Inverted internal limiting membrane versus internal limiting membrane peeling for macular hole retinal detachment in high myopia_Chinese Journal of Ocular Fundus Diseases

Authors：

Hou Yanan , Liu Lei , Wang Gang , Liu Yong ,  Wang Yi

Chongqing Aier Eye Hospital, Aier School of Ophthalmology, Central South University, Chongqing 400038, China;

Corresponding author：

Wang Yi, Email: wangyieye@aliyun.com

Keywords：

High myopia; Retinal perforations; Retinal detachment; Internal limiting membrane peeling; Inverted internal limiting membrane

DOI：

10.3760/cma.j.cn511434-20201023-00502

Video：

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Objective To compare the efficacy of pars plana vitrectomy (PPV) combined inverted internal limiting membrane (ILM) with PPV combined ILM peeling for macular hole retinal detachment (MHRD) in high myopia.Methods A retrospective clinical study. From October 2012 to January 2019, 78 patients (78 eyes) with high myopia macular hole retinal detachment diagnosed from Chongqing Aier Eye Hospital and Hefei Aier Eye Hospital were included in the study. Among them, there were 11 males (11 eyes) and 67 females (67 eyes) with the average age of 55.6±9.6 years. All patients underwent BCVA, diopter, OCT examination and axial length (AL) measurement. The standard logarithmic visual acuity chart was used for BCVA examination, and the visual acuity was converted to logMAR when recorded. Patients were divided into PPV combined with ILM peeling group (ILM peeling group) and PPV combined with ILM inverted group (ILM inverted group) according to the surgical method, with 51 patients (51 eyes) and 27 patients (27 eyes), respectively. The average age (t=－1.170), diopter (t=0.504), AL (t=0.474), logMAR BCVA (t=0.935), and hole diameter (t=－0.334) of the two groups were compared, and there was no statistically significant difference (P＞0.05). Two independent sample t test was used to compare the exposed distance of BCVA and RPE before and after the operation of the two groups of eyes. The χ² test was used to compare the rates between the two groups.Results At the last follow-up, the logMAR BCVA of the eyes in the ILM inverted group and ILM peeling group were 0.87±0.27 and 1.45±0.39, respectively. Compared with pre-operation, the BCVA of the two groups of eyes were significantly improved, and the difference was statistically significant (t=8.790, 4.640, P＜0.001,＜0.001). The logMAR BCVA of the two groups of eyes was compared with statistical significance (t=6.830, P＜0.001). The exposed RPE distances of the eyes in the ILM inverted group and the inner limiting membrane peeling group were 31.81±23.52 and 681.80±466.61 μm, respectively. the difference in the RPE exposure distance between the two groups was statistically significant (t=7.180, P＜0.001). The holes in the 27 eyes in the ILM inverted group were healed (100%, 27/27); no retinal detachment occurred. Among the 51 eyes in the ILM peeling group, the hole healed in 45 eyes (88.2%, 45/51), and the retina was detached in 6 eyes (11.8%, 6/51). There was a statistically significant difference in the incidence of retinal detachment between the two groups of patients (χ²=45.440, P=0.000).Conclusion Compared to ILM peeling, inverted ILM has provided better RPE protection and reduce the rate of retinal redetachment in patients with MHRD.

Citation： Hou Yanan, Liu Lei, Wang Gang, Liu Yong, Wang Yi. Inverted internal limiting membrane versus internal limiting membrane peeling for macular hole retinal detachment in high myopia. Chinese Journal of Ocular Fundus Diseases, 2020, 36(12): 943-947. doi: 10.3760/cma.j.cn511434-20201023-00502 Copy

