Purchase this article with an account.
Maurizio Mete, Alessandro Alfano, Massimo Guerriero, Grazia Pertile; Inverted ILM flap for treatment of myopic macular holes: healing processes and morphologic changes in comparison with complete ILM removal. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2808.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
The aim of this retrospective, observational, clinical study is to describe the healing processes after surgery for myopic macular holes (MMHs), comparing the morphological outcomes of inverted internal limiting membrane (ILM) flap technique and complete ILM removal.
70 consecutive patients surgically treated for MMH were reviewed and included into the study according to the following inclusion criteria: a) presence of high myopia (> 6 diopters [D] and/or axial length > 26.5 mm); b) availability of clinical examination records and SD-OCT scans at baseline, 1, 3, 6 and 12 months postoperatively; c) closure of the MMH occurred after one or more surgery. The remaining patients were divided in 2 groups according to the surgical technique adopted: the inverted flap group included 25 patients undergone complete 23 gauge pars plana vitrectomy (PPV), inverted ILM flap and gas tamponade, while the peeling group included 17 patients undergone PPV, complete ILM removal and gas tamponade. The patients were followed up to 12 months. At each postoperative time point, external limiting membrane (ELM) and ellipsoid zone (EZ) presence or absence were recorded as evaluated by SD-OCT.
As shown in table 1, axial length and preoperative best corrected visual acuity (BCVA) were not significantly different between the two groups, while MMH diameter was significantly higher in inverted flap group. BCVA at 1, 3, 6 and 12 months after surgery didn’t show significant differences between the two groups.ELM and EZ reconstruction is described in table 2. The difference between the two groups resulted not statistically significant, even if the recovery of ELM seemed to occur earlier in inverted flap group than in peeling group. Moreover, the recovery of EZ resulted more frequent in inverted flap group at the end of the follow-up.
Our data confirms that inverted flap technique is able to improve the anatomical and functional results of the surgery for MMH. In our series, the presence of the flap didn’t seem to affect the healing processes and the restoration of the outer retinal layers occur even earlier in inverted flap group than in peeling group, despite of a higher average MMH diameter. Thus, it should be considered the technique of choice for the treatment of MMHs.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only