For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
12
views
45
references
 Top references
cited by
12
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      270
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Inverted internal limiting membrane-flap technique for large macular hole: a microperimetric study

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Inverted Internal Limiting Membrane (ILM)-flap technique would seem to lead to higher closure rate and better visual acuity than traditional procedure with ILM peeling for the treatment of large macular hole (LMH). Visual acuity recovery does not reveal many other functional changes related to surgical approach. Our purpose was to evaluate macular function and morphology over a 1-year follow-up after inverted ILM-flap technique for LMH by using microperimetry in order to predict visual prognosis.

          Methods

          This study was a prospective unrandomized single-center study. 23 eyes of 22 patients with idiopathic LMH, with a minimum diameter ranging from 400 to 1000 μm, were included. All patients underwent vitrectomy with inverted ILM-flap technique and gas tamponade. We analyzed macular hole closure rate and functional outcomes including best-corrected visual acuity (BCVA), macular sensitivity (MS) at central 12° and central macular sensitivity (CMS) at central 4°, and fixation behavior as bivariate contour ellipse area (BCEA, degrees 2) at 68%, 95%, and 99% of fixation points measured by microperimeter, over a follow-up of 12 months.

          Results

          The macular hole closure rate was 98%. The BCVA improved from 20/230 (Logmar, 1.06 ± 0.34) to 20/59 (logMar, 0.47 ± 0.45) at last follow-up (p < 0.001). Retinal sensitivity and BCEA significantly improved (MS, p = 0.001; CMS, p < 0.0001; BCEA: 68%, p < 0.01; 95%, p < 0.01; 99%, p = 0.001). Multiple stepwise regression analysis showed the final BCVA was significantly associated with macular hole size (β = 0.002, p = 0.03), preoperative MS (β = − 0.06, p = 0.001) and BCEA at 95% and 99% of fixation points (β = − 0.12, p = 0.01; β = 0.06, p = 0.01).

          Conclusions

          Inverted ILM-flap technique for LMH results in good morphologic and functional outcomes. Macular hole size and microperimetric parameters as preoperative MS and BCEA have a predictive role on post-surgical visual acuity.

          Related collections

          Most cited references45

          • Record: found
          • Abstract: found
          • Article: not found

          Inverted internal limiting membrane flap technique for large macular holes.

          Zofia Michalewska, Janusz Michalewski, Ron Adelman … (2010)
          Large macular holes usually have an increased risk of surgical failure. Up to 44% of large macular holes remain open after 1 surgery. Another 19% to 39% of macular holes are flat-open after surgery. Flat-open macular holes are associated with limited visual acuity. This article presents a modification of the standard macular hole surgery to improve functional and anatomic outcomes in patients with large macular holes. A prospective, randomized clinical trial. Patients with macular holes larger than 400 μm were included. In group 1, 51 eyes of 40 patients underwent standard 3-port pars plana vitrectomy with air. In group 2, 50 eyes of 46 patients underwent a modification of the standard technique, called the inverted internal limiting membrane (ILM) flap technique. In the inverted ILM flap technique, instead of completely removing the ILM after trypan blue staining, a remnant attached to the margins of the macular hole was left in place. This ILM remnant was then inverted upside-down to cover the macular hole. Fluid-air exchange was then performed. Spectral optical coherence tomography and clinical examination were performed before surgery and postoperatively at 1 week and 1, 3, 6, and 12 months. Visual acuity and postoperative macular hole closure. Preoperative mean visual acuity was 0.12 in group 1 and 0.078 in group 2. Macular hole closure was observed in 88% of patients in group 1 and in 98% of patients in group 2. A flat-hole roof with bare retinal pigment epithelium (flat-open) was observed in 19% of patients in group 1 and 2% of patients in group 2. Mean (or median) postoperative visual acuity 12 months after surgery was 0.17 (range, 0.1-0.6) in group 1 and 0.28 (range, 0.02-0.8) in group 2 (P = 0.001). The inverted ILM flap technique prevents the postoperative flat-open appearance of a macular hole and improves both the functional and anatomic outcomes of vitrectomy for macular holes with a diameter greater than 400 μm. Spectral optical coherence tomography after vitrectomy with the inverted ILM flap technique suggests improved foveal anatomy compared with the standard surgery. Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
          Article 0 comments Cited 298 times – based on 0 reviews     Review now
          Article has an altmetric score of 16
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            TEMPORAL INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE VERSUS CLASSIC INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE: A Comparative Study.

            Jerzy Nawrocki, Ron Adelman, Karolina Dulczewska-Cichecka … (2015)
            To determine if reducing the area of internal limiting membrane (ILM) peeling in the inverted ILM flap technique results in satisfactory outcomes for the repair of large Stage IV idiopathic macular holes.
            Article 0 comments Cited 98 times – based on 0 reviews     Review now
            Article has an altmetric score of 8
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole: a pragmatic randomized controlled trial.

