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Hirano Masayuki, Yuki Morizane, Tetsuhiro Kawata, Shuhei Kimura, Mio Hosokawa, Yusuke Shiode, Shinichiro Doi, Mika Hosogi, Atsushi Fujiwara, Fumio Shiraga; The processes of postoperative macular hole closure after inverted internal limiting membrane flap technique.The processes of postoperative macular hole closure after inverted internal limiting membrane flap technique.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1233.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the closure process of refractory macular holes (MHs) after the inverted internal limiting membrane (ILM) flap technique by comparing that of idiopathic MHs after vitrectomy with ILM removal.
Eight eyes of 8 refractory MH patients (2 men and 6 women, mean age 73.7 ± 5.1 years) who underwent the inverted ILM flap technique and 11 eyes of 11 idiopathic MH patients (5 men and 6 women, mean age 67.5 ± 6.7 years) who were treated with vitrectomy and ILM peeling were studied. The inverted ILM flap technique was basically performed according to the report of Michalewska et al (Ophthalmology 2010). In all patients, at the end of the operation, the eyes were replaced with 20% sulfur hexafluoride gas and patients were asked to remain face down for 3 days. The closure processes of MH were imaged using swept source optical coherence tomography (DRI OCT-1, Topcon, Japan) starting from 6 hours after the operation, followed by everyday examination till MH closure was confirmed.
The final closure rates of MHs after the initial surgery were 75.0% (6 eyes) in refractory MHs and 100.0% (11 eyes) in idiopathic MHs. The durations required for the closure of refractory MHs were 6 hours for 2 eyes (33.3%), 3 days for 2 eyes (33.3%), and 10 days for 2 eyes (33.3%). On the other hand, the durations required for the closure of idiopathic MHs were 6 hours for 5 eyes (45.4%), 1 day for 3 eyes (27.2%), and 3 days for 3 eyes (27.2%). The mean duration until the closure of refractory MHs was significantly longer than that of idiopathic MHs (106 ± 107.9 hours and 28.9 ± 28.7 hours respectively, p < 0.05, unpaired t-test). In refractory MHs that closed after the initial surgery, the type of MH closure was U-type in all eyes (6 eyes), although the restoration of the ellipsoid zone was observed in 3 eyes (50%).
The inverted ILM flap technique is effective to close refractory MHs and aiding the recovery of the macular conformation. The postoperative period of refractory MHs to close was longer than that of idiopathic MHs, possibly due to the differences in the mechanism of MH closure between these MHs.
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