Full-thickness Macular Hole Surgery Research Articles

Macular Pigment Changes and Visual Recovery Following Successful Full-Thickness Macular Hole Closure Using the Inverted Flap Technique.

Objectives: This study aimed to assess the role of macular pigment optical density (MPOD) in patients with a full-thickness macular hole (FTMH) compared to healthy controls, evaluating postoperative changes in MPOD and exploring potential correlations with visual outcomes. Methods: This prospective, cross-sectional, comparative study included 16 eyes from FTMH patients who achieved anatomical hole closure following pars plana vitrectomy with the inverted ILM flap technique. Each eye underwent a comprehensive ophthalmologic examination, including BCVA and intraocular pressure measurements, anterior segment evaluation, fundus examination, and macular assessment with Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT, Spectralis, Heidelberg Engineering Inc., Heidelberg, Germany). Macular pigment optical density (MPOD) was measured using one-wavelength reflectometry (Visucam 200, Zeiss Meditec, Jena, Germany). These evaluations were conducted preoperatively and at 1, 3, and 6 months postoperatively to assess changes over time and correlate MPOD with visual outcomes. Results: Significant baseline differences were observed between FTMH patients and controls for BCVA, mean MPOD, maximum MPOD, and MPOD volume (p < 0.05). Postoperative BCVA improved significantly (p = 0.0011), with a notable increase in MPOD volume at 6 months (p = 0.01). A positive correlation was found between BCVA improvement and MPOD volume increase (r = 0.739; p = 0.002). Conclusions: In conclusion, MPOD measurement may serve as a valuable addition to the follow-up of FTMH surgery, providing insights into photoreceptor function and macular metabolic activity, potentially correlating with visual recovery. Further longitudinal studies are needed to clarify its relationship with clinical variables, such as metamorphopsia and OCT microstructural findings.

PUNCTATE INNER CHOROIDOPATHY FOLLOWING PARS PLANA VITRECTOMY FOR HIGH MYOPIC FULL THICKNESS MACULAR HOLE.

To describe a case of punctate inner choroidopathy (PIC) and secondary or epiphenomenon multiple evanescent white dot syndrome (EpiMEWDS) following surgery for high myopic full-thickness macular hole (FTMH). Case report. A 57-year-old high myopic female was diagnosed with cataract and FTMH in the left eye. Her initial best-corrected visual acuity (BCVA) was 20/20 in her right eye and 20/80 in the left eye. She underwent routine combined phacoemulsification and 25-gauge pars plana vitrectomy (PPV) with the inverted internal limiting membrane (ILM) technique and twice-repeated epiretinal membrane (ERM) and ILM staining in the left eye. Two weeks postoperatively, the patient reported significant visual decline and photopsia in her left eye. BCVA decreased to counting fingers. Anterior segment examination was unremarkable. Ophthalmoscopic examination showed multiple whitish-yellow lesions in the macular region compatible with PIC lesions in the left eye. Optical coherence tomography (OCT), blue-light fundus autofluorescence (BAF), fluorescein angiography, and indocyanine green angiography were performed and confirmed the diagnosis. The patient underwent oral steroid therapy for PIC treatment. One week after treatment initiation, BAF showed the occurrence of EpiMEWDS. After one month, all lesions resolved and BCVA improved to 20/100. We report a rare case of PIC and EpiMEWDS development following surgery for FTMH. We hypothesize that several causes, including individual susceptibility (high myopia and female gender), post-surgical inflammation, and/or dye toxicity due to repeated staining could have amplified this inflammatory chorioretinal response. Larger studies are needed to better understand the potential triggers of PIC development after surgery.