              Luke Vale, Charles Boachie, Laura Ternent … (2011)
              To determine whether internal limiting membrane (ILM) peeling is effective and cost effective compared with no peeling in patients with idiopathic stage 2 or 3 full-thickness maculay hole (FTMH). This was a pragmatic multicenter randomized controlled trial. Eligible participants from nine centers were randomized to ILM peeling or no peeling (1:1 ratio) in addition to phacovitrectomy, including detachment and removal of the posterior hyaloid and gas tamponade. The primary outcome was distance visual acuity (VA) at 6 months after surgery. Secondary outcomes included hole closure, distance VA at other time points, near VA, contrast sensitivity, reading speed, reoperations, complications, resource use, and participant-reported health status, visual function, and costs. Of 141 participants randomized in nine centers, 127 (90%) completed the 6-month follow-up. Nonstatistically significant differences in distance visual acuity at 6 months were found between groups (mean difference, 4.8; 95% confidence interval [CI], -0.3 to 9.8; P = 0.063). There was a significantly higher rate of hole closure in the ILM-peel group (56 [84%] vs. 31 [48%]) at 1 month (odds ratio [OR], 6.23; 95% CI, 2.64-14.73; P < 0.001) with fewer reoperations (8 [12%] vs. 31 [48%]) performed by 6 months (OR, 0.14; 95% CI, 0.05-0.34; P < 0.001). Peeling the ILM is likely to be cost effective. There was no evidence of a difference in distance VA after the ILM peeling and no-ILM peeling techniques. An important benefit in favor of no ILM peeling was ruled out. Given the higher anatomic closure and lower reoperation rates in the ILM-peel group, ILM peeling seems to be the treatment of choice for idiopathic stage 2 to 3 FTMH. (Clinical Trials.gov number, NCT00286507.).
              Article 0 comments Cited 93 times – based on 0 reviews     Review now
              Article has an altmetric score of 6
                Bookmark
                All references

                Author and article information

                Contributors
                Giancarlo Sborgia: gcsborgia@hotmail.it
                Alfredo Niro:
                ORCID: http://orcid.org/0000-0002-7951-3591
                +39 0994585017 , alfred.nir@tiscali.it
                Alessandra Sborgia: alessandrasborgia@yahoo.it
                Valeria Albano: valeria.albano12@gmail.com
                Tiziana Tritto: tiziana.tritto@gmail.com
                Luigi Sborgia: luigi.sborgia@uniba.it
                Valentina Pastore: valentinapastore@hotmail.it
                Rossella Donghia: rossydonghia@gmail.com
                Ermete Giancipoli: ermete.giancipoli@gmail.com
                Nicola Recchimurzo: nicolarecchimurzo@hotmail.it
                Francesco Boscia: francescoboscia@hotmail.com
                Giovanni Alessio: giovanni.alessio@uniba.it
                Journal
                Journal ID (nlm-ta): Int J Retina Vitreous
                Journal ID (iso-abbrev): Int J Retina Vitreous
                Title: International Journal of Retina and Vitreous
                Publisher: BioMed Central (London )
                ISSN (Electronic): 2056-9920
                Publication date (Electronic): 18 October 2019
                Publication date PMC-release: 18 October 2019
                Publication date Collection: 2019
                Volume: 5
                Electronic Location Identifier: 44
                Affiliations
                [1 ]ISNI 0000 0001 0120 3326, GRID grid.7644.1, Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, , University of Bari, ; Bari, Italy
                [2 ]Eye Clinic, Hospital “S. G. MOSCATI”, ASL TA, Via Per Martina Franca, 74010 Statte, Taranto Italy
                [3 ]National Institute of Gastroenterology “S. de Bellis” Research Hospital, Castellana Grotte, Bari, Italy
                [4 ]ISNI 0000 0001 2097 9138, GRID grid.11450.31, Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, , University of Sassari, ; Sassari, Italy
                Author information
                http://orcid.org/0000-0002-7951-3591
                Article
                Publisher ID: 195
                DOI: 10.1186/s40942-019-0195-6
                PMC ID: 6798391
                PubMed ID: 31641530
                SO-VID: 813cd7d9-8a32-418a-abd2-505f6f7cd1b3
                Copyright © © The Author(s) 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 5 July 2019
                Date accepted : 10 October 2019
                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                Keywords: large macular hole,inverted ilm-flap,microperimetry,retinal sensitivity,fixation behaviour
                Data availability:
                Keywords: large macular hole, inverted ilm-flap, microperimetry, retinal sensitivity, fixation behaviour

                Comments

                Comment on this article

                scite_
                0
                0
                0
                0
                Smart Citations
                0
                0
                0
                0
                Citing PublicationsSupportingMentioningContrasting
                View Citations

                See how this article has been cited at scite.ai

                scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

                Similar content270

                See all similar

                Cited by12

                See all cited by

                Most referenced authors512

                See all reference authors