INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUES AND OUTER RETINAL LAYER STRUCTURES. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Faria, Mun Yueh; Proença, Helena; Ferreira, Nuno G.; Sousa, David Cordeiro; Neto, Eliana; Marques-Neves, Carlos
• Is Part Of: Retina. Volume 40:Issue 7(2020)
• Publication Date: 2020-07
• Subjects: internal limiting membrane -- macular hole -- outer retinal layers; Retina -- Diseases -- Periodicals; Retinal Diseases; Vitreous Body; 617.735
• DOI: 10.1097/IAE.0000000000002607
• Languages: English
• ISSNs: 0275-004X

Abstract

Abstract : Purpose: To examine the influence of the inverted flap (IF) internal limiting membrane (ILM) technique in macular hole (MH) closure on outer retinal layers after MH surgery. Methods: Retrospective study. Postoperative position of ILM, recovery rate of external limiting membrane and ellipsoid zone, and best-corrected visual acuity were evaluated. The Inserted group, where the IF is placed inside the hole, was compared with the Cover group, where the IF completely covers the hole. Results: Sixty-two eyes of 58 patients who underwent vitrectomy and ILM peeling with the IF technique for large MHs (>400 µ m) with successful MH closure and a follow-up of 12 months were evaluated. In the 24 eyes of the Inserted group, there was no regeneration of external limiting membrane or ellipsoid zone after 12 months. In the 38 eyes of Cover group, external limiting membrane recovered in 55.3% of patients 1 month after surgery, and in 86.1% after 12 months. The elipsoid zone layer was present in 58% of the patients. Conclusion: Poorer anatomical and visual results were associated with the IF technique where ILM insertion occurs compared with ILM placed over the hole. These findings suggest that insertion of the ILM in the hole might prevent outer retinal layers realignment and visual recovery in MH surgery. Abstract : Inverted flap macular hole surgery has differed mostly in how the internal limiting membrane flap is positioned over the hole. In this study, we found that if internal limiting membrane is buried into the hole, there is no realignment of external layers. If internal limiting membrane is maintained over the hole, most external limiting membrane and ellipsoid zone realign.