1.	Faghihi H, Hajizadeh F, Riazi-Esfahani M. Optical coherence tomographic findings in highly myopic eyes[J]. J Ophthalmic Vis Res, 2010, 5(2): 110-121.
2.	Matsumura N, Ikuno Y, Tano Y. Posterior vitreous detachment and macular hole formation in myopic foveoschisis[J]. Am J Ophthalmol, 2004, 138(6): 1071-1073. DOI: 10.1016/j.ajo.2004.06.064.
3.	Haritoglou C, Reiniger IW, Schaumberger M, et al. Five-year follow-up of macular hole surgery with peeling of the internal limiting membrane: update of a prospective study[J]. Retina, 2006, 26: 618-622. DOI: 10.1097/01.iae.0000236474.63819.3a.
4.	Oie Y, Emi K, Takaoka G, et al. Effect of indocyanine green staining in peeling of internal limiting membrane for retinal detachment resulting from macular hole in myopic eyes[J]. Ophthalmology, 2007, 114(2): 303-306. DOI: 10.1016/j.ophtha.2006.07.052.
5.	Ota H, Kunikata H, Aizawa N. Surgical results of internal limiting membrane flap inversion and internal limiting membrane peeling for macular hole[J/OL]. PLoS One, 2018, 13(9): e0203789[2018-09-13]. https://pubmed.ncbi.nlm.nih.gov/30212576/. DOI: 10.1371/journal.pone.0203789.
6.	Yao Y, Qu J, Zhao M, et al. The impact of extent of internal limiting membrane peeling on anatomical outcomes of macular hole surgery: results of a 54-week randomized clinical trial[J]. Acta Ophthalmol, 2019, 97(3): 303-312. DOI: 10.1111/aos.13853.
7.	Tornambe PE, Poliner LS, Cohen RG. Definition of macular hole surgery end points: elevated/open, ﬂat/open, ﬂat/closed[J]. Retina, 1998, 18(3): 286-287. DOI: 10.1097/00006982-199803000-00021.
8.	Kwok AK, Lai TY, Yip WW. Correlation of clinical and optical coherence tomography findings in postoperative macular hole closure status[J]. Ophthalmic Surg Lasers Imaging, 2003, 34(1): 25-32. DOI: 10.3928/1542-8877-20030101-07.
9.	Michalewska Z, Michalewski J, Adelman RA, et al. Inverted internal limiting membrane flap technique for large macular holes[J]. Ophthalmology, 2010, 117(10): 2018-2025. DOI: 10.1016/j.ophtha.2010.02.011.
10.	Wakabayashi T, Ikuno Y, Shiraki N, et al. Inverted internal limiting membrane insertion versus standard internal limiting membrane peeling for macular hole retinal detachment in high myopia: one-year study[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(8): 1387-1393. DOI: 10.1007/s00417-018-4046-1.
11.	Ho TC, Ho A, Chen MS. Vitrectomy with a modified temporal inverted limiting membrane flap to reconstruct the foveolar architecture for macular hole retinal detachment in highly myopic eyes[J]. Acta Ophthalmol, 2018, 96(1): 46-53. DOI: 10.1111/aos.13514.
12.	Mete M, Alfano A, Guerriero M, et al. Inverted internal limiting membrane flap technique versus complete internal limiting membrane removal in myopic macular hole surgery: a comparative study[J]. Retina, 2017, 37(10): 1923-1930. DOI: 10.1097/IAE.0000000000001446.
13.	Takahashi H, Inoue M, Koto T, et al. Inverted internal limiting membrane flap technique for treatment of macular hole retinal detachment in highly myopic eyes[J]. Retina, 2018, 38(12): 2317-2326. DOI: 10.1097/IAE.0000000000001898.
14.	Xu Q, Luan J. Vitrectomy with inverted internal limiting membrane flap versus internal limiting membrane peeling for macular hole retinal detachment in high myopia: a systematic review of literature and meta-analysis[J]. Eye (Lond), 2019, 33(10): 1626-1634. DOI: 10.1038/s41433-019-0458-3.