Outcomes of epiretinal proliferation embedding technique in the surgery for full-thickness macular hole

To compare visual and anatomical outcomes between peeling and embedding of epiretinal proliferation in patients with full-thickness macular holes (FTMH) with epiretinal proliferation (EP), this retrospective cohort study classified patients into two groups based on whether EP was completely peeled (peeling group, n = 25 eyes), or embedded into the hole (embedding group, n = 31 eyes) during surgery. Preoperative characteristics and postoperative outcomes, including best-corrected visual acuity and the length of the disrupted external limiting membrane and ellipsoid zone, were compared. Preoperative features including visual acuity and hole size did not differ between the two groups. All studied eyes achieved closure of the macular hole postoperatively. Visual acuity significantly improved at 3, 6, and 12 months postoperatively in both groups. The visual acuity 1-month after surgery was better in the embedding group than that in the peeling group (0.28 ± 0.29 vs. 0.50 ± 0.42 logarithm of the minimum angle of resolution, P = 0.016), although the difference was not noted after 3 months postoperatively. The embedding group showed shorter disruption of the external limiting membrane than the peeling group postoperatively (62.6 ± 40.2 μm vs. 326.2 ± 463.9 μm at postoperative 12 months, P = 0.045). In conclusion, the embedding technique during surgical repair of a FTMH with EP facilitates recovery of the outer foveal layers and promotes earlier restoration of visual function.

Accuracy of generative deep learning model for macular anatomy prediction from optical coherence tomography images in macular hole surgery

This study aims to propose a generative deep learning model (GDLM) based on a variational autoencoder that predicts macular optical coherence tomography (OCT) images following full-thickness macular hole (FTMH) surgery and evaluate its clinical accuracy. Preoperative and 6-month postoperative swept-source OCT data were collected from 150 patients with successfully closed FTMH using 6 × 6 mm2 macular volume scan datasets. Randomly selected and augmented 120,000 training and 5000 validation pairs of OCT images were used to train the GDLM. We assessed the accuracy and F1 score of concordance for neurosensory retinal areas, performed Bland–Altman analysis of foveolar height (FH) and mean foveal thickness (MFT), and predicted postoperative external limiting membrane (ELM) and ellipsoid zone (EZ) restoration accuracy between artificial intelligence (AI)-OCT and ground truth (GT)-OCT images. Accuracy and F1 scores were 94.7% and 0.891, respectively. Average FH (228.2 vs. 233.4 μm, P = 0.587) and MFT (271.4 vs. 273.3 μm, P = 0.819) were similar between AI- and GT-OCT images, within 30.0% differences of 95% limits of agreement. ELM and EZ recovery prediction accuracy was 88.0% and 92.0%, respectively. The proposed GDLM accurately predicted macular OCT images following FTMH surgery, aiding patient and surgeon understanding of postoperative macular features.

Динамика анатомических и функциональных показателей после хирургии сквозных макулярных разрывов большого диаметра

Full-thickness macular hole (FTMH) is the macular zone pathology, leading to a significant decrease in visual acuity. According to the literature, classical surgery of FTMH allows to achieve anatomical closure only in 73.3 % of cases. The task of developing a method of surgical treatment of FTMH with the possibility of evaluating its closure intraoperatively is relevant and of strategically important interest for the development of ophthalmic surgery. The purpose of this study is to evaluate the dynamics of functional and anatomical results of large diameter FTMH surgery. Material and methods. A randomized study was conducted on two comparable groups of patients. Surgical treatment of FTMH was performed in both groups, the difference was in the FTMH closure method: in the first group, treatment was carried out according to the proposed method, in the second group, autologous conditioned plasma was used during the surgery. Patients underwent a standard ophthalmological examination, as well as optical coherence tomography of the retina before surgery, 1, 3 and 6 months after surgery. Results and discussion. In the control group, 4 cases of FTMH recurrence were recorded in the postoperative period up to 1 month after surgery. U-shaped closure pattern (Fig. 1) was more often observed in the first group, while in the second group V-shaped closure pattern was more often observed (Fig. 2). Visual acuity 6 months after surgery was higher on average in patients in the first group (p = 0,05). Conclusions. The results obtained indicate a decrease in the risk of recurrence of FTMH, as well as higher visual acuity and close-to-normal retinal histological state in the postoperative period for a period of 6 months when closing the FTMH according to the proposed method. The use of the FTMH closure method under the intraoperative optical coherence tomography control makes it possible to minimize the time of the patient's forced position in the postoperative period, which facilitates its course. Keywords: vitreoretinal surgery, macular hole, optical coherence tomography, autologous conditioned plasma

Surgery for idiopathic full-thickness macular holes within four months of symptom onset yields superior visual outcomes: Results from an Irish patient cohort.

