Microperimetric Biofeedback Training After Successful Inverted Flap Technique for Large Macular Hole

Giancarlo Sborgia,Giovanni Alessio,Gianluigi Giuliani,Umberto Lorenzi,Francesco Boscia,Valentina Pastore,Marco Coassin,Alfredo Niro,Ermete Giancipoli,Mario R Romano,Alessandra Sborgia,Tiziana Tritto,Luigi Sborgia,Valeria Albano,Rossella Donghia

doi:10.3390/jcm9020556

Giancarlo Sborgia, Giovanni Alessio + Show 13 more

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https://doi.org/10.3390/jcm9020556

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Background: Despite the high closure rate of large macular hole (LMH) after surgery, visual recovery is often worse than expected. Microperimetric biofeedback can improve visual function in macular pathologies. We evaluated the efficacy of biofeedback on macular function after successful inverted flap technique for LMH. Methods: In this prospective comparative study, 26 patients after LMH surgical closure were enrolled. The whole sample was equally divided into two groups. In Group 1 (trained), patients underwent a double cycle of microperimetric biofeedback, using structured light stimulus plus acoustic tone; in Group 2 (control), patients underwent scheduled visits. We analyzed visual acuity, retinal sensitivity at central 12° (macular sensitivity, MS) and 4° (central macular sensitivity, CMS), and fixation stability over twelve months. Results: Visual acuity improved mainly in the trained group, without any significant differences between the groups (p > 0.05). Only after training did MS significantly improve (p = 0.01). CMS more significantly improved in the trained (p < 0.001) than the control group (p < 0.01) (Group 1 vs. 2, p = 0.004). Only in the trained group did fixation significantly improve (3 months, p ≤ 0.03; 12 months, p ≤ 0.01). An equality test on matched data confirmed a greater significant improvement of CMS (p ≤ 0.02) at all follow-up and fixation (p ≤ 0.02) at last follow-up after training. Conclusions: Microperimetric biofeedback consolidates and increases the improvement of retinal sensitivity and fixation gained after successful inverted flap technique.

Highlights

Preoperative loss of macular integrity and morphologic modifications after surgery change retinal sensitivity and fixation behavior, measured by microperimetry, that play an important role in visual performance and could have a predictive role on visual acuity recovery [11,12,13,14,15]
The eccentric fixation stability is worse than foveal fixation [22,23], and poor fixation stability is correlated with poor visual acuity [17,24,25,26]
We evaluated the efficacy of a standardized microperimeter biofeedback training, using a combination of visual and acoustic stimuli on the visual performance in patients with successful closure of large macular hole (LMH) after inverted inner limiting membrane (ILM)-flap technique

Summary

Introduction

Idiopathic large macular hole (LMH) leads to a displacement of photoreceptors in the fovea, causing metamorphopsia and a severe visual acuity loss [1].The inverted inner limiting membrane (ILM)-flap technique has become one of the most effective procedures, with more than 90% of closure rate of LMH [2,3,4,5].Despite the high closure rate, not all previous reports made show significant functional improvement, and visual recovery is often worse than expected [6,7,8].The inverted ILM-flap technique, promoting the closure of macular hole by the gliosis process controlled by Müller cells [9,10], could further hinder inner and outer retinal layers recovery with negative functional effects. Wilcoxon rank-sum (Mann–Whitney) test for changes among the groups; 1° Cycle, 12 Sessions/4 weeks of rehabilitation; 2° Cycle, 4 Sessions/4 weeks of rehabilitation; BCVA, Best Corrected Visual Acuity; LogMAR, Logarithm of Minimum Angle of Resolution; MS, Retinal Sensitivity; dB, decibel; CMS, Central Macular

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