First Author: N.Sanduja INDIA
Co Author(s): A. Seth A. Aurora S. Luthra
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Large macular holes usually have an increased risk of surgical failure with conventional macular hole surgery. Inverted ILM flap technique has been described for large holes with good surgical outcome. However, the technique involves risk of RPE damage and has a learning curve. We describe a new technique of ILM peeling, where a rim of ILM is left around the hole but is not inverted over the hole.
Prospective interventional study conducted at Delhi Retina Centre, India
In this prospective, interventional case series 10 eyes with macular holes larger than 400 μm were included. All patients underwent 23 gauge pars plana vitrectomy with posterior vitreous detachment and ILM peeling with C3F8 gas injection and postoperative prone positioning. During ILM peeling, instead of completely removing the ILM after trypan blue staining, a remnant attached to the margins of the macular hole was left in place. However, it was not inverted over the macular hole. Fluid-air exchange was then performed. The patients were followed up with respect to visual acuity (BCVA) and SDOCT pictures for 3 months.
The mean age of patients was 62.6±9.9 years. 60% patients were males while 40% were females. Mean duration of history of decrease in vision was 6.8±4.4 months (Range 3-15 months).Mean baseline BCVA was 0.084±0.04 that improved to 0.28±0.19 at 3 month (p=0.002). The mean minimum linear diameter (MLD) was 623.9±139µm (Range 418-855 µ). The mean macular hole index (MHI) was 0.39 (Range 0.25-0.55). Macular hole closure was observed in 90% of patients in (9 of 10 eyes) at 3 months. Out of these 9 eyes, flat-hole roof with bare retinal pigment epithelium (flat-open) was observed in 2 eyes (20%) of patients. None of the eyes showed a decrease in vision.
This technique of leaving a rim of ILM at the edges of macular hole is effective, prevents inadvertent damage to the parafoveal neurosensory retina and subfoveal RPE, and preserves xanthophyll pigment as well. However, larger studies with more number of subjects and with a control group are required to evaluate its efficacy.