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PEDICLE TRANSPOSITION FLAP, INVERTED FLAP, FREE FLAP, AND STANDARD PEEL FOR LARGE FULL-THICKNESS MACULAR HOLES: A
Iacopo Macchi1, Fernando J Huelin1, Tafadzwa Young-Zvandasara1
1Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom; and.
Retina (Philadelphia, Pa.)
|July 29, 2024
Summary
Pedicle transposition flap offers superior visual recovery and foveal microstructural restoration for large macular holes compared to standard internal limiting membrane peel and free flap techniques.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Macular Hole Treatment
Background:
- Idiopathic full-thickness macular holes (FTMH) larger than 500 µm present significant surgical challenges.
- Standard internal limiting membrane (ILM) peeling is a common surgical approach, but outcomes for large FTMH can be variable.
Purpose of the Study:
- To compare the anatomical and functional outcomes of four surgical techniques for large idiopathic FTMH.
- Evaluate the efficacy of standard ILM peel, pedicle transposition, inverted flap, and free flap techniques.
Main Methods:
- Retrospective study of 129 eyes with large FTMH (>500 µm) undergoing 23/25 G vitrectomy.
- Surgical techniques included standard ILM peel, pedicle transposition, inverted flap, or free flap.
- Postoperative optical coherence tomography (OCT) assessed by masked graders.
Main Results:
- Overall anatomical success rate was 81%, significantly lower (59%) with standard ILM peel (P < 0.0001).
- Pedicle transposition flap showed superior visual recovery (+27 ETDRS letters) versus free flap (+12 ETDRS letters) (P = 0.02).
- External limiting membrane restoration was superior with pedicle transposition flap at 3 and 6 months postoperatively.
Conclusions:
- Standard ILM peel alone yields inferior outcomes for large FTMH management.
- Pedicle transposition flap demonstrates the most complete foveal microstructural recovery among alternative ILM techniques.
