Abstract
Objective:To evaluate the effectiveness of inverted internal limiting membrane flap in large idiopathic macular holes.Methods:Twelve patients diagnosed with idiopathic macular holes larger than 400um underwent 23 gauge Pars Plana Vitrectomy (PPV) with inverted internal limiting flap and gas tamponade at Al-Ehsan Eye Welfare Eye Hospital, Lahore from February 2017 to February 2018. All cases were diagnosed on Spectral Domain Optical Coherence Tomography (SD-OCT) and were followed up for 6 months. At every follow-up, best corrected visual acuity and SD-OCT was done.Results:We achieved macular hole closure in 91.6% (11/12) patients with idiopathic macular holes larger than 400um. Five out of 12 patients underwent combined phacoemulsification and PPV. One patient has flat hole closure which was considered failure. One patient was excluded from the study due to per-operative flap loss. This patient was not included in final data analysis of 12 patients. There was statistically significant gain in best corrected visual acuity after successful macular hole closure. We did not report any untoward events during or in the post-operative period.Conclusion:Inverted internal limiting flap is an effective method for repairing large macular holes.
Highlights
Idiopathic Macular Hole (IMH) is one of the most widely studied vitreoretinal interface pathology.[1]
Afterwards, various modifications were introduced in IMH surgery and the most notable was Internal Limiting Membrane (ILM) peeling
As the technique gained popularity, more ambitious studies showed that inverted ILM peel technique was successful in IMH larger than 1000um.[10,11]. These results showed that those macular holes that may have been left untreated due to their large size have a potential to benefit from this technique
Summary
Idiopathic Macular Hole (IMH) is one of the most widely studied vitreoretinal interface pathology.[1] Its reported incidence is 7.8 / 100,000 per annum with women being more commonly effected as compared to males.[1,2] Before 1991, macular hole was considered an untreatable condition. It was Kelly and Wendel who for the first time reported Pars Plana Vitrectomy (PPV) and fluid gas exchange as a procedure of choice for IMH. With ILM peeling, structural success of more than 90% was
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