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Maurizio Mete, Alessandro Alfano, Grazia Pertile, Guido Prigione, Mauro Sartore; Complete ILM Removal versus Inverted ILM Flap for Surgical Repair of Myopic Macular Holes: one year follow-up. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5080.
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To compare the results of complete internal limiting membrane (ILM) removal and inverted ILM flap in the surgery of myopic macular holes (MMHs).
Ninety-one eyes affected by macular hole in high myopia (axial length > 26 mm) had been included in this retrospective study. They were treated with pars plana vitrectomy (PPV), ILM peeling and gas tamponade. In 62 cases, a complete ILM removal was performed (group 1); in 29 cases, an inverted ILM flap was executed (group 2). Postoperative face-down positioning was prescribed for both groups. Patients had been followed with best-corrected visual acuity (BCVA) evaluation and optical coherence tomography (OCT) scans up to 1 year postoperatively.
Average preoperative myopia was -14.8 in group 1 and -11.8 in group 2. BCVA improved from 0.60 to 0.40 logMAR and from 0.58 to 0.32 in group 1 and 2 respectively. OCT scans revealed MH closure in 40 cases of group 1 (64.5%) and in 27 cases of group 2 (93.4%). Reoperations were needed in 22 cases of group 1 (35.5%) and in 1 case of group 2 (3.5%) and was successfully only in 6 cases of group 1. Each patient of group 1 needed an average number of 1.19 procedures (range 0-5), while in group 2 the average number of surgeries was 0.04 per patient (range 0-1).
The inverted ILM flap technique may lead to better anatomical and functional outcomes than the complete ILM removal for the treatment of MH in high myopia. Based on these promising results, wider case series are desirable to establish the role of inverted ILM flap as the standard technique for myopic MHs.
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