15.	Baba R, Wakabayashi Y, Umazume K, et al. Efficacy of the inverted internal limiting membrane flap technique with vitrectomy for retinal detachment associated with myopic macular holes[J]. Retina, 2017, 37: 466-471. DOI: 10.1097/IAE.0000000000001211.
16.	Tian T, Chen C, Peng J, et al. Novel surgical technique of peeled internal limiting membrane reposition for idiopathic macular holes[J]. Retina, 2019, 39(1): 218-222. DOI: 10.1097/IAE.0000000000001745.
17.	Hu Z, Ye X, Lv X, et al. Non-inverted pedicle internal limiting membrane transposition for large macular holes[J]. Eye (Lond), 2018, 32(9): 1512-1518. DOI: 10.1038/s41433-018-0107-2.
18.	Mete M, Alfano A, Maggio E, et al. Inverted ILM flap for the treatment of myopic macular holes: healing processes and morphological changes in comparison with complete ILM removal[J/OL]. J Ophthalmol, 2019,2019:1314989[2019-06-02]. https://pubmed.ncbi.nlm.nih.gov/31275628/. DOI: 10.1155/2019/1314989.
19.	Iwasaki M, Kinoshita T, Miyamoto H. Influence of inverted internal limiting membrane flap technique on the outer retinal layer structures after a large macular hole surgery[J]. Retina, 2019, 39(8): 1470-1477. DOI: 10.1097/IAE.0000000000002209.
20.	Kim K, Kim ES, Kim Y, et al. Correlation between preoperative en face optical coherence tomography of photoreceptor layer and visual prognosis after macular hole surgery[J]. Retina, 2018, 38(6): 1220-1230. DOI: 10.1097/IAE.0000000000001679.
21.	Neelam K, O'Gorman N, Nolan J. Macular pigment levels following successful macular hole surgery[J]. Br J Ophthalmol, 2005, 89(9): 1105-1108. DOI: 10.1136/bjo.2004.063834. .
22.	Chung H, Shin CJ, Kim JG, et al. Correlation of microperimetry with fundus autofluorescence and spectral-domain optical coherence tomography in repaired macular holes[J]. Am J Ophthalmol, 2011, 151(1): 128-136. DOI: 10.1016/j.ajo.2010.06.040.
23.	Schutt F, Davies S, Kopitz J, et al. Photodamage to human RPE cells by A2-E, a retinoid component of lipofuscin[J]. Invest Ophthalmol Vis Sci, 2000, 41(8): 2303-2308.
24.	Hammer M, Richter S, Guehrs KH, et al. Retinal pigment epithelium cell damage by A2-E and its photo-derivatives[J]. Mol Vis, 2006, 12: 1348-1354.
25.	Itoh Y, Inoue M, Rii T, et al. Correlation between length of foveal cone outer segment tips line defect and visual acuity after macular hole closure[J]. Ophthalmology, 2012, 119(7): 1438-1446. DOI: 10.1016/j.ophtha.2012.01.023.
26.	de Sisternes L, Hu J, Rubin DL, et al. Visual prognosis of eyes recovering from macular hole surgery through automated quantitative analysis of spectral-domain optical coherence tomography (SD-OCT) scans[J]. Invest Ophthalmol Vis Sci, 2015, 56(8): 4631-4643. DOI: 10.1167/iovs.14-16344.
27.	Boldt HC, Munden PM, Folk JC, e al. Visual field defects after macular hole surgery[J]. Am J Ophthalmol, 1996, 122(3): 371-381. DOI: 10.1016/s0002-9394(14)72064-1.
28.	Tarita-Nistor L, González EG, Mandelcorn MS, et al. Fixation stability, fixation location, and visual acuity after successful macular hole surgery[J]. Invest Ophthalmol Vis Sci, 2009, 50(1): 84-89. DOI: 10.1167/iovs.08-2342.