To describe the anatomical, visual, and safety results of full-thickness macular hole (FTMH) repair surgery and determine factors influencing outcomes. A retrospective chart review was performed on all patients who underwent primary FTMH repair surgery by a single surgeon over a 3-year period. For comparisons, Snellen visual acuity (VA) was converted to logMAR equivalent. Anatomical hole closure, visual improvement, and final VA of ≤ 0.30 logMAR were the primary outcome measures. Twenty eyes of 19 patients were included. Mean patient age was 69years (range 55 to 80years) and 74% were female. Mean minimum linear diameter (MLD) was 440μm (range 170μm to 1200μm). Mean duration of symptoms before surgery was 16weeks (range 3 to 39weeks). 100% of eyes achieved successful anatomical FTMH closure. Mean VA improved from 1.03 ± 0.43 logMAR (Snellen 6/60) preoperatively to 0.35 ± 0.22 logMAR (Snellen 6/15) postoperatively (p = 0.0001). Patients with worse preoperative VA gained more vision than those with better preoperative VA (p = 0.01). Eyes operated on within 4months of symptom onset were more than twice as likely to achieve a postoperative VA of ≤ 0.30 logMAR (Snellen 6/12 or better) compared to eyes with a longer duration of symptoms (p = 0.03). FTMH repair surgery was safe and effective, with outcomes comparing favourably with published international studies. All patients benefited from surgery regardless of symptom duration, presenting VA or FTMH size. However, surgery performed within 4months of symptom-onset was particularly beneficial, highlighting the need for prompt referral and surgery.

Сравнение ранних анатомических и морфофункциональных результатов различных методик закрытия сквозных макулярных разрывов большого диаметра

Relevance. Full-thickness macular hole (FTMH) is a vitreomacular interface pathology leading to a significant visual acuity decrease. Traditional surgery of FTMH is not effective enough. With the constant improvement of FTMH surgery, a comparative analysis of various surgical techniques is relevant. Purpose. To compare the early anatomical and functional results of large-diameter FTMH surgery using platelet-rich plasma (PRP) and the technique of hole edges convergence with the intraoperative optical coherence tomography (OCT) control. Material and methods. A randomized study was conducted on two comparable groups of patients. In both groups, surgical treatment of FTMH was performed, the difference was in the direct closure of the FTMH: PRP was used in the first group, the closure of MH was performed with intraoperative OCT control according to the proposed method in the second group. Results. The methods of FTMH closing were comparable in safety. Functional and anatomical results were comparable and did not differ significantly. A difference in the outer retinal layers matching was noted by OCT 1 week after surgery. In group 2, there was a greater number of FTMH closures with the formation of a U-shaped profile of the foveolar zone, which was accompanied by a better inner and outer retinal layers matching. Conclusion. The studied methods of FTMH treatment are comparable in functional results. However, it is necessary to continue studying and analyzing the long-term data. Keywords: macular hole, vitreoretinal surgery, platelet-rich plasma, optical coherence tomography

Modification of the inverted flap technique compared to conventional internal limiting membrane peeling in complete macular hole surgery.

