Comparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole
Received 28 October 2019
Accepted for publication 17 December 2019
Published 27 December 2019 Volume 2019:13 Pages 2599—2606
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Scott Fraser
Fariba Ghassemi,1 Hassan Khojasteh,1 Alireza Khodabande,1 Lauren A Dalvin,2 Mehdi Mazloumi,1,3 Hamid Riazi-Esfahani,1 Masoud Mirghorbani1
1Eye Research Center (ERC), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; 2Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA; 3Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
Correspondence: Hassan Khojasteh
Eye Research Center (ERC), Farabi Eye Hospital, Qazvin Square, PO Box: 14155-7146, Tehran, Iran
Purpose: To evaluate and compare three different techniques of inverted internal limiting membrane (ILM) flap in the treatment of large idiopathic full-thickness macular hole.
Methods: In a comparative interventional case series, 72 eyes from 72 patients with large (> 400 μm) full-thickness macular hole were randomly enrolled into three different groups: group A – hemicircular ILM peel with temporally hinged inverted flap; group B – circular ILM peel with temporally hinged inverted flap; and group C – circular ILM peel with superior inverted flap. Best-corrected visual acuity (BCVA), anatomical closure rate, and ellipsoid zone (EZ) or external limiting membrane (ELM) defects were evaluated preoperatively, at week 1, and months 1, 3 and 6 after surgery.
Results: There were 24 eyes in group A, 23 in group B, and 25 in group C. In all three groups, larger diameter macular hole was associated with worse preoperative visual acuity (r=0.625, P<0.001). Mean BCVA improved significantly in all three groups 6 months after surgery (0.91vs 0.55, p<0.001). 6 months after surgery, mean BCVA improved from 0.91 logMAR to 0.52±0.06 in group A, 0.90 to 0.53±0.06 in group B, and 0.91 to 0.55±0.11 in group C. In group A vs. B vs. C, improvement of BCVA was 0.380±0.04 vs. 0.383±0.04 vs. 0.368±0.11 logMAR, with no statistically significant difference between groups (P=0.660). The rate of successful hole closure was 87.5% vs. 91.3% vs. 100%. Although the closure rate was 100% in Group C (circular ILM peel with superiorly hinged inverted flap), this difference was not statistically significant (P=0.115).
Conclusion: ILM peel with an inverted flap is a highly effective procedure for the treatment of large, full-thickness macular hole. Different flap techniques have comparable results, indicating that the technique can be chosen based on surgeon preference.
Keywords: internal limiting membrane peel, inverted flap, macular hole, pars plana vitrectomy
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