Comparison of Anatomical and Visual Outcomes between Idiopathic and Myopic Macular Holes Using the Internal Limiting Membrane or Inverted Internal Limiting Membrane Flap Technique.

Federico Peralta Iturburu,Claudia Garcia-Arumi,Jose Garcia-Arumi,Maria Bové Alvarez

doi:10.1155/2019/6723824

Federico Peralta Iturburu, Claudia Garcia-Arumi + Show 2 more

Open Access

https://doi.org/10.1155/2019/6723824

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Abstract

Purpose To compare the results of vitrectomy with those of internal limiting membrane (ILM) peeling or inverted ILM flap for treating myopic or idiopathic macular hole. Methods Thirty-nine eyes of 39 patients undergoing vitrectomy with ILM peeling for macular hole (25 idiopathic and 14 myopic) and 27 eyes of 27 patients undergoing vitrectomy with inverted ILM flap (15 idiopathic and 12 myopic) were included. Outcome measures were macular hole closure by optical coherence tomography and visual acuity at 6 months. Results Closure was achieved in 25 (100%) idiopathic and 12 (86%) myopic macular holes in the ILM peeling group and in 14 (93%) idiopathic and 11 (91.77%) macular holes in the inverted ILM flap group. There were no statistically significant differences in restoration of the external limiting membrane and ellipsoid zone between the groups. Median best-corrected visual acuity (logarithm of minimal angle of resolution) at the end of follow-up was 0.22 (20/32 Snellen) in idiopathic and 0.4 (20/50) in myopic (P=0.042) patients in the ILM peeling group and 0.4 (20/50) in idiopathic and 0.4 (20/50) in myopic (P=0.652) patients in the inverted ILM flap group. Conclusion Both techniques were associated with high closure rates in myopic and idiopathic macular holes, with somewhat better visual outcomes in idiopathic cases. The small sample size may have provided insufficient power to support the superiority of one technique over the other in the two groups.

Highlights

The anatomic closure rates are high with this procedure, there is no consensus as to whether the functional outcome is more favorable with the inverted internal limiting membrane (ILM) technique than with complete ILM peeling
Patients were divided into subgroups according to the ILM removal technique and axial length (AL) < 26 mm or ≥26 mm
Over the period of the study, 39 patients (18 men and 21 women) (39 eyes) underwent vitrectomy using the ILM peeling technique and 27 patients (15 men and 12 women) (28 eyes) were treated with vitrectomy using the inverted ILM flap procedure. e median (SD) age of the patients was 64.14 (±10.86) years, and the distribution of the study variables was similar in the two groups (Table 1)

Summary

Research Article

Federico Peralta Iturburu, Claudia Garcia-Arumi ,1,2 Maria Bove Alvarez, and Jose Garcia-Arumi 1,2. Optical coherence tomography (OCT) has become a pivotal technique for the diagnosis and follow-up of idiopathic and myopic MHs, including the course of MH closure [3, 4]. E most common procedure for treating idiopathic MH is pars plana vitrectomy (PPV), posterior vitreous detachment, internal limiting membrane (ILM) peeling, filling of the vitreous cavity using a gas bubble, and postoperative face-down positioning [5]. The anatomic closure rates are high with this procedure, there is no consensus as to whether the functional outcome is more favorable with the inverted ILM technique than with complete ILM peeling. E purpose of this study was to evaluate the anatomic and functional outcomes in patients with idiopathic MH or myopic MH using the inverted ILM flap technique versus complete ILM peeling

Methods

Results

Macular hole

Chronic MH Closed