J Korean Ophthalmol Soc.  2018 May;59(5):428-436. 10.3341/jkos.2018.59.5.428.

The Treatment of Large Macular Holes Using a Multi-layered Inverted Internal Limiting Membrane Flap Technique

Affiliations
  • 1Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea. Pjm1438@hanmail.net

Abstract

PURPOSE
To describe a multi-layered inverted internal limiting membrane (ILM) flap technique and to evaluate the surgical outcomes of this surgery in patients with macular holes > 800 µm in base diameter.
METHODS
The medical records of patients who received a multi-layered ILM flap technique were retrospectively studied and patients with macular holes > 800 µm were included in the analyses. Best-corrected visual acuity (BCVA) before and after surgery, preoperative hole size, hole base size, vertical size, and hole closure after surgery were checked using spectral domain optical coherence tomography. Pars plana vitrectomy was performed and the ILM was stained using indocyanine green and peeled with the base attached at the hole margin. The ILM flap was inverted over the macular hole with 2~3 layers, and gas injection was performed.
RESULTS
The mean age of 12 patients was 65.2 ± 12.3 years. The mean BCVA (logMAR) was 1.27 ± 0.61. The mean hole size was 563.6 ± 221.9 µm, the mean vertical size was 418.8 ± 80.9 µm, and the mean hole base size was 1,182.8 ± 298.5 µm. The mean follow-up period was 174.4 ± 143.3 days. Nine macular holes were closed after surgery but three macular holes were not closed. The postoperative mean BCVA (logMAR) was 0.21 ± 0.51. Eight eyes showed visual improvement while three eyes did not show visual improvement after macular hole surgery.
CONCLUSIONS
The macular hole was closed successfully and the visual acuity improved after the multi-layered, inverted ILM flap technique. The multi-layered, inverted ILM flap technique is therefore considered the treatment of choice for large macular holes.

Keyword

Inverted internal limiting membrane (ILM) flap technique; Large macular hole; Macular hole; Macular hole surgery; Multi-layered

MeSH Terms

Follow-Up Studies
Humans
Indocyanine Green
Medical Records
Membranes*
Retinal Perforations*
Retrospective Studies
Tomography, Optical Coherence
Visual Acuity
Vitrectomy
Indocyanine Green
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