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Related Experiment Video

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Macular hole closure patterns associated with different internal limiting membrane flap techniques.

Tommaso Rossi1,2, Aldo Gelso3, Ciro Costagliola4

  • 1IRCCS Azienda Ospedaliera Universitaria San Martino, IST, Genoa, Italy. tommaso.rossi@usa.net.

Graefe'S Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie
|February 6, 2017
PubMed
Summary

The inverted internal limiting membrane (I-ILM) flap technique, in its Cover and Fill variants, shows comparable outcomes for large idiopathic macular holes (IMH). The Fill technique may be more effective for very large holes, while Cover offers faster initial visual recovery.

Keywords:
Inverted internal limiting membrane flapMacular holesPars plana vitrectomy

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Area of Science:

  • Ophthalmology
  • Retinal Surgery
  • Macular Hole Treatment

Background:

  • Idiopathic macular holes (IMH) larger than 400 µm present surgical challenges.
  • The inverted internal limiting membrane (I-ILM) flap technique is a surgical approach for IMH repair.
  • Variations in I-ILM flap folding may influence surgical outcomes.

Purpose of the Study:

  • To compare the anatomic and functional results of two I-ILM flap technique variants.
  • To evaluate the efficacy of the 'Cover' versus 'Fill' I-ILM techniques for large IMH (>400 µm).

Main Methods:

  • A randomized study of 27 patients undergoing pars plana vitrectomy (PPV) for IMH.
  • Patients were assigned to either the Cover group (single-layer I-ILM flap) or Fill group (multi-layer I-ILM flap).
  • Outcomes assessed included macular hole closure rates, visual acuity, and inner/outer segments (IS/OS) junction integrity.

Main Results:

  • Macular hole closure rates were high in both groups (84.6% Cover vs. 100% Fill), with no significant difference.
  • Visual acuity at 3 months was similar between groups; however, the Cover group showed better vision at 1 month.
  • The Fill group demonstrated higher closure rates for MHs exceeding 700 µm (100% vs. 0%) and fewer outer retinal cystic changes.

Conclusions:

  • Both Cover and Fill I-ILM techniques achieve similar closure rates and 3-month visual outcomes for large IMH.
  • The Cover technique offers faster initial visual recovery and anatomical restoration at 1 month.
  • The Fill technique appears more effective for closing significantly larger macular holes (>700 µm) and may reduce cystic changes.