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Macular hole repair using a refined viscoelastic assisted membrane positioning technique markedly improves surgical
Anny M S Cheng1,2,3, Shailesh K Gupta1,2, Nizar S Abdelfattah4
1Department of Ophthalmology, Broward Health, Fort Lauderdale, FL, USA.
Introduction:
To evaluate the surgical outcomes of pars plana vitrectomy (PPV) using dispersive viscoelastic-assisted inverted internal limiting membrane (VILM) flap technique in patients with full-thickness macular holes (MH).
Methods:
We retrospectively review 247 eyes that underwent PPV with the VILM flap technique and had a minimum follow-up of six months. Following core vitrectomy, the internal limiting membrane (ILM), stained with indocyanine green, was placed on the MH. A dispersive viscosurgical device was applied over the ILM flat to secure its placement before fluid-gas exchange. Sulfur hexafluoride gas was used for tamponade, and patients maintained face-down positioning postoperatively. The primary outcomes assessed were anatomical closure of MH at 90 days confirmed with optical coherence tomography and changes in best-corrected visual acuity (BCVA).
Results:
Anatomical closure of MH was achieved in 98% of eyes at 90 days postoperatively. Success rates were inversely correlated with MH diameter: 100% for small (< 400 μm; n = 122), 98% for medium (400-800 μm; n = 102), and 91.3% for large (> 800 μm; n = 23) holes. The median improvement in BCVA was 0.3 logMAR. Significant improvement in BCVA was observed at three months (p = 0.025) and six months (p = 0.019) postoperatively. Final BCVA improved in 87% of eyes (n = 215), remained stable in 11% (n = 27), and worsened in 2% (n = 5). No cases of ILM flap displacement were noted.
Conclusion:
The VILM flap technique during PPV is highly effective for treating MH, demonstrating high anatomical closure rates and significant visual improvement. This method enhances the likelihood of successful outcomes after initial surgery.
Insights
The viscoelastic-assisted inverted internal limiting membrane (VILM) flap technique shows high success in closing macular holes (MH) after pars plana vitrectomy (PPV). This method significantly improves visual acuity in most patients, offering a promising surgical option.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Surgical Techniques
Background:
- Macular holes (MH) are a significant cause of vision loss.
- Pars plana vitrectomy (PPV) is a standard surgical approach for MH repair.
- Novel techniques are explored to improve MH closure rates and visual outcomes.
Purpose of the Study:
- To evaluate the surgical outcomes of a novel technique for full-thickness macular hole repair.
- To assess the efficacy of the viscoelastic-assisted inverted internal limiting membrane (VILM) flap technique.
- To determine the impact of the VILM flap technique on anatomical closure and visual acuity.
Main Methods:
- Retrospective review of 247 eyes undergoing PPV with the VILM flap technique.
- Internal limiting membrane (ILM) staining with indocyanine green and inverted placement.
- Use of a dispersive viscosurgical device to secure the ILM flap.
- Postoperative assessment of macular hole closure via optical coherence tomography and best-corrected visual acuity (BCVA).
Main Results:
- Anatomical closure of MH achieved in 98% of eyes at 90 days.
- Success rates were highest for small MH (100%) and decreased with increasing MH size.
- Median BCVA improvement was 0.3 logMAR, with 87% of eyes experiencing improved vision.
- No ILM flap displacement was observed.
Conclusions:
- The VILM flap technique is highly effective for treating full-thickness macular holes.
- This technique demonstrates high anatomical closure rates and significant visual acuity improvement.
- The VILM flap method enhances the likelihood of successful outcomes in MH surgery.
