FTMH is statistically similar to that seen in conventional ILM peeling.Trial registrationClinical Trials Registry – India (Indian Medical Research) CTRI/2017/11/010474.
Highlights
The anatomical success rate of macular hole surgery ranges around 93–98%
Michalewska et al, first described a novel technique of inverted internal limiting membrane (ILM) flap for the treatment of large macular holes [14]. They found that their technique achieved better anatomical and visual outcomes compared to conventional Internal Limiting Membrane (ILM) peeling (ILMP)
Full-Thickness Macular Holes (FTMH) parameters and indices were gauged with Heidelberg Spectralis Spectral-Domain Optical Coherence Tomography (SD-OCT) (Heidelberg Engineering, Inc., Heidelberg, Germany) using high definition 5-line raster scans and 3-dimensional 512 × 128 macular cube scans passing through the fovea, before and after the surgery [6, 7, 9]
Summary
The anatomical success rate of macular hole surgery ranges around 93–98%. the prognosis of large macular holes is generally poor. The study was conducted to compare the anatomical and visual outcomes of Internal Limiting Membrane (ILM) peeling vis-a-vis inverted ILM flap for the treatment of idiopathic large Full-Thickness Macular Holes (FTMH). Michalewska et al, first described a novel technique of inverted internal limiting membrane (ILM) flap for the treatment of large macular holes [14]. They found that their technique achieved better anatomical and visual outcomes compared to conventional ILM peeling (ILMP). In last couple of years, a number of studies have suggested that inverted ILM flap technique (IFT) may be better for the treatment of large macular holes [14,15,16,17,18,19,20,21,22,23,24]. A systemic review and single-arm meta-analysis showed that the anatomical closure and visual improvement rates after IFT for FTMH with minimum diameter (MD)
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