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Inverted internal limiting membrane flap technique versus internal limiting membrane removal in large macular hole
Xiang-Yue Zheng1,2, De-Jin Cheng3, Xiao-Yi Yu4
1Guangzhou University of Chinese Medicine, Guangzhou, China.
Purpose:
To compare the anatomical and functional outcomes of the inverted internal limiting membrane (ILM) flap technique and the complete ILM removal in the treatment of large macular hole (MH) > 400 μm with or without Hole-door structures.
Methods:
This retrospective study analyzed 56 patients with MH > 400 μm. Based on hole edge morphology evaluated by archived intraoperative optical coherence tomography (iOCT) images, patients were divided into the Hole-door group (Group 1) and the Negative group (Group 2). Within each group, patients were further classified into two subgroups based on the surgical technique performed: complete ILM removal (Group 1-a, 2-a) and visco-assisted ILM flap (Group 1-b, 2-b). External limiting membrane (ELM) and ellipsoid zone (EZ) restoration and best-corrected visual acuity (BCVA) were assessed at 3 and 6 months post-surgery.
Results:
Correlation analysis found no significant link between preoperative MHD and postoperative outcomes. The Hole-door group showed better vision, ELM, and EZ recovery than the Negative group, regardless of ILM removal or visco-assisted ILM flap (P < 0.05). In evaluating the prognoses between both techniques for macular holes with or without Hole-door structures, at 6 months, BCVA and ELM/EZ restoration were similar in Groups 1-a and 1-b (P > 0.05), but at 3 months, Group 1-b showed better results (P < 0.05). In the negative subgroups, Group 2-b outperformed Group 2-a in BCVA and ELM and EZ restoration at 6 months (P < 0.05) and in BCVA and ELM restoration at 3 months, though not in EZ restoration (P<0.05) Furthermore, functional and anatomical outcomes at 3 months showed significant correlation with the 6-month results, despite the ongoing microstructural improvements identified between these two time points.
Conclusion:
Large macular holes with Hole-door structures have a better prognosis than those without. In these cases, BCVA and retinal microstructure restoration are similar between ILM removal and ILM flap surgery, but the ILM flap accelerates recovery.
