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Christine Morozova, Andy Morozov, Dan Kamen, Jin Zhang, Rossella Favale, Mark Walsh, Francesco Boscia, David S Boyer, Homayoun Tabandeh; Localization of the Internal Limiting Membrane Flap After Macular Hole Surgery. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3404 – F0304.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the status of the internal limiting (ILM) flap following various ILM flap techniques for macular holes (MH).
Retrospective case series including eyes that underwent pars plana vitrectomy (PPV) and ILM flap for MH. The FLAP techniques included conventional ILM flap (C-ILM), temporal ILM flap (T-ILM), superior wide-base ILM flap transposition (SWIFT), and pedicle ILM flap (P-ILM). Postoperative imaging included ICG fluorescence imaging (ICG-FI) (Spectralis, Heidelberg Engineering Inc., Heidelberg, Germany) and optical coherence tomography (OCT).
49 eyes of 40 patients, mean age 68.3 years, with mean follow-up of 10.3 months were included in the study. Ten (20%) eyes were highly myopic, 22 (45%) eyes had chronic MH, and 7 (14%) eyes had history of prior MH surgery. The ILM flap technique included C-ILM / T-ILM (22 eyes), SWIFT (25 eyes), and P-ILM (2 eyes).The MH closed in 46 (94%) eyes. ICG fluorescence attributable to ILM flap was detected in all eyes, however, in 3 eyes the flap borders were not discernable. The ILM flap covered the MH completely in 36 (75%) eyes, partially in 7 (15%) eyes, and provided no coverage in 5 (10%) eyes. In 1 eye it was not possible to ascertain coverage on ICG-FI or OCT. In the 2 eyes with P-ILM the ICG-FI showed a displaced flap with no coverage of the MH.In cases with closed MH, OCT demonstrated intraretinal ILM fragments in 5 (23%) eye in I-ILM /T-ILM groups, and in none of the eyes in SWIFT or P-ILM group. Imaging with ICG-FI / OCT showed folding of the ILM flap in 14 (64%) eyes in I-ILM / T-ILM group, in 6 (24%) eyes in SWIFT /P-ILM group, and in 1 eye in P-ILM group.
ILM flap techniques are associated with a high MH closure rate and are useful in the management of MHs with high-risk characteristics. Postoperative multimodal imaging including ICG-FI and OCT indicates good coverage of the MH by the ILM flap in the majority of the cases.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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