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Maurizio Mete, Grazia Pertile, Guido Prigione, Mauro Sartore; Inverted internal limiting membrane flap technique for the treatment of high myopic macular hole. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1172.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the efficacy of pars plana vitrectomy (PPV) with inverted internal limiting membrane (ILM) flap technique for myopic macular hole either associated or not with retinal detachment.
Ten eyes of 10 patients underwent PPV with inverted ILM flap technique and gas tamponade (SF6) for macular hole in high myopia (> -6 D). Five eyes (50%) showed a retinal detachment (4 recurrences, 1 primitive), while 5 eyes (50%) a primary macular hole. 3 eyes (30%) were phakic. Preoperative and postoperative visual acuity and spectral domain optical coherence tomography (OCT) scans were evaluated. The mean follow-up period was 6 months.
Macular hole closure was observed in 10 eyes (100%) after one surgery. When the macular hole was associated to a retinal detachment, retinal reattachment was achieved in all cases. OCT scans confirmed the complete closure of the macular, with no appearance of flat-opened macular hole. Based on the OCT images, the healing process was characterized by the early appearance of an exuberant hyperreflective material filling the macular hole (the inverted flap). Gradually, this material reduced and contracted, favouring the hole closure. Six months after surgery, a great part of the hyprereflective material was substantially reabsorbed, while the remnants were completely embedded into the retina. At the same time, an initial improvement of external retinal layers defects could be observed. Mean BCVA slightly improved from 1.24 +/- 0.97 LogMAR to 1.10 +/- 1.09 LogMAR.
Vitrectomy with inverted ILM flap seemed to be an effective technique for treating myopic macular holes with or without retinal detachment. OCT images suggested that better anatomical results could be achieved with this technique compared with other surgical strategies, preventing the postoperative flat-open appearance. A longer follow-up and a larger number of cases are needed to fully evaluate the anatomical and functional outcomes of this technique.
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