1. Faghihi H, Hajizadeh F, Riazi-Esfahani M. Optical coherence tomographic findings in highly myopic eyes[J]. J Ophthalmic Vis Res, 2010, 5(2): 110-121.
2. Matsumura N, Ikuno Y, Tano Y. Posterior vitreous detachment and macular hole formation in myopic foveoschisis[J]. Am J Ophthalmol, 2004, 138(6): 1071-1073. DOI: 10.1016/j.ajo.2004.06.064.
3. Haritoglou C, Reiniger IW, Schaumberger M, et al. Five-year follow-up of macular hole surgery with peeling of the internal limiting membrane: update of a prospective study[J]. Retina, 2006, 26: 618-622. DOI: 10.1097/01.iae.0000236474.63819.3a.
4. Oie Y, Emi K, Takaoka G, et al. Effect of indocyanine green staining in peeling of internal limiting membrane for retinal detachment resulting from macular hole in myopic eyes[J]. Ophthalmology, 2007, 114(2): 303-306. DOI: 10.1016/j.ophtha.2006.07.052.
5. Ota H, Kunikata H, Aizawa N. Surgical results of internal limiting membrane flap inversion and internal limiting membrane peeling for macular hole[J/OL]. PLoS One, 2018, 13(9): e0203789[2018-09-13]. https://pubmed.ncbi.nlm.nih.gov/30212576/. DOI: 10.1371/journal.pone.0203789.
6. Yao Y, Qu J, Zhao M, et al. The impact of extent of internal limiting membrane peeling on anatomical outcomes of macular hole surgery: results of a 54-week randomized clinical trial[J]. Acta Ophthalmol, 2019, 97(3): 303-312. DOI: 10.1111/aos.13853.
7. Tornambe PE, Poliner LS, Cohen RG. Definition of macular hole surgery end points: elevated/open, ﬂat/open, ﬂat/closed[J]. Retina, 1998, 18(3): 286-287. DOI: 10.1097/00006982-199803000-00021.
8. Kwok AK, Lai TY, Yip WW. Correlation of clinical and optical coherence tomography findings in postoperative macular hole closure status[J]. Ophthalmic Surg Lasers Imaging, 2003, 34(1): 25-32. DOI: 10.3928/1542-8877-20030101-07.
9. Michalewska Z, Michalewski J, Adelman RA, et al. Inverted internal limiting membrane flap technique for large macular holes[J]. Ophthalmology, 2010, 117(10): 2018-2025. DOI: 10.1016/j.ophtha.2010.02.011.
10. Wakabayashi T, Ikuno Y, Shiraki N, et al. Inverted internal limiting membrane insertion versus standard internal limiting membrane peeling for macular hole retinal detachment in high myopia: one-year study[J]. Graefe's Arch Clin Exp Ophthalmol, 2018, 256(8): 1387-1393. DOI: 10.1007/s00417-018-4046-1.
11. Ho TC, Ho A, Chen MS. Vitrectomy with a modified temporal inverted limiting membrane flap to reconstruct the foveolar architecture for macular hole retinal detachment in highly myopic eyes[J]. Acta Ophthalmol, 2018, 96(1): 46-53. DOI: 10.1111/aos.13514.
12. Mete M, Alfano A, Guerriero M, et al. Inverted internal limiting membrane flap technique versus complete internal limiting membrane removal in myopic macular hole surgery: a comparative study[J]. Retina, 2017, 37(10): 1923-1930. DOI: 10.1097/IAE.0000000000001446.
13. Takahashi H, Inoue M, Koto T, et al. Inverted internal limiting membrane flap technique for treatment of macular hole retinal detachment in highly myopic eyes[J]. Retina, 2018, 38(12): 2317-2326. DOI: 10.1097/IAE.0000000000001898.
14. Xu Q, Luan J. Vitrectomy with inverted internal limiting membrane flap versus internal limiting membrane peeling for macular hole retinal detachment in high myopia: a systematic review of literature and meta-analysis[J]. Eye (Lond), 2019, 33(10): 1626-1634. DOI: 10.1038/s41433-019-0458-3.
