Abstract
Purpose :
To compare postoperative visual outcomes of inverted internal limiting membrane flap (ILMF) versus internal limiting membrane peel (ILMP) in the closure of full thickness macular holes (FTMH).
Methods :
Retrospective chart review included patients who have undergone PPV with ILMP or ILMF to close FTMH at Atrium Health Wake Forest Baptist with at least 3 months of follow up from January 2012 to October 2022. Baseline preoperative characteristics included were lens status, preoperative BCVA, baseline IOP, duration of macular hole, duration of follow up, and history of optic nerve, macular, and retinal abnormalities. Macular hole morphology (minimum linear diameter, height, base diameter, etc.) and surgical characteristics (gauge of vitrectomy, use of Kenalog, induction of PVD, etc.) were recorded. Outcome measurements included successful primary FTMH closure (defined as closure after single surgery) and postoperative BCVA analyzed in mean logMAR.
Results :
137 eyes (129 patients) including 32 ILMF and 105 ILMP eyes were included. There were no significant differences in baseline characteristics including preoperative BCVA [ILMF: 0.93±0.38; ILMP: 0.99±0.44, p=0.5], stage of FTMH [ILMF: 59% (n=19) stage 2, 28% (n=9) stage 3, 13% (n=4) stage 4; ILMP: 52% (n=54) stage 2, 41% (n=42) stage 3 and 7% (n=7) stage 4; p=0.3], duration of MH (months) [ILMF: 3.9 ±3.5; ILMP: 4.8 ± 8.3, p=0.8], and the minimum linear diameter (μm) [ILMF: (405 ±231); ILMP: (364 ±170); p=0.35]. Successful primary hole closure was achieved in 94% (n=30) of the ILMF group and 95% (n=100) of the ILMP group (p=0.7). In multivariate analysis, baseline characteristics associated with worse BCVA at 1 year included use of the ILMF technique (p=0.03), larger minimum linear diameter (p=0.002), and worse baseline BCVA (p=0.0002). The mean BCVA at 12 months was 0.62 (approximately 20/80) in ILMF eyes (95%CI: 0.28, 0.97) and 0.44 (approximately 20/50) (95%CI: 0.14, 0.75) in ILMP eyes.
Conclusions :
Despite similarly high primary FTMH closure rates between both ILMF and ILMP, the ILMF technique was independently associated with worse BCVA at 1 year in multivariate analysis. We hypothesize that this is because the ILM flap is a basement membrane and not a photo transducing neuron, so in the closure of FTMH it may be a physical barrier to the full recovery of photoreceptor function.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.