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Published on: February 12, 2018
Comparison of long-term visual and anatomical outcomes between internal limiting membrane flap and peeling techniques
Jay Jiyong Kwak1, Suk Ho Byeon2
1Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea.
Objectives:
To compare visual and anatomical outcomes between internal limiting membrane (ILM) flap (IF) and peeling (IP) techniques for full-thickness macular holes (FTMHs).
Methods:
A retrospective case series with propensity-score matching (PSM). Patients with a minimum 12 months follow-up were divided into IF and IP groups and matched based on FTMH size and preoperative best-corrected visual acuity (BCVA). BCVA and optical coherence tomography (OCT) findings were obtained to assess outer retinal layer integrity, foveal thickness, and foveal displacement.
Results:
Twenty-six eyes were included in each group after PSM. The IF group showed significantly greater BCVA after 1 month, its corresponding change from preoperative BCVA, proportions of eyes with ellipsoid zone defects <250 μm after 1 month, and interdigitation zone restoration after 6 and 12 months (P = 0.007, 0.038, 0.048, 0.025, and 0.023, respectively), as well as less foveal gliosis after 1, 3, 6, and 12 months (P = 0.020, 0.017, 0.050, and 0.024, respectively). In the IP group, the mean outer nuclear layer thickness significantly decreased at 3 (P = 0.019) and 12 months (P = 0.016) compared to 1 month, and the foveal displacement toward the optic disc was significant after 1, 3, 6, and 12 months (P = 0.049, 0.006, 0.001, and <0.001, respectively).
Conclusions:
Compared to IP, IF promoted faster recovery of BCVA and outer retinal layers and was more protective against postoperative foveal thinning and displacement; hence, it should be considered for small and large FTMHs.