15. Baba R, Wakabayashi Y, Umazume K, et al. Efficacy of the inverted internal limiting membrane flap technique with vitrectomy for retinal detachment associated with myopic macular holes[J]. Retina, 2017, 37: 466-471. DOI: 10.1097/IAE.0000000000001211.
16. Tian T, Chen C, Peng J, et al. Novel surgical technique of peeled internal limiting membrane reposition for idiopathic macular holes[J]. Retina, 2019, 39(1): 218-222. DOI: 10.1097/IAE.0000000000001745.
17. Hu Z, Ye X, Lv X, et al. Non-inverted pedicle internal limiting membrane transposition for large macular holes[J]. Eye (Lond), 2018, 32(9): 1512-1518. DOI: 10.1038/s41433-018-0107-2.
18. Mete M, Alfano A, Maggio E, et al. Inverted ILM flap for the treatment of myopic macular holes: healing processes and morphological changes in comparison with complete ILM removal[J/OL]. J Ophthalmol, 2019,2019:1314989[2019-06-02]. https://pubmed.ncbi.nlm.nih.gov/31275628/. DOI: 10.1155/2019/1314989.
19. Iwasaki M, Kinoshita T, Miyamoto H. Influence of inverted internal limiting membrane flap technique on the outer retinal layer structures after a large macular hole surgery[J]. Retina, 2019, 39(8): 1470-1477. DOI: 10.1097/IAE.0000000000002209.
20. Kim K, Kim ES, Kim Y, et al. Correlation between preoperative en face optical coherence tomography of photoreceptor layer and visual prognosis after macular hole surgery[J]. Retina, 2018, 38(6): 1220-1230. DOI: 10.1097/IAE.0000000000001679.
21. Neelam K, O'Gorman N, Nolan J. Macular pigment levels following successful macular hole surgery[J]. Br J Ophthalmol, 2005, 89(9): 1105-1108. DOI: 10.1136/bjo.2004.063834. .
22. Chung H, Shin CJ, Kim JG, et al. Correlation of microperimetry with fundus autofluorescence and spectral-domain optical coherence tomography in repaired macular holes[J]. Am J Ophthalmol, 2011, 151(1): 128-136. DOI: 10.1016/j.ajo.2010.06.040.
23. Schutt F, Davies S, Kopitz J, et al. Photodamage to human RPE cells by A2-E, a retinoid component of lipofuscin[J]. Invest Ophthalmol Vis Sci, 2000, 41(8): 2303-2308.
24. Hammer M, Richter S, Guehrs KH, et al. Retinal pigment epithelium cell damage by A2-E and its photo-derivatives[J]. Mol Vis, 2006, 12: 1348-1354.
25. Itoh Y, Inoue M, Rii T, et al. Correlation between length of foveal cone outer segment tips line defect and visual acuity after macular hole closure[J]. Ophthalmology, 2012, 119(7): 1438-1446. DOI: 10.1016/j.ophtha.2012.01.023.
26. de Sisternes L, Hu J, Rubin DL, et al. Visual prognosis of eyes recovering from macular hole surgery through automated quantitative analysis of spectral-domain optical coherence tomography (SD-OCT) scans[J]. Invest Ophthalmol Vis Sci, 2015, 56(8): 4631-4643. DOI: 10.1167/iovs.14-16344.
27. Boldt HC, Munden PM, Folk JC, e al. Visual field defects after macular hole surgery[J]. Am J Ophthalmol, 1996, 122(3): 371-381. DOI: 10.1016/s0002-9394(14)72064-1.
28. Tarita-Nistor L, González EG, Mandelcorn MS, et al. Fixation stability, fixation location, and visual acuity after successful macular hole surgery[J]. Invest Ophthalmol Vis Sci, 2009, 50(1): 84-89. DOI: 10.1167/iovs.08-2342.

Chinese Journal of Ocular Fundus Diseases

Inverted internal limiting membrane versus internal limiting membrane peeling for macular hole retinal detachment in high myopia

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