Double inverted flap of epiretinal membrane and internal limiting membrane technique for treatment of idiopathic lamellar macular hole

Abstract

Purpose : To compare surgical results between conventional surgical technique with complete peeling of epiretinal membrane (ERM) and internal limiting membrane (ILM) and new surgical technique of double inverted ERM and ILM flap technique for treatment of idiopathic lamellar macular hole (LMH)

Methods : Group control, 21 eyes of 21 patients, underwent pars plana vitrectomy (PPV) and complete ERM and ILM peeling. ‘Double inverted flap’ group, 26 eyes of 26 patients, underwent PPV and double inverted ERM and ILM flap technique. Demographic data were: age, sex, eye, previous cataract surgery. The authors distinguished 2 types of LMH according to the ERM type: conventional ERM (C ERM) characterized by tractional properties, atypical ERM (A ERM) characterized by increased thickness, yellowish aspect and without tractional properties, as described in literature (see figure). Pre- and post-operative tomographic parameters were: residual foveal thickness RFT (micron μ), maximal diameter of intraretinal splitting (μ). Postoperative closure of the hole, full thickness macular hole (FTMH) development, intraretinal cysts and macular atrophy were evaluated. Best corrected visual acuity (BCVA LogMAR) at baseline, 1^st, 3^rd, 6^st month was estimated. Intraoperative data were: posterior vitreous detachment, tamponade (gas/air), cataract surgery.

Results : Statistical analysis confirmed that LMH with A ERM is associated with a more severe clinical entity compared to LMH with C ERM, with poorer visual acuity (p 0.0074) and thinner RFT (p 0.0158).
Group control was composed of 9 (42.9%) patients affected by LMH with A ERM and 12 (57.1%) by LMH with C ERM. Three patients affected by LMH with A ERM developed FTMH after surgery. No patients affected by LMH with C ERM, developed FTMH.
Double inverted flap group was composed of 17 (65.4%) patients affected by LMH with A ERM and 9 (34.6%) by LMH with C ERM. No patients developed FTMH.
Although the comparison of preoperative BCVA of LMH with A ERM between the 2 surgical group was not statistically significant, at 6^st month after surgery BCVA of the double inverted flap group was better compared to group control (p 0.0373).

Conclusions : Double inverted flap technique for treating LMH with A ERM reduces the risk of FTMH development, preserving fovea by iatrogenic damage due to surgical peeling.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.