Efficacy of standard vs inverted internal limiting membrane flap technique for the treatment of large idiopathic macular hole more than 700, presenting to a tertiary eye care centre in north-east India

Session Details

Session Title: Free Paper Session 8: Vitreoretinal Surgery III

Session Date/Time: Friday 08/09/2017 | 08:00-09:30

Paper Time: 09:00

Venue: Room 111

First Author: : R.Soibam INDIA

Co Author(s): :    H. Bhattacharjee   M. Barman   P. Bawankar   S. Dhar   S. Hawaibam                 

Abstract Details

Purpose:

Large macular holes (MH) usually have higher surgical failure rate. Up to 44% of large macular holes remain open after one surgery and also associate with increased risk of flat-open appearance. Flat open macular holes are associated with limited visual acuity. Present study is to evaluate efficacy of standard vs inverted internal limiting membrane flap technique for the treatment of large idiopathic macular hole (>700µ), presenting to a tertiary eye care centre.

Setting:

A retrospective, comparative and interventional study in a tertiary eye care centre of North-East India.

Methods:

Patients with idiopathic macular holes larger than 700 microns were included. In group 1, 15 eyes of 15 patients underwent standard 3-port pars plans vitrectomy with air. In group 2, 15 eyes of 15 patients underwent a modification of the standard technique, called the inverted internal limiting membrane (ILM) flap technique. We compared changes in best-corrected visual acuity (BCVA) before and after surgery and closure rates of MH between both groups.

Results:

Preoperative mean visual acuity was 1.059±0.22logMAR in group 1 and 1.055±0.29logMAR in group 2. Macular hole closure was observed in 53% of patients in group 1 and in 93% of patients in group 2. A flat-hole roof with bare retinal pigment epithelium (flat-open) was observed in 27% of patients in group 1 and 7% of patients in group 2. Mean postoperative visual acuity 12 months after surgery was 1.02±0.26 logMAR in group 1 and 0.83±0.30 logMAR in group 2.

Conclusions:

The inverted ILM flap technique improves both the functional and anatomic outcomes of vitrectomy for macular holes with a diameter greater than 700 microns. Spectral optical coherence tomography after vitrectomy with the inverted ILM flap technique suggests improved foveal anatomy compared with the standard surgery.

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