Abstract
Purpose :
The inverted internal limiting membrane (ILM) flap technique was developed as an alternative technique to the standard ILM peel for the closure of macular holes (MH). This study aimed to systematically review all prospective randomized clinical trials evaluating the inverted ILM flap technique for idiopathic MH of all sizes.
Methods :
A systematic review was conducted by searching the relevant literature in databases, including PubMed, Web of Science, Embase, and Cochrane Library. Inclusion criteria included prospective randomized controlled trials that evaluated inverted ILM flaps.
Results :
A total of 31 studies were collected from the initial search query. Of those, 14 (Table 1) matched the inclusion criteria. A total of 539 eyes underwent the inverted ILM flap procedure, 282 eyes who underwent a standard ILM peel (8 studies), 27 eyes that underwent ILM peel and MH fill (2 studies), and 14 eyes that underwent an ILM peel with a free flap (1 study) (Table 2). A total of 10 studies evaluated only large MHs (708 eyes), 2 studies evaluated only small and medium MHs (66 eyes), and 1 study evaluated MHs of all sizes (28 eyes).
Macular hole diameters and closure rates
The average MH diameter across studies for inverted ILM flaps was 546um (range 269um – 803um), for ILM peels was 527um (range 244um - 760um), and for ILM fills was 504um (453um – 555um). Overall, the closure rate ranged from 85.7%-100% in the inverted ILM flap group, and 76.7%-100% in the ILM peel group.
Pre-op and post-op BCVA
In the inverted ILM flap groups, the pre-operative average best corrected visual acuity (BCVA) was 0.96 (range 0.70-1.34) logMAR and at last follow-up post-operatively improved to 0.40 (range 0.10-0.94) logMAR. In the ILM peel groups, the pre-operative average BCVA was 0.87 (range 0.53-1.30) logMAR and post-operatively improved to 0.49 (range 0.10-0.94) logMAR.
Four studies compared inverted ILM flaps directly to standard ILM peel for large MHs, and 3 found that inverted ILM flaps improved BCVA significantly more compared to standard ILM peel. One study found ILM flaps greater than 2 disc diameters (DD) improved BCVA significantly more than ILM flaps less than 2 DD.
Conclusions :
Inverted ILM flap is an effective technique for closing macular holes. In large MHs, the inverted ILM flap technique may result in better post-op BCVA compared to standard ILM peel technique.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.