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Published on: January 11, 2016
Ten-Year Follow-Up after Vitrectomy with the Inverted Internal Limiting Membrane Flap Technique for Full-Thickness
Zofia Anna Nawrocka1, Jerzy Nawrocki1
1Ophthalmic Clinic "Jasne Blonia", Lodz, Poland.
Purpose:
To evaluate the 10-year anatomical and functional outcomes after vitrectomy with the inverted internal limiting membrane (ILM) flap technique for full-thickness macular hole (FTMH) and assess the incidence of long-term postoperative complications.
Design:
Retrospective consecutive case series.
Subjects:
From 295 patients (323 eyes), who had pars plana vitrectomy with inverted ILM flap technique for idiopathic FTMH in our clinic in the years 2007-2014, 89 patients (99 eyes) completed a 10-year follow-up.
Methods:
Medical records were reviewed retrospectively. Patients who had pars plana vitrectomy with the inverted ILM flap technique for idiopathic FTMH in the years 2007-2014 were invited for a 10-year follow-up. Preoperative and postoperative parameters were analyzed, including age, sex (male/female), visual acuity, initial hole size, swept-source OCT parameters, surgical technique, and postoperative complications.
Main Outcome Measures:
Primary outcomes were long-term anatomical closure at 10 years and best-corrected visual acuity (BCVA). Secondary outcomes included OCT-based macular morphology (ellipsoid zone [EZ], interdigitation zone [IZ], and foveal contour) and complication rates (e.g., epiretinal membrane [ERM], gliosis, or secondary glaucoma).
Results:
The initial closure rate in 323 eyes was 93.5%; final closure rate after reoperation was 100%. Notably, 20/40 vision was achieved in 44.5% of eyes 1 year after surgery and in 70.7% of eyes followed until the 10th year. The number of eyes with >20/25 vision improved from 12% to 42.4% during that time. Patients achieving final BCVA better than 20/25 had a continuous IZ and EZ line before surgery (P = 0.03), and a continuous IZ and EZ line 1 year after surgery (P = 0.01). Foveal contour improved over time. No FTMH reopenings were observed. Epiretinal gliosis developed in 7% of cases, associated with larger baseline hole size and preoperative ERM, but did not significantly impact final visual acuity. Retinal detachment incidence was 0.85% per patient/year.
Conclusions:
The inverted ILM flap technique provides sustained anatomical and functional success in idiopathic FTMH over a 10-year period. Continued improvement in BCVA beyond the first year and low complication rates support the use of this technique as an effective and durable surgical approach.
Financial Disclosure(S):
The authors have no proprietary or commercial interest in any materials discussed in this article.
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