First Author: J.Chhablani INDIA
Co Author(s): S.R. Singh A. Dogra
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Conventional internal limiting membrane (ILM) peeling has a high closure rate of more than 90%. However, some special situations like recurrent, large, traumatic and chronic macular holes merit special attention in which anatomical success has been low. Over the past decade, a number of modifications have been introduced which have brought a paradigm shift in the hole closure rates along with good functional outcome. This video intends to highlight these innovative techniques along with the surgical outcomes.
Tertiary care centre
Inverted ILM flap technique involves placing small remnant of peeled ILM, which was left attached to hole margins on the macular hole upside down. Similarly, a free flap with similar dimension to macular hole is recovered from the margin of previously peeled ILM in ILM free flap technique. Autologous neurosensory retinal free flap involves lifting a full thickness flap from nearby location and placing it over the hole. Lens capsular flap transplantation uses an alternative of using anterior or posterior lens capsule at the base of the hole.
These newer modalities were employed for large or refractory macular holes. A favorable anatomical outcome was observed in all of the cases followed by a modest improvement in visual acuity.
The above described techniques are found suitable in these special situations where conventional ILM peeling procedure have traditionally been found to give unsatisfactory results either in the form of non closure or type 2 closure (flat open). However, long term functional outcomes and effects of structural remodelling are yet to be analyzed.