To describe the efficacy of a modification of the superior inverted flap technique, with maculorrhexis, in vitrectomy for full-thickness macular hole (MH) surgery compared to internal limiting membrane peeling (ILM). Retrospective and comparative study of patients with MH. In group A, a superior ILM flap is created to cover the macular hole, and in group B conventional ILM peeling was performed. A total of 80 eyes were included (44 group A and 36 group B). MH closure occurred in 100% in group A and 91.67% in group B (p = 0.0869). There were more U-type closures in group A(90.91%) than in group B(58.33%), p = 0.0017. Both groups showed Best corrected visual acuity (BCVA) improvement at 3 and 6 months. At 3 months BCVA in group A was significantly better but at 6 months results were similar. Ellipsoid layer (EZ) recovery at 6 months was achieved in 81.82% patients in group A and 52.78% in B (p = 0.005), and external limiting membrane in 81.82% in group A and 69.44% in B (p = 0.1957). The superior inverted flap maculorrhexis technique is suitable for idiopathic MH treatment, with better anatomical and non-inferior functional results than the classic ILM peeling. It achieves functional recoveries earlier, better BCVA and greater gains at 3 months compared to the classic ILM peeling. It also obtains a higher number of U-shaped closures and higher EZ restorations.

Non-Invasive Retinal Imaging Modalities for the Identification of Prognostic Factors in Vitreoretinal Surgery for Full-Thickness Macular Holes.

In this review, we will focus on different non-invasive retinal imaging techniques that can be used to evaluate morphological and functional features in full-thickness macular holes with a prognostic purpose. Technological innovations and developments in recent years have increased the knowledge of vitreoretinal interface pathologies by identifying potential biomarkers useful for surgical outcomes prediction. Despite a successful surgery of full-thickness macular holes, the visual outcomes are often puzzling, so the study and the identification of prognostic factors is a current topic of interest. Our review aims to provide an overview of the current knowledge on prognostic biomarkers identified in full-thickness macular holes by means of different retinal imaging tools, such as optical coherence tomography, optical coherence tomography angiography, microperimetry, fundus autofluorescence, and adaptive optics.

Unique Optical Coherence Tomography Imaging in Spontaneous Closure of Full Thickness Macular Hole Post Laser Photocoagulation

Purpose: To study events in spontaneous full thickness macular hole (FTMH) closure following laser photocoagulation (LP). Methods: Retrospective case study of a patient of spontaneous FTMH closure documented by SD-OCT following laser. Results: A 51-year-old lady presented with FTMH and a subclinical retinal detachment (RD) in her right eye. LP for subclinical RD was done and surgery for FTMH was advised. On day of surgery, repeat SD-OCT showed spontaneous closure of FTMH with an outer retinal defect, following which surgery was abandoned. Conclusion: Spontaneous PVD induction relieves antero-posterior traction and Inner limiting membrane (ILM) micro breaks relieves tangential traction, which can result in spontaneous closure of FTMH.

特发性黄斑裂孔术后黄斑中心凹外层显微结构变化与视力的相关性

特发性黄斑裂孔术后黄斑中心凹外层显微结构变化与视力的相关性

TREATMENT OF PERSISTENT MACULAR HOLES WITH HEAVY SILICONE OIL.

To determine anatomical success and best-corrected visual acuity after secondary surgery with heavy silicone oil tamponade in patients with persistent full-thickness macular holes. In this retrospective study, 63 eyes with persistent full-thickness macular holes after primary pars plana vitrectomy and internal limiting membrane peeling underwent secondary surgery with heavy silicone oil tamponade. Macular spectral domain optical coherence tomography and best-corrected visual acuity measurements were performed during the follow-up. Fifty of 63 eyes (79.4%) achieved anatomical success. In eyes achieving anatomical success, best-corrected visual acuity before primary vitreoretinal surgery was significantly better (0.77 [∼20/125 Snellen] ± 0.24 [1.3-0.3] logarithm of the minimum angle of resolution) compared with eyes not achieving anatomical success (0.88 [∼20/160 Snellen] ± 0.17 [1.1-0.6] logarithm of the minimum angle of resolution, P = 0.044). Minimum linear diameter of full-thickness macular holes was significantly smaller in eyes achieving anatomical success, both before primary (403.4 ± 128.7 [199.0-707.0] µ m vs. 568.1 ± 209.1 [307.0-953.0] µ m, P = 0.009) and secondary surgery (464.1 ± 215.0 [178.0-1,521.0] µ m vs. 663.3 ± 228.5 [451.0-1,301.0] µ m, P = 0.010). Patients remaining phakic during all three surgeries did not benefit from best-corrected visual acuity improvement, although anatomical success was achieved. Heavy silicone oil tamponade in secondary surgery for persistent full-thickness macular holes is a safe and efficient surgical method. Best-corrected visual acuity and minimum linear diameter before surgery may be indicators for anatomical success.

