Abstract
Purpose :
Large full-thickness macular holes (FTMH) have an increased risk of surgical failure at conventional macular hole surgery. We performed a retrospective, observational clinical study to evaluate the morphological and functional results of the inverted internal limiting membrane (ILM) flap technique for the treatment of idiopathic FMTH.
Methods :
56 patients with FTMH were included. The average age was 68 (SD 7) years and 76.8% were females. We analyzed the collective in total as well as separated in two subgroups (group 1: n=37, FTMH >400 µm, group 2: n=19: FTMH >250 µm and base >500 µm). Instead of completely removing the ILM during surgery, a remnant attached to the margins of the macular hole was left in place and was inverted over the macular hole. All surgical steps were monitored with the intraoperative OCT (SDiOCT) as it provides additional information enabling optimization of surgical strategy. Best corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT) were performed preoperatively, after one, 3, 6 and 9 months postoperatively. The primary outcome measures were visual acuity and macular hole closure rate.
Results :
The mean minimum linear diameter of the FTMH was 473 µm (range 251-863 µm). BCVA improved from 0.88 logMAR preoperatively to 0.40 logMAR (p<0.005) 9 months after surgery. There was no significant difference between the subgroups. We confirmed the closure of the FTMH with SD-OCT in all cases. The retinal layers where analyzed with SD-OCT. There was a difference between visual acuity in patients with a complete restoration of the macular configuration and those with remaining defect situations in the external limiting membrane (p<0.01). Further SD-OCT enabled us to distinguish between 3 different healing mechanisms of the macular holes as the ILM flap appeared in distinct ways. We did not find an association between the healing mechanisms and visual acuity.
Conclusions :
As the inverted ILM flap technique improves both the functional and morphological outcomes it might be the treatment of choice for not only large FTMH but also medium-sized FTMH with a large base. SDiOCT is an effective tool for controlled and save performance of the inverted ILM flap technique. The restoration of normal macular configuration plays an important role concerning the visual acuity.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.