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Inverted Internal Limiting Membrane Flap vs Complete Internal Limiting Membrane Peeling for Large Macular Holes in

Rubina Rahman1, Mohammad Waseem Sarfraz1, Mohamad El-Wardani1

  • 1Calderdale Royal Hospital, Salterhebble Hill, Halifax, UK.

Journal of Vitreoretinal Diseases
|April 3, 2023
PubMed
Summary

Complete ILM peeling (ILMP) offers superior visual acuity outcomes compared to the inverted ILM flap (ILMF) technique for large macular holes, with no positioning required post-surgery.

Keywords:
internal limiting membranemacular holesvitreoretinal surgery

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Area of Science:

  • Ophthalmology
  • Retinal Surgery
  • Macular Hole Treatment

Background:

  • Large, full-thickness macular holes (MHs) present significant challenges in visual restoration.
  • Surgical techniques aim to improve anatomical closure and visual function.
  • The role of internal limiting membrane (ILM) management is crucial in MH repair.

Purpose of the Study:

  • To compare the anatomical and functional outcomes of the inverted internal limiting membrane flap (ILMF) technique versus complete ILM peeling (ILMP).
  • To evaluate these techniques in non-posturing surgery for large, full-thickness macular holes.

Main Methods:

  • Retrospective, comparative, single-surgeon study.
  • Inclusion of idiopathic large full-thickness MHs (minimum diameter > 400 μm).
  • Analysis of 46 patients: 22 ILMF cases and 24 ILMP cases, with no postoperative positioning.

Main Results:

  • 100% primary hole closure achieved in both ILMF and ILMP groups.
  • Significant improvement in visual acuity (VA) in both groups compared to preoperative values.
  • ILMP demonstrated a statistically significant greater improvement in VA compared to ILMF (P = .02).

Conclusions:

  • Both ILMF and ILMP techniques achieve 100% MH closure.
  • Complete ILM peeling (ILMP) results in superior visual acuity outcomes compared to the ILMF technique.
  • Non-posturing after surgery does not compromise surgical success for either technique.