Abstract
BackgroundLarge, chronic full thickness macular holes which failed previous treatments are difficult to manage and even left untreated due to poor prognosis. A retrospective review of consecutive cases with chronic (at least 1 year) full thickness macular holes and internal limiting membrane (ILM) free flap transposition with tuck technique, after previously failed vitrectomy.MethodsThis was a retrospective and interventional study conducted in a single centre by a single surgeon. Patients with full thickness macular hole for at least 1 year and at least one previously failed vitrectomy with ILM peeling were recruited. A 25G vitrectomy with ILM free flap transposition was done without assistance of PFCL, viscoelastic or autologous blood. The free flap was manually tucked into the macular hole free space and gas fluid exchange was performed with 20% SF6 as tamponade. The patients were postured prone for 2 weeks postoperatively. Best corrected visual acuity, macular hole duration, previous surgeries, optical coherence tomography (OCT) appearance, hole size and closure rate were recorded.Results8 consecutive patients were included from May 2016 to Feb 2018. Transposition surgery was performed an average of 1481 days (SD 1096) after diagnosis of macular hole and average of 1226 days (SD 1242) after first vitrectomy. Macular hole mean size was 821 μm (SD 361.3), preoperative VA was logMAR 1.038 (SD 0.19), postoperative VA was logMAR 0.69 (SD 0.19) at 3 months. There were 1.13 lines gained and a significant improvement of logMAR 0.33 (p = 0.0084) at 6 months. Hole closure was seen in 7 out of 8 eyes (87.5%). The OCT with failed closure showed ILM flap within a flat hole, however no overlying neurosensory layers was seen. The duration from diagnosis to surgery was 2349 days in this case.ConclusionFree flap ILM transposition tuck without the use of additional intraoperative tamponade is an effective technique in treating large chronic macular holes with previously failed primary macular hole surgeries.Trial registration (IRB of the Hong Kong University and Hospital Authority Hong Kong West Cluster, ref UW19-440), June 17, 2019.
Highlights
Large, chronic full thickness macular holes which failed previous treatments are difficult to manage and even left untreated due to poor prognosis
We describe a similar method of autologous internal limiting membrane (ILM) transplantation without the use of viscoelastic, for the treatment of persistent, large, chronic full-thickness macular holes
There were no significant correlations between closure rate and macular hole duration or hole size (− 0.435, p = 0.281)
Summary
Chronic full thickness macular holes which failed previous treatments are difficult to manage and even left untreated due to poor prognosis. A retrospective review of consecutive cases with chronic (at least 1 year) full thickness macular holes and internal limiting membrane (ILM) free flap transposition with tuck technique, after previously failed vitrectomy. Fung et al Int J Retin Vitr (2020) 6:3 holes, myopic macular holes and retinal detachments associated with macular holes were all associated with poorer visual outcome and lower macular hole closure rates. This has led to modification of conventional macular hole surgery, such as inverted ILM flap, to improve success. Some macular holes are still persistent after primary vitrectomy with ILM peeling; treatment for these cases remain a surgical challenge. Due to lack of randomized control trials and small sample sizes of existing case series, there is currently no consensus on the best technique for the treatment of persistent macular holes
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