Foveal-Sparing ILM Peeling with ILM Flap Transposition over the Macular Hole for Repair of Full-Thickness Macular Holes

Abstract

Background Full-thickness macular holes, defined as full-thickness defects of the fovea, lead to central scotoma and deterioration of vision. Apart from peeling of the internal limiting membrane (ILM), ILM flap techniques have been reported to have potential in improving results in macular hole surgery. In addition, foveal-sparing ILM peeling gives a high macular hole closure rate and improvement in postoperative visual acuity. The aim of this study was to examine outcomes in a cohort of patients with full-thickness macular holes that underwent vitrectomy with foveal-sparing ILM peeling and transposition of an ILM flap over the macular hole.

Methods This retrospective study included patients scheduled for pars plana vitrectomy with foveal-sparing ILM peeling, combined with ILM flap transposition over the macular hole, for macular hole repair. All patients received a gas tamponade with 20% sulphur hexafluoride and were encouraged to undergo postoperative face-down positioning for 48 hours after surgery. Optical coherence tomography (OCT) imaging of the macula and distance-corrected visual acuity (DCVA) were performed before and 3 months after surgery.

Results In total, 42 eyes of 42 patients were included in this study. Leaving a broad area of residual ILM at the foveal rim led to a high risk of failure in macular hole closure, while leaving a narrow zone of residual ILM at the foveal rim resulted in high macular hole closure rates (97% type 1 closure and 3% type 2 closure), with a median improvement of DCVA of 4 lines [interquartile range (IQR): 3 to 6] among pseudophakic and 3.5 lines (IQR: 2 to 5) among phakic patients.

Conclusions A combination of foveal-sparing ILM peeling with ILM flap techniques was shown to be a safe and effective surgical option for patients with full-thickness macular holes, resulting in a high macular hole closure rate and improvement in visual acuity in the majority of patients.

Zusammenfassung

Hintergrund Makulaforamina werden definiert als alle retinalen Schichten betreffende Defekte der Fovea, und führen zu zentralen Skotomen und Visusverschlechterung. Abgesehen vom Peeling der “internal limiting membrane” (ILM) und “ILM flap” Techniken, die Potenzial zur Verbesserung der Resultate in der Chirurgie von Makulaforamina haben, zeigte das foveaaussparende Peeling der ILM eine hohe Verschlussrate von Makulaforamina und Verbesserung des Visus. Das Ziel dieser Studie war es, die Resultate in eine Patientenkohorte nach Vitrektomie mit foveaaussparendem ILM-Peeling mit Transposition eines ILM-Lappens über das Makulaforamen zu untersuchen.

Patienten/Material und Methoden Diese retrospektive Studie inkludierte Patient*innen, die zur Pars Plana Vitrektomie mit foveaaussparendem ILM-Peeling mit ILM-flap-Transposition über das Makulaforamen geplant waren. Alle Patient*innen erhielten eine Gastamponade mit Sulfur Hexafluorid 20% und wurden zur postoperativen “face down” Positionierung motiviert. Aufnahmen mit der optischen Kohärenztomographie (OCT) und Testung des bestkorrigierten Fernvisus (DCVA) erfolgten vor und 3 Monate nach der Operation.

Ergebnisse Es konnten 42 Augen von 42 Patient*innen in diese Studie inkludiert werden. Das Belassen einer breiten residualen ILM-Zone um das Makulaforamen führte zu einem hohen Risiko eines Versagens in Bezug auf den Makulaforamenverschluß, während beim Belassen einer schmalen ILM-Zone um das Makulaforamen eine hohe Verschlußrate der Makulaforamina erfolgte (97% Typ 1 und 3% Typ 2 Verschluß). Die mediane Verbesserung des DCVA betrug 4 Zeilen (Interquartilrange (IQR): 3 bis 6) bei pseudophaken Patient*innen und 3.5 Zeilen (IQR: 2 bis 5) bei phaken Patient*innen.

Schlussfolgerung Die Kombination eines foveaaussparenden ILM-Peelings mit ILM-flap Techniken erwies sich als sichere und effektive chirurgische Option für Patient*innen mit Makulaforamina und resultierte in einer hohen Makulaforamenverschlussrate und einer Verbesserung des Visus bei einer Mehrzahl der Patient*innen.

Conclusion Box

Already known:

Foveal-sparing ILM peeling has resulted in a high macular hole closure rate and better postoperative visual acuity among patients with full-thickness macular holes compared to patients that underwent standard ILM peeling [9], [10].

Newly described:

The combination of foveal-sparing ILM peeling with a narrow residual ILM zone combined with ILM flap techniques has been shown to be a safe and effective surgical option for patients with full-thickness macular holes, resulting in a high macular hole closure rate with a low rate of occurrence of postsurgical central atrophy of the EZ, and improvement of visual acuity in the majority of patients.

Key words

foveal-sparing ILM peeling - ILM flap transposition - full-thickness macular hole

Schlüsselwörter

foveaaussparendes ILM-Peeling - ILM-Flap-Transposition - Makulaforamen

Publication History

Received: 13 September 2023

Accepted: 16 November 2023

Article published online:
19 January 2024

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