Comparative study of conventional internal limiting membrane peeling versus temporal inverted internal limiting membrane flap for large macular hole treatment

Purpose: To compare the anatomical, morphological, and functional outcomes of the conventional internal limiting membrane (ILM) peeling versus temporal inverted ILM flap technique for large full?thickness macular holes (FTMHs). Methods: Sixty eyes of 60 patients with a minimum base diameter >600 ?m were included in this retrospective interventional study. Patients were divided into conventional ILM peeling (Group 1) and temporal inverted ILM flap (Group 2) groups. The hole closure rate, best?corrected visual acuity (BCVA), ellipsoid zone (EZ), and external limiting membrane (ELM) defects were analyzed at baseline and 6 months after surgery. Results: Hole closure was achieved in 24/32 (75.0%) cases of Group 1 and 27/28 (96.4%) cases of Group 2 (P = 0.029). The mean BCVA (logMAR) changed from 1.23 ± 0.47 to 0.70 ± 0.29 logMAR in Group 1 and from 1.03 ± 0.36 to 0.49 ± 0.24 logMAR in Group 2 at 6 months (P < 0.001 in both cases). U?shaped closure was observed in 5 (15.6%) eyes in Group 1 and 19 (67.9%) eyes in Group 2 (P < 0.001). The total restoration rates of ELM and EZ were significantly higher in the temporal inverted ILM flap group (P = 0.002, P = 0.001, respectively). Conclusion: The study results suggested that the FTMH closure rate, recovery of the outer retinal layers, and, consequently, the post?operative BCVA were better with the temporal inverted ILM flap technique than with the conventional ILM peeling for larger than 600 ?m macular holes.

Pars plana vitrectomy combined with inverted internal limiting membrane flap technique for treating macular hole retinal detachment in high myopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical efficacy of pars plana vitrectomy(PPV)combined with inverted internal limiting membrane flap technique in the treatment of macular hole retinal detachment(MHRD)in high myopia.METHODS: A retrospective clinical study was conducted. A total of 63 patients(64 eyes)with high myopia and MHRD who treated at our hospital from October 2017 to October 2021 were selected as research subjects. They were divided into two groups according to different surgery, with 34 cases(35 eyes)who received PPV combined with inverted internal limiting membrane flap technique in group A, and 29 cases(29 eyes)received PPV combined with internal limiting membrane peeling in group B. The patients were followed up for 6mo. The two groups were compared in terms of the hole closure rate, the reduction rate of retinal detachment and best corrected visual acuity(BCVA)before operation and at 1wk, 1, 3 and 6mo after operation, and the postoperative complications were recorded.RESULTS: The hole closure rate within 6mo after operation was significantly higher in group A than in group B(P&#x0026;#x003C;0.05), but there was no statistically significant difference in the reduction rate of retinal detachment(P&#x0026;#x003E;0.05). The BCVA of the two groups was significantly improved over time after operation(P&#x0026;#x003C;0.05). There was no statistically significant difference in BCVA between the two groups before operation and at 1wk, 1, 3 and 6mo after operation(P&#x0026;#x003E;0.05). Complications were observed in the two groups, but there was no statistically significant difference in the incidence of complications between the two groups(P&#x0026;#x003C;0.05).CONCLUSION: PPV combined with inverted internal limiting membrane flap technique is safe and effective in the treatment of MHRD in high myopia, which can effectively improve the patients' BCVA and the hole closure rate without influence on intraocular pressure.

Pathogenesis and treatment progress of idiopathic macular hole / 国际眼科杂志(Guoji Yanke Zazhi)

@#Idiopathic macular hole(IMH)refers to a full-thickness tissue defect of the retinal neuroepithelial layer in the macular region without obvious etiology. At present, with the gradual deepening of the understanding of IMH and the continuous innovation and improvement of its treatment methods, its treatment technology has also matured and diversified. Studies have shown that early IMH with small diameter can be observed and followed up. The Ocriplasmin has been approved for use in patients with small to medium sized macular holes and vitreomacular adhesion(VMA); internal limiting membrane(ILM)removal can improve anatomical closure rate. However, for IMH with a diameter of less than 250μm, it is uncertain whether ILM removal is always required. This paper discusses the pathogenesis, stages, classification and current treatment of IMH. Based on the characteristics of IMH and patient differences, an evidence-based medicine method is proposed to select the best and most practical treatment plan for individual patients.

Nuevas tendencias en el manejo quirúrgico del agujero macular / New trends in the surgical management of macular holes

El agujero macular es un desorden de la interfase vitreorretinal definido como un defecto de espesor completo desde la membrana limitante interna hasta los segmentos externos de los fotorreceptores que normalmente involucra a la fóvea. Es más frecuente en mujeres mayores de 55 años y existe un riesgo de un 10-15 por ciento de afectación del ojo contralateral. Con el aumento de la esperanza de vida, se demandan nuevos retos y técnicas quirúrgicas para este problema de salud. Se realizó una revisión de artículos publicados e indexados en la base de datos de PubMed, que se refirieran a las características y clasificación por tomografía de coherencia óptica del agujero macular y las opciones terapéuticas para este. Nuevas técnicas quirúrgicas se han descrito para los agujeros maculares idiopáticos. El surgimiento de la tomografía de coherencia óptica, sobre todo la de dominio espectral, ha aumentado las posibilidades diagnósticas de tratamiento y seguimiento en las enfermedades de la interfase vitreorretinal, específicamente el agujero macular(AU)

A macular hole is a disorder of the vitreous-retina interface defined as a full-thickness defect from the internal limiting membrane to the external segments of photoreceptors which typically involves the fovea. It is more common among women aged over 55 years, and there is a 10-15 percent risk that the contralateral eye is affected. As life expectancy increases, new challenges come up and new surgical techniques are required for this health problem. A review was conducted of papers published and indexed in the database PubMed which referred to the optical coherence tomography classification and characteristics of macular holes, as well as the therapeutic options to treat it. New surgical techniques have been described for idiopathic macular holes. Introduction of optical coherence tomography, especially spectral domain OCT, has increased the diagnostic possibilities of the treatment and follow-up of vitreous-retina interface disorders, particularly macular holes(AU)

Surgical outcomes of inverted internal limiting membrane flap technique for large macular hole.

We are presenting the initial results of inverted internal limiting membrane (ILM) flap technique for large macular hole. Five eyes of five patients with large diameter macular hole (>700 µm) were selected. All patients underwent inverted ILM flap technique for macular hole. Anatomical closure and functional success were achieved in all patients. There was no loss of best‑corrected visual acuity in any of the patients. Inverted ILM flap technique in macular hole surgery seems to have a better hole closure rates, especially in large diameter macular holes. Larger case series is required to assess the efficacy and safety of this technique.