Swept-Source OCT Angiography Features in Patients after Macular Hole Surgery.

This study aimed to compare findings of optical coherence tomography (OCT) angiography (OCTA) between eyes with nearly recovered and partially recovered outer retina after full-thickness macular hole (FTMH) surgery and to identify OCTA findings associated with visual acuity. We retrospectively reviewed 30 patients who underwent surgery for idiopathic FTMH. Swept-source OCT (SS-OCT) and OCTA were performed preoperatively and at three and six months postoperatively. Subgroups were divided according to the integrity of the external limiting membranes and ellipsoid zones postoperatively. Correlations of best-corrected visual acuity six months postoperatively with SS-OCT and OCTA measurements were analyzed. There was no difference in preoperative retinal or choroidal vascular index on OCTA between the nearly and partially recovered groups. Six months postoperatively, the choriocapillaris flow-void area was significantly higher in the partially recovered group than in the fellow eye. The nearly recovered group showed better choroidal vascular flow, and vision at six months postoperatively correlated with the ratio of the operated eye’s choriocapillaris flow-void area to the fellow eye. Sufficient choriocapillaris flow on OCTA is associated with better outer retinal recovery and visual outcomes after macular hole surgery.

Prognostic Role of Optical Coherence Tomography in Outcome of Idiopathic full thickness Macular Hole Surgery

Abstract&#x0D; Purpose: To assess the prognostic value of Optical Coherence Tomography indices preoperatively in outcome of idiopathic full thickness macular hole surgery.&#x0D; Material &amp; Methods: A Quasi experimental study was carried out at Al Ibrahim eye hospital, Karachi from June 2019 to Feb 2020. Patients between 50 to 70 years of age, including both genders with full thickness idiopathic macular hole on Optical Coherence Tomography (OCT) were included while patients with secondary causes of macular hole like trauma, myopia, detachment of retina with macular hole, macular hole with other causes of poor vision like corneal scaring, Age related macular degeneration and diabetic retinopathy were excluded. OCT measurements are basal diameter, height of macular hole, right and left arm length and derived indices are macular hole index (MHI) and hole form factor (HFF).&#x0D; Results: A total 33 patients including 23 (69.6%) male and 10(30.3%) females of idiopathic full thickness macular hole were taken. Patients mean age was 55.25±6.9. Among 33 patients, MHI (&gt;0.5) was found in 21(63.6%) patients while 12 (36.3%) patients had MHI (&lt; 0.5). In 25 patients HFF calculation was possible. 17(68%) patients had HFF (&gt;0.9) while 8 (32%) patients had HFF (&lt; 0.9). Anatomical and visual outcomes were assessed at 1st and 3rd month follow-up. Of 21 patients for MHI &gt;0.5, vision improved (i.e. ≥ 6/18) in 15 (71.4%). Similarly, out of 17 patients for HFF &gt; 0.9, 13 (76.47%) patients had improved vision post-operatively.&#x0D; Conclusion: Optical coherence tomography indices can be helpful to predict surgical outcomes of idiopathic full thickness macular hole surgery.

OUTCOME OF REVISION PROCEDURES FOR FAILED PRIMARY MACULAR HOLE SURGERY.

