Vitrectomy with Inverted Internal Limiting Membrane Flap Technique for Treatment of a Traumatic Macular Hole

Abstract

Background: Macular hole is a round full-thickness opening in foveal center which is an important cause of central vision loss. In most cases it is idiopathic, i.e., due to abnormal vitreo-foveal traction without any apparent predisposing conditions. Other causes include 1) High myopia. 2) Blunt ocular trauma. Aim: to evaluate the anatomical closure rates and visual outcomes in patients with traumatic macular holes treated by vitrectomy with inverted internal limiting membrane (ILM) flap technique. Patients and Methods: a prospective interventional study was conducted on 10 eyes of 10 patients with traumatic macular holes not spontaneously closed for more than 3 months after trauma and treated by vitrectomy with inverted internal limiting membrane flap technique at I-vision private center, Cairo and Alforsan eye private center, Assiut between September 2015 and December 2018. After surgery, both closure rate and visual outcome were re-evaluated monthly during the follow up period up to 6 months. Results: the main best-corrected visual acuity improved after PPV with inverted ILM flap technique from 0.87 ± 0.09 logMAR at baseline to 0.73 ± 0.11 logMAR at 1st month, to 0.49 ± 0.13 logMAR at 3rd month and reached to the maximum improvement 0.29 ± 0.10 logMAR by the end of 6th month (P < 0.001). The macular holes were successfully closed in all cases (100%). Conclusion: vitrectomy with inverted internal limiting membrane flap technique is associated with complete closure of the macular hole with restoration of the normal architecture and also a significant improvement of vision.