Tailored internal limiting membrane flap technique for primary macular hole
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Tailored internal limiting membrane flap technique for primary macular hole Jia-Horung Hung 1,2 & Yu-Harn Horng 3 & Hui-Chen Chu 4 & Meng-Syuan Li 3 & Shwu-Jiuan Sheu 3,4,5,6 Received: 17 September 2019 / Revised: 23 December 2019 / Accepted: 27 December 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To investigate the outcomes of primary full-thickness macular hole (MH) after surgical intervention with tailored internal limiting membrane (ILM) flap technique. Methods Patients were reviewed for their clinical characteristics and surgical outcomes. The technique included incomplete circular peeling of the perifoveal ILM which was then trimmed according to the size of the MH. Fluid-gas exchange was done without further manipulation. Results Nineteen eyes of 19 patients were included. The patients were in average 61 years old (range 41–83) and had an average follow-up period of 11.0 months. At baseline visit, minimal linear diameter of the MH was 311.6 μm (range 80–768). After a single surgery, the MH closed in all cases with improvement of mean visual acuity (from 0.9 to 0.4 logarithm of the minimum angle of resolution units, p < 0.0001, Wilcoxon signed-rank test). At the final visit, 15 (78.9%) eyes achieved a visual acuity ≥ 20/ 40. Outer retinal gliosis was found to be associated with less favorable postoperative visual acuity. Factors related to the formation of outer retinal gliosis were worse preoperative visual acuity and a large MH with a diameter > 400 μm. Conclusion Tailored ILM flap technique is an effective method for favorable anatomical and visual outcomes for treatment of primary MH. Keywords Full-thickness macular hole . Internal limiting membrane peeling . Vitrectomy
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00417-019-04596-5) contains supplementary material, which is available to authorized users. * Shwu-Jiuan Sheu [email protected] 1
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
2
Department of Ophthalmology National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
3
Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
4
Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
5
School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
6
Department of Ophthalmology, Kaohsiung Medical University, No.100, Tzyou 1st Rd. Sanmin Dist., 80756 Kaohsiung City, Taiwan
Idiopathic macular holes (MH) have long been a cause of central vision loss, especially in the elderly population. The concept that full-thickness MH is a treatable disease has become widely accepted since the pilot study published by Kelly and Wendel in 1991 [1]. Various techniques have evolved to manage MH, but significant controversy still exists regarding the surgical methods and the visual outcome of t
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