To analyze the outcomes of revision surgery for idiopathic full-thickness macular holes that have failed to close after primary surgery, and also to assess factors predicting success and to review the relative effect of adjunctive surgical techniques. A multicenter retrospective study. Anatomical closure rates and visual acuity change between pre and postrevision surgery were assessed. Hole size, age, symptom duration, surgical interval, and reduced hole size were analyzed as predictive factors for success. Effectiveness of adjunctive surgical techniques was reviewed. Seventy-seven eyes were included in the study. Anatomical closure was achieved in 71% (55/77) cases. There was a median gain of 11 Early Treatment of Diabetic Retinopathy Score letters in all holes and 14 letters in closed holes. Full-thickness macular holes that increased in size by more than 10% following primary surgery had a closure rate of 50% compared with 80% in holes that reduced by 10% or stayed the same (P = 0.015). Increasing hole size is associated with a modest reduction in odds of closure (odds ratio = 0.99; P = 0.04). Surgical interval <2 months is not associated with better outcomes compared with >2 months (P = 0.14). Revision surgery for full-thickness macular holes that have failed to close after primary surgery is associated with high closure rates and significant visual gains.

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY FINDINGS BEFORE AND AFTER VITRECTOMY FOR MACULAR HOLES: Useful or Useless?

To investigate the vascular remodeling of optical coherence tomography angiography in full-thickness macular hole surgery. This retrospective, observational case series included 33 eyes of 33 patients with a full-thickness macular hole who underwent epiretinal membrane removal. Data were collected on best-corrected visual acuity, structural B-scan optical coherence tomography, and optical coherence tomography angiography preoperatively and at 1, 3, and 6 months postoperatively. Optical coherence tomography angiography was used to assess the retinal vascular density (VD) of the superficial vascular plexus and deep vascular plexus (DVP). Vascular density was assessed using the Early Treatment Diabetic Retinopathy Study grid for the whole, inner, and outer grids. A statistically significant correlation was found between the VD (whole, inner, and outer grids) of the superficial vascular plexus alone from baseline to 1-month postoperatively (P < 0.001). Similarly, VD was correlated from baseline to 1, 3, and 6 months postoperatively to the whole (P < 0.0005, F = 23.22), inner (P < 0.0005, F = 28.23), and outer Early Treatment Diabetic Retinopathy Study grids of DVP (P = 0.033, F = 3.49). The best-corrected visual acuity and VD were significantly correlated with the superficial vascular plexus and DVP at baseline and 6 months (P < 0.05, all correlations). The most significant correlation was observed at 6 months between best-corrected visual acuity and DVP in the whole, inner, and outer Early Treatment Diabetic Retinopathy Study grids (P < 0.001). Superficial vascular plexus and DVP are affected by full-thickness macular holes, with the most significant effects being on the DVP. Full-thickness macular hole surgery leads to an improvement in the best-corrected visual acuity in many eyes and the restoration of the VD, especially of the DVP.

Changes in each retinal layer and ellipsoid zone recovery after full-thickness macular hole surgery

To analyze the changes in each retinal layer and the recovery of the ellipsoid zone (EZ) after full-thickness macular hole (FTMH) surgery. Patients who underwent surgery for FTMH were included. Spectral-domain optical coherence tomography (SD-OCT) was performed preoperatively and postoperatively at 1, 3, 6, 9, and 12 months. A total of 32 eyes were enrolled. Ganglion cell layer, inner plexiform layer, and inner nuclear layer showed significant reductions over time after surgery (P = 0.020, P = 0.001, and P = 0.001, respectively), but were significantly thicker than those of fellow eyes at 12 months postoperatively. The average recovery duration of the external limiting membrane (ELM), outer nuclear layer (ONL), and EZ was 1.5, 2.1, and 6.1 months, respectively. Baseline best-corrected visual acuity (BCVA) (P = 0.003), minimum linear diameter (MLD) (P = 0.025), recovery of EZ (P = 0.008), and IRL thickness (P < 0.001) were significant factors associated with changes in the BCVA. Additionally, axial length (P < 0.001), MLD (P = 0.020), and IRL thickness (P = 0.001) showed significant results associated with EZ recovery. The IRL gradually became thinner after FTMH surgery but was still thicker than that of the fellow eye at 12 months postoperatively. The recovery of ELM and ONL may be a prerequisite for the EZ recovery. The BCVA change was affected by baseline BCVA, MLD, recovery of EZ, and IRL thickness. Additionally, axial length, MLD, and IRL thickness were significantly associated with EZ recovery.

