DIFFERENCES IN ANATOMICAL AND VISUAL OUTCOMES AMONG THREE INTERNAL LIMITING MEMBRANE TECHNIQUES TREATING EXTRA-LARGE IDIOPATHIC MACULAR HOLES. Issue 2 (February 2023)

• Record Type: Journal Article
• Authors: Liu, Lingzi; Yu, Yanping; Yang, Xiaohan; Wang, Zengyi; Qi, Biying; Zhang, Ke; Wu, Xijin; Wang, Xinbo; Liu, Wu
• Is Part Of: Retina. Volume 43:Issue 2(2023)
• Page Start: 222
• Page End: 229
• Publication Date: 2023-02
• Subjects: idiopathic macular hole -- internal limiting membrane -- optical coherence tomography -- visual acuity -- vitrectomy; Retina -- Diseases -- Periodicals; Retinal Diseases; Vitreous Body; 617.735
• DOI: 10.1097/IAE.0000000000003672
• Languages: English
• ISSNs: 0275-004X

Abstract

Abstract : Cover technique provides more satisfactory anatomical and visual outcomes, whereas insertion technique may adversely affect the recovery of foveal microstructure and best-corrected visual acuity for extralarge idiopathic macular holes. Low preoperative best-corrected visual acuity and long final length of ellipsoid zone defect were the influencing factors of poor final best-corrected visual acuity. Abstract : Purpose: To compare the anatomical and visual outcomes of extra-large idiopathic macular holes treated with internal limiting membrane peeling and two inverted internal limiting membrane flap techniques, namely insertion and cover technique. Methods: Patients with idiopathic macular holes (minimum linear diameter ≥ 650 µ m) were divided into peeling group, insertion group, and cover group. The initial closure rate, final length of external limiting membrane and ellipsoid zone recovery, and best-corrected visual acuity were evaluated. Results: A total of 124 eyes were included, and the average follow-up was 7.2 months. All the baseline characteristics were comparable among the three groups. Initial closure rate of the peeling group, the insertion group, and the cover group was 65.0% (26/40), 97.6% (41/42), and 90.5% (38/42), respectively ( P < 0.001). In closed idiopathic macular holes, the peeling group and the cover group exhibited significantly longer length of external limiting membrane recovery than the insertion group ( P < 0.001), and the peeling group exhibited significantly longer length of ellipsoid zone recovery than the other two groups ( P = 0.021). The peeling group and the cover group exhibited significantly better best-corrected visual acuity improvement than the insertion group ( P = 0.009). Conclusion: For extra-large idiopathic macular holes, cover technique surpasses internal limiting membrane peeling technique in closure rate and outperforms insertion technique in anatomical and functional recovery, whereas insertion technique may adversely affect the recovery of foveal microstructure and best-corrected visual acuity.