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salvatore parrulli, Isabella D'Agostino, Ugo Nava, Matteo Giuseppe Cereda, Giovanni Staurenghi; Inverted flap for large macular holes: a functional evaluation. Invest. Ophthalmol. Vis. Sci. 2018;59(9):882. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate relationship among functional and morphological findings before and after 25G pars plana vitrectomy (PPV) with inverted internal limiting membrane (ILM) flap technique for full thickness macular hole (FTMH)
This is a prospective case series of patients with idiopathic FTMH ≥ 450µm who underwent 25G PPV with 360° inverted ILM flap technique performed by the same surgeon (MC). Patients with pathologic refractive errors (±6D), glaucoma and ocular diseases were excluded. Complete ophthalmologic assessment, including BCVA, slit-lamp biomicroscopy, indirect ophthalmoscopy, SD-OCT (HRA-Spectralis, Heidelberg Engineering) and MAIA-Microperimetry (4-2 strategy), was performed at baseline, 1, 3 and 6 months after surgery.
From 6/28/2016 to 11/3/17 we enrolled 8 patients, mean age was 68yrs(range 42-82). Macular hole diameter ranged from 451 to 925µm (SD±149,62). Successful procedure after 1 month was registered in 100% of cases. Mean BCVA was 1,44±0,20 LogMar at baseline and raised to 0,55±0,35 LogMar 1 month after VPP with an average gain of 44 letters. At 3 months mean BCVA was 0,41±0,23 LogMar and 0,41±0,27 LogMar at 6 months.SD-OCT showed that ELM restored more rapidly compared with EZ/IZ. Continuous or partial restoration of ELM was observed in 7 patients (87%) at first month follow up, two of them also presented a visible EZ/IZ at the same time. At 3 months, all patients presented a continuous or partial restoration of ELM, 3 patient (37,5%)did not show a recovered EZ/IZ. At last follow up, 5 patients (75%) had a visible EZ/IZ.At Microperimetry average threshold improved during follow up: 13,95±6.37dB at baseline, 18,43±7,88dB at 1 month, 19,85±6,97dB at 3 months, 22,28±3,89dB at 6 months. At baseline 4 patients had unstable fixation, 3 a relatively unstable fixation and only 1 patient stable fixation. Fixation stability gradually improved in all patients after surgery, only 1 patient mantained a relatively unstable fixation from baseline to last follow up. Since first follow up, fixation shifted to a new macular area closer to the fovea.
Inverted ILM flap technique ensures closure even in large FTMH at stage IV with improved BCVA. Adding microperimetry we were able to associate anatomical and functional findings. In particular foveal sensitivity threshold and fixation stability improved since first follow up. In one case, new fixation point was observed more stable and closer to the fovea.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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