Prevalence and Progression of Stage 0 Macular Hole in Fellow Eyes of Patients with Idiopathic Full-thickness Macular Hole.

PurposeTo assess the prevalence and progression of a stage 0 macular hole in the fellow eye of patients with an idiopathic full-thickness macular hole.MethodsThe fellow eyes of 189 patients who underwent idiopathic full-thickness macular hole surgery were examined by biomicroscopy and spectral domain-optical coherence tomography (SD-OCT). A subset of 21 fellow eyes with a stage 0 macular hole was observed. Changes in the macular hole were evaluated by biomicroscopy and SD-OCT for an average of 29 months.ResultsAmong the 21 eyes, 15 showed no change in perifoveal vitreous detachment (71.4%). Two eyes (9.5%) developed complete vitreofoveal separation, and one of the two developed a separation after progression to stage 1A. Among 21 eyes, 5 (23.8%) developed above stage 1A, and one of the five progressed to stage 1B after five years, which was successfully treated with vitrectomy and gas tamponade.ConclusionsPerifoveal vitreous detachment in the fellow eye on SD-OCT, defined as a stage 0 macular hole, occurred at an earlier phase than stage 1A macular holes and may progress to an advanced stage. Therefore, patients who undergo macular hole surgery and have a stage 0 macular hole or perifoveal vitreous detachment in the fellow eye should be followed closely.

Inverted ILM Flap Technique in Idiopathic Full-Thickness Macular Hole Surgery: Functional Outcomes and Their Correlation with Morphologic Findings.

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.

Twelve-month follow-up after posterior 25G vitrectomy due to idiopathic full-thickness macular hole treated with “inverted ILM flap” technique

Background: We conducted a prospective, follow-up study to analyze a long-term recovery process after posterior vitrectomy for idiopathic full-thickness macular hole. Material and methods: Sixty eyes were evaluated in 59 patients who underwent surgery for idiopathic fullthickness macular hole using posterior 25G vitrectomy with the “inverted ILM flap” technique from the beginning of 2013 to the end of 2014. In 55 eyes, posterior 25G phaco-vitrectomy with ILM peeling was performed using the “inverted ILM flap” technique with IOL implantation. In 5 pseudophakic eyes, posterior vitrectomy was performed with the technique as above. All patients were interviewed regarding the duration of the disease and pre- and postoperatively at intervals of 1, 3, 6, and 12 months. The following tests were performed: best-corrected visual acuity (BCVA), best-corrected near visual acuity (BCNVA), intraocular pressure (IOP) measurement, physical examination of the anterior and posterior segment of the eye, and spectral domain optical coherence tomography (SD-OCT). Results: The anatomical success in the study was 95%, and we achieved the improvement in visual acuity in 91.7% of the operated eyes. The visual acuity in the time interval before surgery and 12 months afterward improved from 0.1 to 0.29 and was statistically significant (p &lt; 0.05). Shorter duration and smaller hole size were significant predictors of improved postoperative visual acuity. The U-type of the hole closure predisposed to the most significant improvement in visual acuity in patients. Conclusions: The obtained functional and anatomical results may confirm the effectiveness of posterior vitrectomy using the “inverted ILM flap” technique in treating idiopathic full-thickness macular holes. The observed sparce complications did not differ from the complication profile described by other authors.