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Modified inverted internal limiting membrane flap technique for lamellar macular hole
Khusbu Keyal1, Li Bing1, Liu Chunyu1
1Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
Background:
Lamellar macular hole (LMH) is a partial-thickness macular defect thought to be caused by vitreofoveal traction, anteroposterior and tangential forces exerting traction on the fovea.
Methods:
This is a retrospective study involving 19 eyes. 25-gauge pars plana vitrectomy (PPV), fovea sparing internal limiting membrane (ILM) peeling combined with modified inverted ILM flap under air for treatment of LMH was used.
Results:
The study comprised 14 females and 5 males, involving 13 right and 6 left eyes, with a mean age of 69.52 ± 8.13 years. Symptom duration averaged 498.94 ± 646.96 days. The preoperative residual foveal thickness, which initially averaged 62.26 ± 46.21 μm, increased to a post-operative central foveal thickness of 85.05 ± 48.11 μm after 6 months. Foveal configuration was improved in 15 of 19 eyes (78.94%), one patient had persistent macular edema, and 3 eyes had irregular foveal contour. Among 19 eyes examined, 13 eyes (68.42%) showed intact external limiting membrane (ELM) and ellipsoid zone (EZ) lines both before and after the surgery, resulting in a smooth restoration of the foveal contour. Conversely, in 6 eyes (31.57%) assessed before the operation, the ELM and EZ lines were disrupted. Of these, 3 eyes (15.78%) exhibited improvement, while in the remaining 3 eyes (15.78%), the ELM and EZ lines remained disrupted even after 6 months of follow-up. The mean pre-operative best corrected visual acuity (BCVA) in LogMAR was 0.66 ± 0.43 and the mean post-operative BCVA in LogMAR at 1 months was 0.55 ± 0.24, at 3 months was 0.53 ± 0.25 and at 6 months was 0.51 ± 0.24, indicating an overall improvement in BCVA compared to pre-operative levels. Mean BCVA improved from 0.66 ± 0.43 logMAR pre-operative to 0.51 ± 0.24 logMAR at 6 months post-operatively (p = 0.058). There were no instances of full thickness macular hole and no foveal detachment.
Conclusion:
PPV with fovea sparing ILM peeling combined with modified inverted ILM flap under air results in good morphological and functional outcomes.
Trial Registration:
The study project registration number (Tongji Hospital affiliated with Tongji University School of Medicine (Number: K-W-2024-001)).
