Vol 1 No 1 (2018): Current Issue
Research Article

Inverted Internal Limiting Membrane Flap Technique for Extra Large Macular Holes: Surgery for Extra Large Macula Holes.

Okonkwo ON
Eye Foundation Retina Institute, Eye Foundation Center for Prevention of Blindness. Nigeria
Hassan AO
Eye Foundation Retina Institute, Eye Foundation Center for Prevention of Blindness. Nigeria
Oderinlo O
Eye Foundation Retina Institute, Eye Foundation Center for Prevention of Blindness. Nigeria
Published March 1, 2018
Keywords
  • Macular hole,
  • Vitrectomy surgery,
  • Internal limiting membrane,
  • Optical coherence tomography

Abstract

Aim: To investigate the outcome of the inverted Internal Limiting Membrane (ILM) flap technique for extra large idiopathic macular holes (MHs).
Methods: A retrospective non-comparative surgical case series of seven eyes of 7 patients with MHs (base diameter of at least 1000 ?m) was conducted. All the MHs were treated using pars plana vitrectomy and brilliant blue G (BBG)-assisted inverted ILM flap technique. Spectral Domain- Optical Coherence Tomography (SD-OCT) images were used to assess the anatomical outcomes of surgery including the macular microstructure, while Best Corrected Snellen Visual Acuity (BCSVA) was used to evaluate the functional outcomes.
Results: The average MH size was 1241microns and average symptom duration was nineteen months. All eyes achieved successful anatomical closure and there was no occurrence of a flat open type closure. SD-OCT microstructural study revealed a reconstruction of the Ellispod Zone (EZ) and External Limiting Membrane (ELM), in only 3 eyes. There was an improvement in visual acuity in 5 eyes, while 2 eyes maintained the same as pre operative vision. The largest increase in post operative visual acuity gain was a 4-line improvement in Best Corrected Snellen Visual Acuity (BCSVA) noted in one of the 3 eyes with reconstructed EZ and ELM. The 3 months symptom duration in this patient was the shortest in this series.
Conclusion: Inverted ILM flap technique is a safe and effective approach for the management of extra large chronic idiopathic MHs with demonstrably good anatomical and limited functional results in a majority of cases. Postoperative reconstruction of the microstructure is however seen only in a minority of eyes. Despite an absence of the outer retina (EZ and ELM), some eyes still experience an improvement in vision. The symptom duration may play a vital role in functional outcome in this subset of extra large chronic MHs.