July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Internal Limiting Membrane “Flower Technique” improves foveal anatomy compared to standard surgical management for large macular holes
Author Affiliations & Notes
  • Tahsin Khundkar
    Department of Ophthalmology, New York Medical College, New York, New York, United States
  • Julia P Shulman
    Department of Ophthalmology, New York Medical College, New York, New York, United States
  • Jonathan Feistmann
    Department of Ophthalmology, New York Medical College, New York, New York, United States
  • Footnotes
    Commercial Relationships   Tahsin Khundkar, None; Julia Shulman, None; Jonathan Feistmann, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 5774. doi:
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    • Get Citation

      Tahsin Khundkar, Julia P Shulman, Jonathan Feistmann; Internal Limiting Membrane “Flower Technique” improves foveal anatomy compared to standard surgical management for large macular holes. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5774.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Surgical intervention for large macular holes, measuring >400mm, or chronic macular holes is challenging because of their lower closure rates and worse visual outcomes. As an adjunct to conventional Internal Limiting Membrane (ILM) peeling for large macular holes, various techniques have been described that preserve a portion of the ILM and utilize it to help close the macular defect. We present 3 consecutive cases of a novel technique that conserves the entire peeled portion of the ILM and uses it as a scaffold for hole closure.

Methods : Three patients had large macular holes > 400mm that were chronic (present over 1 year). All 3 underwent vitrectomy, staining of the ILM with indocyanine green followed by the “ILM flower technique”, in which the ILM is peeled 360 degrees around the macula toward the hole, with the ILM attachment to the circumference of the hole left intact, leaving an appearance of a flower. An air fluid exchange was then performed with the redundant ILM settling into the hole with little manipulation. SF6 tamponade was used in all 3 cases.

Results : Macular hole closure was observed in 100% of the holes and none demonstrated a flat open configuration. Visual acuity improved from a mean of 1.77 to 1.13. Keeping the ILM attached at the edge of the hole made the surgical manipulation much easier during the air fluid exchange and obviated the concern for migration that can occur with a free flap.

Conclusions : The ILM flower technique was successful in macular hole closure in these three cases. This technique is easy to surgically execute and the redundant ILM provided an excellent scaffold for hole closure without interfering with vision. Further study and follow up is necessary to validate this surgical technique.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

Preoperative OCT of 64-year-old woman with a macular hole with a base distance of 764μm. Visual acuity was 0.70.

Preoperative OCT of 64-year-old woman with a macular hole with a base distance of 764μm. Visual acuity was 0.70.

 

1 month post-operative ILM flower technique. The ILM can be seen covering the macular hole with flower-petal like projections of hyperreflective tissue corresponding to the ILM. Visual acuity was 0.60.

1 month post-operative ILM flower technique. The ILM can be seen covering the macular hole with flower-petal like projections of hyperreflective tissue corresponding to the ILM. Visual acuity was 0.60.

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