Clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane flap covering technique for complicated macular hole_Chinese Journal of Ocular Fundus Diseases

Authors：

 Liu Haiyun , Gao Min , Yang Ming , Sun Xiaodong

Shanghai General Hospital, Shanghai Jiaotong University, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai 200080, China;

Corresponding author：

Liu Haiyun, Email: drliuhaiyun@126.com

Keywords：

Retinal Perforations/surgery; Vitrectomy

DOI：

10.3760/cma.j.issn.1005-1015.2017.04.007

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

ObjectiveTo observe the clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane (ILM) flap covering technique for complicated macular hole (MH).MethodsThis is a retrospective case series. Twenty-one eyes of 20 patients who underwent vitrectomy combined with modified inverted ILM flap covering technique were enrolled in this study. Among these eyes, 9 eyes were idiopathic MH (IMH), with the mean basal diameter of (1 188.3±155.1) μm, minimum diameter of (626.9±86.2) μm, logarithm of the minimum angle of resolution (logMAR) best corrected visual acuity (BCVA) of 1.1±0.3; 2 eyes were MH with high myopia, with the mean basal diameter of (696.5±232.6) μm, minimum diameter of (259.0±69.3) μm, logMAR BCVA of 1.3; 5 eyes were high myopia MH with retinal detachment (RD), with the mean BCVA of 1.5±0.1; 3 eyes were rhegmatogenous RD (RRD) with MH, with the mean logMAR BCVA of 1.6; 2 eyes were MH after vitrectomy for RRD, with the mean basal diameter of (1 606.0±69.3) μm, minimum diameter of (909.0±387.5) μm, logMAR BCVA of 1.6. All patients received 23G or 25G vitrectomy after removal of posterior vitreous cortex intraoperatively. Indocyanine green staining assisted circle-wise ILM peeling was performed. ILM of diameter 1.5 disc-diameters around fovea was residual and loosened; perfluoronoctane assisted inverting superior or temporal residual ILM covering on macular hole. C₃F₈, gas or silicone oil tamponade was performed at the end. BCVA and hole closure were followed up for 1-4 months. C₃F₈, gas or silicone oil was tamponaded at the end. BCVA and hole closure were followed up for 1-4 months.ResultsMH of 21 eyes were closed after surgery. Nine IMH were closed at typeⅠ, with U shape closure in 7 eyes, V shape closure in 2 eyes. Two eyes of MH with high myopia, 3 eyes of RRD with MH, 2 eyes of MH after vitrectomy for RRD were closed at typeⅠ of U shape. Five eyes of high myopia MHRD including MH closure at typeⅠof U shape 3 eyes, typeⅡ of W shape 2 eyes. The mean logMAR BCVA of IMH, MH with high myopia, high myopia MHRD, RRD with MH, MH after vitrectomy for RRD eyes were 0.8±0.3, 0.9±0.2, 1.4±0.1, 0.7±0.3, 0.9±0.2, respectively. The mean postoperative logMAR BCVA in IMH eyes was improved compared preoperative one (P=0.02). There was no obvious change of pre-and postoperative logMAR BCVA in MH with high myopia, high myopia MHRD, RRD with MH, MH after vitrectomy for RRD eyes (P=0.18, 0.10, 0.11, 0.18).ConclusionVitrectomy combined with inverted ILM flap covering technique for complicated MH is an effective method to improve the success rate of MH closure and the visual function.

Citation： Liu Haiyun, Gao Min, Yang Ming, Sun Xiaodong. Clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane flap covering technique for complicated macular hole. Chinese Journal of Ocular Fundus Diseases, 2017, 33(4): 354-358. doi: 10.3760/cma.j.issn.1005-1015.2017.04.007 Copy

