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[Large macular hole-Always a poor prognosis?]

J Friedrich1, N Bleidißel2, J Klaas2

  • 1Klinikum rechts der Isar, Augenklinik, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland. julia.friedrich@mri.tum.de.

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|July 16, 2020
PubMed
Summary
This summary is machine-generated.

The inverted flap internal limiting membrane peeling technique may offer similar visual outcomes for large macular holes as conventional peeling for smaller holes. Outer retinal layers, like the external limiting membrane, show early recovery in both methods.

Keywords:
Macular surgerySD-OCTSurgical imagingVitreoretinal surgeryiSD-OCT

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Area of Science:

  • Ophthalmology
  • Retinal Surgery
  • Surgical Techniques

Background:

  • Full thickness macular holes (FTMH) impact visual acuity.
  • Prognostic markers for FTMH outcomes include age, preoperative visual acuity, and hole size.
  • Evaluating novel surgical techniques is crucial for improving FTMH patient outcomes.

Purpose of the Study:

  • To compare the postoperative course of conventional internal limiting membrane peeling (c-ILM) versus inverted flap ILM peeling (i-ILM) for FTMH.
  • To assess visual acuity and retinal morphology in patients undergoing different ILM peeling techniques.
  • To determine if i-ILM peeling is effective for larger macular holes compared to c-ILM peeling.

Main Methods:

  • Retrospective observational clinical study of 45 FTMH patients.
  • Patients divided into two groups: c-ILM peeling and i-ILM peeling.
  • Postoperative evaluation using spectral domain optical coherence tomography (SD-OCT) to analyze outer retinal layers (ELM, EZ, OS) and best corrected visual acuity (BCVA) for at least 6 months.

Main Results:

  • The i-ILM group had significantly larger preoperative macular holes (408.4 µm) compared to the c-ILM group (287.4 µm).
  • The c-ILM group showed significantly better preoperative and 1-month postoperative BCVA.
  • No significant difference in BCVA was observed between the groups after 6 months.
  • The external limiting membrane (ELM) demonstrated the earliest postoperative recovery in both groups.

Conclusions:

  • The i-ILM peeling technique may achieve comparable visual outcomes to c-ILM peeling, even in patients with large FTMH.
  • This suggests i-ILM peeling is a viable option for managing larger macular holes.
  • Early recovery of outer retinal layers is a positive prognostic indicator regardless of the surgical technique.