Inverted ILM flap technique for the treatment of chronic and large Idiopathic MH with the use as a vital dye suspension `Vitreocontrast`

Session Details

Session Title: Quick Fire Free Paper Session

Session Date/Time: Saturday 17/02/2018 | 11:45-13:00

Paper Time: 12:55

Venue: Ballroom II & III.

First Author: : M.Veselkova RUSSIAN FEDERATION

Co Author(s): :    V. Zakharov   N. Kislitsina   S. Novikov   S. Kolesnik   A. Kolesnik                 

Abstract Details

Purpose:

Recently, inverted internal limiting membrane (ILM) flap technique has been reported to increase the anatomical closure rates of large and chronic macular holes(MH). But the technique is limited by difficulty in visualizing the flap using traditional vital dyes, its possible cytotoxic effects and relative mobility of the flap, complicating maintaining the inverted ILM flap inside the hole during fluid-air exchange with high rate of accidental ILM loss. The present study is to evaluate efficacy of Inverted ILM Flap Technique for the Treatment of chronic and large Idiopathic MH with the use as a vital dye suspension "Vitreocontrast".

Setting:

S.Fyodorov “Eye Microsurgery Complex” - Federal State Institution of Rosmedtechnology, Moscow, Russian Federation

Methods:

Patients with chronic (>12 month) idiopathic MHs larger than 500 microns were included. To aid in visualization of semi-transparent vitreous fibers and ILM we used originally developed non-toxic"Vitreocontrast" ultra dispense suspension (non-organic barium sulfate in isotonic solution, a particle size of less than 5 microns and a density of 4.4 g / cm3), poorly soluble in water with high mechanical adhesion properties to VB fibers, epiretinal membranes and ILM. 30 eyes of 30 patients underwent standard 3-port pars plana vitrectomy, surgically induced posterior vitreous detachment and ILM staining with "Vitreocontrast"suspension. During circular ILM peeling, the remnant of ILM was left attached to the margins of the macular hole and after trimming its edges, the ILM was folded inside the macular hole in an inverted manner and fluid gas exchange was performed. Preoperative and postoperative visual acuity (at 1 week, 1,3,6 and 12 month) and spectral domain optical coherence tomography images were evaluated. The main outcome measure was visual outcome and macular hole closure rate.

Results:

In all cases, a bright white staining of ILM was observed, this color did not lose brightness with time, no abscission of the dye was observed. Due to the adhesion of the suspension particles to the surface, the ILM became relatively heavier, did not float away into the vitreous cavity, thus facilitating the surgery execution. The flap remained in the position given by the surgeon, its fragments did not shift. Also, due to the adhesive properties of the suspension, the flap petals stuck together, holding retained inside macular hole even during fluid gas exchange in all cases. Mean visual acuity increased in all cases, all patients reported a decrease in metamorphosia. We confirmed the closure of the macular hole with spectral domain optical coherence tomography in all cases. The closure of the macular hole began in the inner retinal layers, and the architecture gradually filled with tissue. At the observation period 1 year the result remained stable.

Conclusions:

We present ILM flap technique with the use as a vital dye non-toxic ultra dispense suspension "Vitreocontrast" to improve the visualization, retention of the ILM flap within the macular hole without the need for additional administration of viscoelastics and Perfluoro-n-octane, thus improving the reliability and reproducibility of the operation.

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