1.	Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes: results of a pilot study[J]. Arch Ophthalmol, 1991, 109(5): 654-659.
2.	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.
3.	Shin MK, Park KH, Park SW, et al. Perfluoro-n-octane-assisted single-layered inverted internal limiting membrane flap technique for macular hole surgery[J]. Retina, 2014, 34(9): 1905-1910. DOI: 10.1097/IAE.0000000000000339.
4.	Gass JD. Idiopathic senile macular hole: its early stages and pathogenesis[J]. Arch Ophthalmol, 1988, 106(6): 629-639.
5.	Pauk ET, Lon SP, Robyn GC. Definition of macular hole surgery end points: elevated/open, flat/open, flat/closed[J]. Retina, 1998, 18(3): 286-287.
6.	Masahito I, Hiroyuki I, Teruhiko G, et al. Optical coherence tomography of successfully repaired idiopathic macular holes[J]. Am J Ophthalmol, 1999, 128(5): 621-627.
7.	Liu HY, Zou HD, Liu K, et al. Posterior vitreous cortex contribute to macular hole in highly myopic eyes with retinal detachment[J]. Chin Med J (Engl), 2011, 124(16): 2474-2479.
8.	Oleñik A, Rios J, Mateo C. Inverted internal limiting membrane flap technique for macular holes in high myopia with axial length ≥30 mm[J]. Retina, 2016, 36(9): 1688-1693. DOI: 10.1097/IAE.0000000000001010.
9.	Kuriyama S, Hayashi H, Jingami Y, et al. Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia[J]. Am J Ophthalmol, 2013, 156(1): 125-131. DOI: 10.1016/j.ajo.2013.02.014.
10.	Chen SN, Yang CM. Inverted internal limiting membrane insertion for macular hole-associated retinal detachment in high myopia[J]. Am J Ophthalmol, 2016, 162: 99-106. DOI: 10.1016/j.ajo.2015.11.013.
11.	Stefan M, Nadia K, Josep C. Scleral buckling in rhegmatogenous retinal detachment with concomitant full-thickness macular hole[J]. Acta Ophthalmol, 2012, 90(6): 590-591. DOI: 10.1111/j.1755-3768.2010.02002.x.
12.	Edwin HR, Carolyn TB, Robert AM, et al. Management of rhegmatogenous retinal detachment with coexistent macular hole in the era of internal limiting membrane peeling[J]. Am J Ophthalmol, 2011, 152(5): 815-819. DOI: 10.1016/j.ajo.2011.04.026.

1. Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes: results of a pilot study[J]. Arch Ophthalmol, 1991, 109(5): 654-659.
2. 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.
3. Shin MK, Park KH, Park SW, et al. Perfluoro-n-octane-assisted single-layered inverted internal limiting membrane flap technique for macular hole surgery[J]. Retina, 2014, 34(9): 1905-1910. DOI: 10.1097/IAE.0000000000000339.
4. Gass JD. Idiopathic senile macular hole: its early stages and pathogenesis[J]. Arch Ophthalmol, 1988, 106(6): 629-639.
5. Pauk ET, Lon SP, Robyn GC. Definition of macular hole surgery end points: elevated/open, flat/open, flat/closed[J]. Retina, 1998, 18(3): 286-287.
6. Masahito I, Hiroyuki I, Teruhiko G, et al. Optical coherence tomography of successfully repaired idiopathic macular holes[J]. Am J Ophthalmol, 1999, 128(5): 621-627.
7. Liu HY, Zou HD, Liu K, et al. Posterior vitreous cortex contribute to macular hole in highly myopic eyes with retinal detachment[J]. Chin Med J (Engl), 2011, 124(16): 2474-2479.
8. Oleñik A, Rios J, Mateo C. Inverted internal limiting membrane flap technique for macular holes in high myopia with axial length ≥30 mm[J]. Retina, 2016, 36(9): 1688-1693. DOI: 10.1097/IAE.0000000000001010.
9. Kuriyama S, Hayashi H, Jingami Y, et al. Efficacy of inverted internal limiting membrane flap technique for the treatment of macular hole in high myopia[J]. Am J Ophthalmol, 2013, 156(1): 125-131. DOI: 10.1016/j.ajo.2013.02.014.
10. Chen SN, Yang CM. Inverted internal limiting membrane insertion for macular hole-associated retinal detachment in high myopia[J]. Am J Ophthalmol, 2016, 162: 99-106. DOI: 10.1016/j.ajo.2015.11.013.
11. Stefan M, Nadia K, Josep C. Scleral buckling in rhegmatogenous retinal detachment with concomitant full-thickness macular hole[J]. Acta Ophthalmol, 2012, 90(6): 590-591. DOI: 10.1111/j.1755-3768.2010.02002.x.
12. Edwin HR, Carolyn TB, Robert AM, et al. Management of rhegmatogenous retinal detachment with coexistent macular hole in the era of internal limiting membrane peeling[J]. Am J Ophthalmol, 2011, 152(5): 815-819. DOI: 10.1016/j.ajo.2011.04.026.

Chinese Journal of Ocular Fundus Diseases

Clinical efficacy of vitrectomy combined with modified inverted internal limiting membrane flap covering technique for complicated macular hole

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content