Inverted internal limiting membrane flap technique in the surgical treatment of macular holes: 8-year experience
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ORIGINAL PAPER
Inverted internal limiting membrane flap technique in the surgical treatment of macular holes: 8-year experience Nisa Silva . Nata´lia Ferreira . Bernardete Pessoa . Nuno Correia . Joa˜o Melo Beira˜o . Angelina Meireles
Received: 15 April 2020 / Accepted: 1 October 2020 Ó Springer Nature B.V. 2020
Abstract Purpose To evaluate the ellipsoid zone (EZ) structural recovery, hole closure rate, and visual acuity improvement after inverted internal limiting membrane (ILM) flap technique. Methods Retrospective cohort of eyes affected by idiopathic macular holes (MH) that underwent pars plana vitrectomy combined with inverted ILM flap technique in a tertiary center, over an 8-year period (2011–2019). The main outcomes were the postoperative qualitative analysis of EZ structure on spectraldomain optical coherence tomography, hole closure rate, and best-corrected visual acuity (BCVA) improvement of C 0.3 units in the logarithm of minimal angle of resolution (logMAR) scale. Results Our study included 76 eyes of 72 patients; 65% were female, with a mean age of 70 ± 8 yearsold. Median (range) follow-up was 21 (3–92) months. Hole closure rate was 92%. Structural defects in EZ were observed in 66% of closed holes (EZ atrophy in 33%, EZ disruption in 22%, and EZ thinning in 11%).
N. Silva (&) N. Ferreira B. Pessoa N. Correia J. M. Beira˜o A. Meireles Ophthalmology Department, Centro Hospitalar Universita´rio Do Porto, Largo Do Prof. Abel Salazar, 4099-001 Porto, Portugal e-mail: [email protected] J. M. Beira˜o A. Meireles Instituto de Cieˆncias Biome´dicas Abel Salazar, Universidade Do Porto, Porto, Portugal
The mean final BCVA was 0.5 ± 0.4 logMAR (Snellen 20/63), but visual acuity improvement occurred in 80% of the eyes. Final BCVA was significantly worse in eyes with EZ atrophy compared with eyes with EZ disruption (0.75 vs. 0.36 logMAR, p = 0.004) and EZ thinning (0.75 vs. 0.32 logMAR, p = 0.015). In multivariate regression, minimum linear diameter (OR 1.01; IC 95% 1.01–1.02) independently predicted a final BCVA (logMAR) \ 0.3 units. Conclusion Inverted ILM flap technique provided a hole closure rate above 90%, similar to previous studies. Although the modest value of the final BCVA, a significant visual acuity improvement occurred in most eyes. Structural defects of EZ were found in more than half of closed MHs after surgery. Evidence of postoperative retinal atrophy was associated with a worse visual outcome. Keywords Macular hole Inverted internal limiting membrane flap technique Ellipsoid zone analysis
Introduction The prevalence of full-thickness macular holes (MH) ranges from 0.02 to 0.8%, with the vast majority being idiopathic [1–4]. In 1988, Gass postulated that tangential vitreomacular traction resulting in centrifugal displacement of photoreceptors was the key factor in the development of idiopathic MHs [5]. According
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to this theory, removing tangential vitreomacular traction was speculated to avoid the p
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