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Single-Layer Inverted Internal Limiting Membrane Flap Versus Conventional Peel for Small- or Medium-Sized
Hung-Da Chou1, Laura Liu1, Chung-Ting Wang2
1From the Department of Ophthalmology (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., E.Y.-C.K.,Y.-H.C., C.-C.L.), Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan; College of Medicine (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., Y.-P.C., E.Y.-C.K.,Y.-H.C., L.Y., C.-C.L.), Chang Gung University.
Purpose:
To analyze the outcomes of using an internal limiting membrane (ILM) flap and the conventional ILM peel technique for small- or medium-sized full-thickness macular hole (FTMH) repair.
Design:
Retrospective, interventional case series.
Methods:
Eyes with an FTMH ≤400 µm that underwent vitrectomy with a single-layer inverted ILM flap (flap group, 55 eyes) or an ILM peel (peel group, 62 eyes) were enrolled. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) measurements were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively.
Results:
Primary hole closure was achieved in 54 (98%) and 60 (97%) eyes in the flap and peel groups, respectively. The preoperative and postoperative 12-month BCVA values were comparable between the groups but were significantly better in the flap than in the peel group at 1 month (mean ± SD logMAR: 0.83 ± 0.43 vs 1.14 ± 0.50; P = .001), 3 months (0.58 ± 0.33 vs 0.82 ± 0.43; P = .002), and 6 months (0.56 ± 0.32 vs. 0.72 ± 0.48; P = .028). In the flap group, foveal gliosis was less common than in the peel group at 1 month (P = .030), and restored external limiting membrane and interdigitation zone was more common at 3 months (P = .046 and P < .001, respectively).
Conclusions:
The single-layer ILM flap and conventional ILM peel techniques both closed FTMHs and improved vision. ILM flaps were associated with better visual outcomes up to 6 months postoperatively and should be considered in FTMHs ≤400 µm.
