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Modification of the inverted flap technique compared to conventional internal limiting membrane peeling in complete
M J Crespo Carballés1, M Sastre-Ibáñez1, M Prieto Del Cura1
1Servicio de Oftalmología, Hospital Universitario Infanta Leonor, Madrid, Spain.
Aim:
To describe the efficacy of a modification of the superior inverted flap technique, with maculorrhexis, in vitrectomy for full-thickness macular hole (MH) surgery compared to internal limiting membrane peeling (ILM).
Methods:
Retrospective and comparative study of patients with MH. In group A, a superior ILM flap is created to cover the macular hole, and in group B conventional ILM peeling was performed.
Results:
A total of 80 eyes were included (44 group A and 36 group B). MH closure occurred in 100% in group A and 91.67% in group B (p = 0.0869). There were more U-type closures in group A(90.91%) than in group B(58.33%), p = 0.0017. Both groups showed Best corrected visual acuity (BCVA) improvement at 3 and 6 months. At 3 months BCVA in group A was significantly better but at 6 months results were similar. Ellipsoid layer (EZ) recovery at 6 months was achieved in 81.82% patients in group A and 52.78% in B (p = 0.005), and external limiting membrane in 81.82% in group A and 69.44% in B (p = 0.1957).
Conclusions:
The superior inverted flap maculorrhexis technique is suitable for idiopathic MH treatment, with better anatomical and non-inferior functional results than the classic ILM peeling. It achieves functional recoveries earlier, better BCVA and greater gains at 3 months compared to the classic ILM peeling. It also obtains a higher number of U-shaped closures and higher EZ restorations.
Insights
The superior inverted flap maculorrhexis technique offers better anatomical outcomes for macular hole surgery compared to standard internal limiting membrane peeling. This method also leads to earlier visual recovery and improved ellipsoid layer restoration.
Area of Science:
- Ophthalmology
- Surgical Techniques
- Retinal Surgery
Background:
- Idiopathic full-thickness macular holes (MH) represent a significant challenge in retinal surgery.
- Current surgical treatments often involve internal limiting membrane (ILM) peeling, with varying success rates.
- Novel techniques aim to improve MH closure and visual recovery outcomes.
Purpose of the Study:
- To evaluate the efficacy of a modified superior inverted flap technique with maculorrhexis for full-thickness macular hole (MH) surgery.
- To compare the outcomes of this technique against conventional ILM peeling.
Main Methods:
- A retrospective comparative study involving 80 patients with MH.
- Group A: Superior ILM flap created to cover the MH.
- Group B: Conventional ILM peeling performed.
Main Results:
- 100% MH closure in the flap group (Group A) versus 91.67% in the peeling group (Group B).
- Significantly higher rate of U-type closures in Group A (90.91%) compared to Group B (58.33%).
- Superior ellipsoid layer (EZ) recovery in Group A (81.82%) versus Group B (52.78%) at 6 months.
Conclusions:
- The superior inverted flap maculorrhexis technique is effective for idiopathic MH treatment.
- It demonstrates superior anatomical results and non-inferior functional outcomes compared to classic ILM peeling.
- This technique facilitates earlier functional recovery, better visual acuity at 3 months, and enhanced EZ restoration.
