PROGNOSTIC FACTORS FOR DEVELOPMENT OF GLIOSIS AFTER INTERNAL LIMITED MEMBRANE FLAP FOR IDIOPATHIC MACULAR HOLES

Area of Science:

• Ophthalmology
• Retinal Surgery
• Macular Diseases

Background:

• Idiopathic macular hole (IMH) surgery aims for anatomical and functional success.
• Gliosis, a glial scar, can develop post-macular hole surgery and impact outcomes.
• Internal limiting membrane (ILM) flap techniques are employed to improve macular hole closure.

Purpose of the Study:

• To identify prognostic factors for gliosis development after IMH surgery.
• To assess the relationship between gliosis and surgical success (functional and anatomical).

Main Methods:

• Retrospective analysis of patients undergoing pars plana vitrectomy (PPV) with ILM flap for IMH.
• Optical coherence tomography (OCT) used for pre- and post-operative assessment (1 and 6 months).
• Evaluation of hole closure, outer retinal layer continuity, and gliosis development.

Main Results:

• Gliosis was observed in 12.3% of eyes at 1 and 6 months post-surgery.
• Eyes with gliosis had larger initial hole diameters and worse presenting visual acuity.
• While gliosis correlated with poorer visual acuity at 1 month, this difference diminished by 6 months.

Conclusions:

• The inverted ILM flap technique is supported for primary IMH repair.
• No gliosis was noted in small macular holes treated with this technique.
• Surgical intervention can lead to visual acuity improvement even in large IMH with resultant gliosis.