Comparing surgical outcome between conventional and inverted ILM flap technique for full thickness macular hole repair

Abstract

Introduction: Macular holes are primarily managed surgically; either conventional full-thickness Macular Hole (FTMH) repair or the inverted flap technique. Large macular holes (>than 400 micrometers) have poor surgical outcome, with only 44% closure and inverted flap method has resulted better outcome in visual recovery and a higher closure rate. Objective: To compare surgical outcome (anatomical and functional) between conventional and inverted ILM flap technique in macular hole surgery. Methodology: A prospective randomized clinical trial; a longitudinal study with 2 waves of data collection. 154 Pseudo-phakic clients (50-70 years) with full-thickness large macular hole were randomly selected to 2 groups to undergo either technique by same consultant VR surgeon. The approval of Ethics Committee of the National Eye Hospital was obtained. Results: There is 88.3% closure in conventional group and 96% closure in inverted flap technique. However, no significant difference between 2 groups (p>0.05) in the anatomical success and even when compared sub-categorically with U, V, W closure and non-closure. There was a statistically significant improvement in visual acuity (p=0.002) observed in the inverted flap group, but the improvement observed in visual acuity among CG (p=0.18), the improvement in Snellen Chart reading of both groups (p=0.15) and type of closure and surgical technique (p=.369) were not statistically significant. Conclusion: The overall success of anatomical closure following FTMH repair is significantly better compared to literature (92.2% Vs 44%); but there is no statistically significant difference in anatomical success between the two groups. Both groups had a better functional outcome and a statistically significant improvement seen in the ILM-G and CG group. Recommendations: Being the first such study, data gives promising evidence to support the current surgical practice and assist in service development and training.