Efficacy of modified Inverted internal limiting membrane flap technique for the treatment of chronic and large idiopathic macular hole, presenting to a tertiary eye care centre in north-east India

Session Details

Session Title: Free Paper Session 20: Vitreoretinal Surgery V

Session Date/Time: Sunday 10/09/2017 | 08:00-09:30

Paper Time: 08:48

Venue: Room 117

First Author: : R.Soibam INDIA

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

Abstract Details

Purpose:

Chronic and large macular holes have the poorest surgical outcomes with closure rates of 40% to 83%. Inverted internal limiting membrane (ILM) flap technique was reported to increase the anatomical closure rates of large macular holes but the technique is limited by difficulty in maintaining the inverted ILM flap inside the hole during fluid-air exchange and with high rate of accidental ILM detachment during the procedure. The present study is to evaluate efficacy of modified Inverted Internal Limiting Membrane Flap Technique for the Treatment of chronic and large Idiopathic Macular Hole, presenting to a tertiary eye care centre in North-East India.

Setting:

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

Methods:

Patients with chronic (>12 month) idiopathic macular holes larger than 700 microns were included. 11 eyes of 11 patients underwent standard 3-port pars plana vitrectomy with modifications of inverted internal limiting membrane flap technique that improve retention of the ILM flap on the macular surface. in this technique after folding ILM flap inside the macular hole, Approximately 0.2 mL of viscoelastic is injected over the ILM flap, forming a “viscoelastic cap”, that help in retention of flap inside macular hole during fluid gas exchange. 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:

Mean visual acuity improved from 1.2 logMAR to 0.56 logMAR. 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.

Conclusions:

We present a modified ILM flap technique to improve retention of the ILM flap within the macular hole and improve the reliability and reproducibility of the operation. Procedure suitable for redo cases where there is no ILM bordering the macular hole.

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