Abstract
Objectives The inverted internal limiting membrane (ILM) flap technique has been shown to increase the success rate in large full-thickness macular holes (FTMHs) and in FTMHs associated with high myopia. The aim of our study was to confirm the efficacy and safety of inverted ILM flap technique in idiopathic FTMHs independent of their dimensions and to assess functional outcomes and their correlation to morphologic findings. Methods Sixteen consecutive patients affected by idiopathic FTMH were enrolled in this prospective study. The preoperative mean (±SD) diameter of the FTMH was 422 (±106) µm. All patients underwent vitrectomy and ILM peeling with inverted ILM flap. At 1-, 3-, and 6-month postoperative visits, visual acuity measurement, indirect ophthalmoscopy, and microperimetry were performed, and the foveal contour and the integrity of the ellipsoid zone (EZ) and external limiting membrane (ELM) were investigated using spectral domain optical coherence tomography (SD-OCT). Results At six months postoperatively, 15 out of 16 (93.75%) patients obtained FTMH closure. The mean best corrected visual acuity (BCVA) improved from 1.1 LogMAR to 0.3 LogMAR, and the mean retinal sensitivity (MS) improved from 7.2 to 23.4 dB. ELM defects were evident in 1 out of 16 (6.25%) eyes, and EZ defects were detected in 2 out of 16 (12,50%) eyes. A statistically significant relationship was observed between BCVA, MS, and EZ reconstitution at each follow-up visit. Conclusions Results confirm that the inverted ILM flap technique is a safe and effective option for FTMH treatment and show a strong correlation between higher BCVAs and MSs and EZ reconstitution after surgery.
Highlights
Idiopathic full-thickness macular hole (FTMH) is a sightthreatening vitreoretinal disorder, which affects approximately 8.7 eyes per 100,000 per year [1, 2]
The inverted internal limiting membrane (ILM) flap was introduced as an alternative surgical technique, and it was shown to increase the success rate in large FTMHs, in FTMHs associated with high myopia, and in refractory FTMHs [7,8,9,10,11]
ILM peeling was demonstrated to be an important surgical step in FTMH surgery, since it relieves the tangential tractional forces occurring around the fovea and ensures removal of the whole epiretinal tissue [16,17,18]. e ILM peeling was demonstrated to significantly increase the anatomic success rate in FTMH surgery, while no differences in visual acuity were observed between patients with and without ILM peeling [6, 19]
Summary
Idiopathic full-thickness macular hole (FTMH) is a sightthreatening vitreoretinal disorder, which affects approximately 8.7 eyes per 100,000 per year [1, 2]. Given the improvements in diagnostic and surgical techniques and instrumentation, the closure rate increased to as high as 90% [5] and the additional use of internal limiting membrane (ILM) peeling represented a fundamental progression in FTMH surgery [6]. The inverted ILM flap was introduced as an alternative surgical technique, and it was shown to increase the success rate in large FTMHs, in FTMHs associated with high myopia, and in refractory FTMHs [7,8,9,10,11]. Some studies recently demonstrated that the intraoperative optical coherence tomography (iOCT) is a useful tool to guide intraoperative decision in the attempt to improve both the morphological and functional outcome in FTMH surgery [12,13,14]. Functional results as best corrected visual acuity (BCVA) and mean retinal sensitivity (MS) were correlated to spectral domain optical coherence tomography (SD-OCT) morphologic findings as external limiting membrane (ELM) and ellipsoid zone (EZ) integrity
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