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      Glial-Plug Proliferation after Inverted Internal Limiting Membrane Flap Technique for Idiopathic Macular Hole

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          Abstract

          Purpose

          This study aimed to analyze the effect of multiple folded internal limiting membrane (ILM) flap in the inverted ILM flap technique on postoperative outcomes of patients with full-thickness macular hole (FTMH).

          Methods

          This retrospective study included 41 eyes of 41 patients with FTMH treated with vitrectomy using the inverted ILM flap technique. Complete ophthalmic examination was performed preoperatively, at 1 week, and at 1, 3, 6, 9, and 12 months after surgery.

          Results

          Postoperative SD-OCT confirmed macular hole (MH) closure in all patients. The mean BCVA improved from 0.7 LogMAR (20/100) preoperatively to 0.5 LogMAR (20/63) postoperatively. In two cases, 7 days after vitrectomy, flap closure was noted. At the final visit after 12 months, the following foveal contours were noted: 14 U-shape (34.1%), 12 irregular (W-shape) (29.3%), and 6 V-shape (14.6%). We observed a type of “plug closure” in 9 (22%) eyes in which hyperproliferation was noted in one eye.

          Conclusions

          The surgeons should be aware of potential hyperproliferation on the retinal surface after the multi-layered flap technique.

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          Most cited references15

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          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.
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            Autologous transplantation of the internal limiting membrane for refractory macular holes.

            Yuki Morizane, Fumio Shiraga, Shuhei Kimura … (2014)
            To determine the effectiveness of autologous transplantation of the internal limiting membrane (ILM) for refractory macular holes.
            Article 0 comments Cited 100 times – based on 0 reviews     Review now
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              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 94 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Karolina Bonińska:
                ORCID: https://orcid.org/0000-0002-9856-8790
                Journal
                Journal ID (nlm-ta): J Ophthalmol
                Journal ID (iso-abbrev): J Ophthalmol
                Journal ID (publisher-id): JOPH
                Title: Journal of Ophthalmology
                Publisher: Hindawi
                ISSN (Print): 2090-004X
                ISSN (Electronic): 2090-0058
                Publication date Collection: 2022
                Publication date (Electronic): 30 September 2022
                Volume: 2022
                Electronic Location Identifier: 2919358
                Affiliations
                1Centrum Medyczne, Julianów Ul Żeglarska 4, 91-321 Łodz, Poland
                2Miejskie Centrum Medyczne, Ul Milionowa 14, 93-113 Łodz, Poland
                Author notes

                Academic Editor: In s Contreras

                Author information
                https://orcid.org/0000-0002-6100-4991
                https://orcid.org/0000-0002-9856-8790
                https://orcid.org/0000-0003-3721-7302
                https://orcid.org/0000-0002-7269-2240
                Article
                DOI: 10.1155/2022/2919358
                PMC ID: 9553358
                SO-VID: b26c00c0-3c43-4c7a-b3bd-261e9493ff09
                Copyright © Copyright © 2022 Sławomir Cisiecki et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 2 April 2022
                Date revision received : 30 August 2022
                Date accepted : 13 September 2022
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Ophthalmology & Optometry
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry

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