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INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUES AND OUTER RETINAL LAYER STRUCTURES.

Mun Yueh Faria1,2, Helena Proença1,2, Nuno G Ferreira1,2

  • 1Ophthalmology University Clinic, Faculdade de Medicina Lisboa, Universidade de Lisboa, Lisbon, Portugal.

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The inverted flap (IF) technique for macular hole (MH) surgery may hinder outer retinal layer recovery. Inserting the internal limiting membrane (ILM) inside the hole showed poorer anatomical and visual outcomes compared to covering it.

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Area of Science:

  • Ophthalmology
  • Retinal Surgery
  • Macular Diseases

Background:

  • Macular holes (MHs) are a common cause of vision loss.
  • The inverted flap (IF) technique using internal limiting membrane (ILM) peeling is used for MH closure.
  • Optimal surgical methods for restoring outer retinal layers and visual function are actively researched.

Purpose of the Study:

  • To evaluate the impact of the inverted flap (IF) internal limiting membrane (ILM) technique on outer retinal layer integrity after macular hole (MH) surgery.
  • To compare the outcomes of inserting the ILM within the MH versus covering the MH with the ILM flap.

Main Methods:

  • Retrospective analysis of 62 eyes from 58 patients who underwent vitrectomy for large MHs (>400 µm).
  • Comparison between the 'Inserted' group (ILM placed inside the hole) and the 'Cover' group (ILM covers the hole).
  • Evaluation of postoperative ILM position, recovery of the external limiting membrane (ELM) and ellipsoid zone (EZ), and best-corrected visual acuity (BCVA) at 12 months.

Main Results:

  • No regeneration of ELM or EZ was observed in the 24 eyes of the Inserted group after 12 months.
  • In the Cover group (38 eyes), ELM recovery was 55.3% at 1 month and 86.1% at 12 months.
  • The EZ was present in 58% of the Cover group patients at 12 months.

Conclusions:

  • Inserting the ILM within the MH is associated with poorer anatomical and visual outcomes compared to covering the MH.
  • ILM insertion may impede the realignment of outer retinal layers and subsequent visual recovery in MH surgery.
  • The 'Cover' technique appears more favorable for restoring outer retinal integrity and visual function after MH repair.