Visco-assisted Internal Limiting Membrane Translocation Technique for Unclosed Macular Hole

Abstract

Purpose : Autologous transplantation of the internal limiting membrane (ILM) has been reported to improve the functional and anatomical outcomes for unclosed refractory macular holes (MHs) after previous vitrectomy with ILM removal, in which the inverted ILM flap technique could not be performed. The purpose of this study is to present the modified surgical technique to perform autologous ILM transplantation, visco-assisted ILM translocation technique, for unclosed MHs after the foveal ILM removal.

Methods : Retrospective observational case series. Four eyes of 4 patients with unclosed MHs after the previous surgery with ILM peeling were included in this study (1 male and 3 females; mean age 73.7±13.8). Primary diseases causing MH were myopic foveoschisis, MH (stage 1B), idiopathic epiretinal membrane, and vitreo-macular traction syndrome. In all cases, visco-assisted ILM translocation technique was performed by the same surgeon (MS) in Hokkaido University Hospital from Dec 2014 to Apr 2016. In the visco-assisted ILM translocation technique, residual ILM was stained with brilliant blue G solution and then the edge of the residual ILM was peeled to form a long unseparated flap to cover the MH. The viscoelastic material was placed on the ILM flap for stabilization and fluid-air exchange and gas tamponade was performed. Comprehensive ophthalmologic examinations and spectral-domain optical coherence tomography were performed preoperatively and postoperatively. The main outcome measures were best-corrected visual acuity (BCVA) and MH closure rate.

Results : The mean postoperative follow-up duration was 14.3±7.0 months. The mean maximum diameter of the MHs was 636±245µm. MHs were closed successfully in all eyes (100%) after the vitrectomy with visco-assisted ILM translocation technique. The mean duration of MH closure from the surgery was 3.4±2.4 days. The postoperative logMAR value of mean BCVA (0.28±0.49) was improved from the preoperative value (0.85±0.17). The mean postoperative central foveal thickness was 160±86.6µm.

Conclusions : Vitrectomy with visco-assisted ILM translocation technique may improve the closure rate in patients with unclosed MHs after foveal ILM removal.

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