Anatomical and functional results after vitrectomy with conventional ILM peeling versus inverted ILM flap technique in large full-thickness macular holes.

IF 1.9 Q2 OPHTHALMOLOGY

International Journal of Retina and Vitreous Pub Date : 2023-11-14 DOI:10.1186/s40942-023-00509-1

Adrianna U Dera, Doerte Stoll, Verena Schoeneberger, Marcus Walckling, Claudia Brockmann, Thomas A Fuchsluger, Friederike Schaub

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Abstract

Background: Aim of the study was to compare success rate and functional outcome following pars plana vitrectomy (PPV) with conventional internal limiting membrane (ILM) peeling versus ILM flap technique for full-thickness idiopathic macular holes (FTMH).

Methods: Retrospective analysis of consecutive eyes with FTMH having undergone vitrectomy with sulfur hexafluoride (SF6) endotamponade 25% at the University Medical Center Rostock, Germany (2009-2020). Eyes were divided according to applied surgical technique (ILM peeling [group P] versus ILM flap [group F]). Inclusion criteria were macular hole base diameters (MH-BD) ≥ 400 μm plus axial length ≤ 26.0 mm. Each group was divided into two subgroups based on macular hole minimum linear diameter (MH-MLD): ≤ 400 μm and > 400 μm. Exclusion criteria were FTMH with MH-BD < 400 μm, trauma, myopia with axial length > 26.0 mm or macular schisis. Demographic, functional, and anatomical data were obtained pre- and postoperatively. Preoperative MH-BD and MH-MLD were measured using optical coherence tomography (OCT; Spectralis®, Heidelberg Engineering GmbH, Heidelberg, Germany). Main outcome parameter were: primary closure rate, best-corrected visual acuity (BCVA), and re-surgery rate.

Results: Overall 117 eyes of 117 patients with FTMH could be included, thereof 52 eyes underwent conventional ILM peeling (group P) and 65 additional ILM flap (group F) technique. Macular hole closure was achieved in 31 eyes (59.6%) in group P and in 59 eyes (90.8%) in group F (p < 0.001). Secondary PPV was required in 21 eyes (40.4%) in group P and in 6 eyes (9.2%) in group F. Postoperative BCVA at first follow-up in eyes with surgical closure showed no significant difference for both groups (MH-MLD ≤ 400 μm: p = 0.740); MH-MLD > 400 μm: p = 0.241).

Conclusion: Anatomical results and surgical closure rate following ILM flap technique seems to be superior to conventional ILM peeling for treatment of FTMH.

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玻璃体切除术后常规ILM剥离术与倒置ILM瓣技术在大全层黄斑孔中的解剖和功能对比。

背景:研究的目的是比较常规内限制膜(ILM)剥离与ILM皮瓣技术治疗全层特发性黄斑孔(FTMH)的成功率和功能结果。方法:回顾性分析2009-2020年在德国罗斯托克大学医学中心接受25%六氟化硫(SF6)内填塞玻璃体切除术的连续眼FTMH患者。按应用手术技术分眼(ILM剥离[P组]和ILM皮瓣[F组])。纳入标准为黄斑孔底直径(MH-BD)≥400 μm +轴向长度≤26.0 mm。各组根据黄斑孔最小线性直径(MH-MLD)分为≤400 μm和> 400 μm两组。排除标准为伴MH-BD 26.0 mm或黄斑裂的FTMH。术前和术后获得人口学、功能和解剖学数据。术前采用光学相干断层扫描(OCT)测量MH-BD和MH-MLD;Spectralis®，海德堡工程有限公司，海德堡，德国)。主要结局参数为:初次闭合率、最佳矫正视力(BCVA)、再手术率。结果117例FTMH患者共117眼，其中常规ILM剥离52眼(P组)，外加ILM瓣技术65眼(F组)。P组31眼(59.6%)、F组59眼(90.8%)完成黄斑孔闭合(P 400 μm: P = 0.241)。结论:ILM皮瓣技术治疗FTMH的解剖效果和手术闭合率优于传统的ILM剥离。

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来源期刊

International Journal of Retina and Vitreous Medicine-Ophthalmology

CiteScore

3.50

自引率

4.30%

发文量

审稿时长

19 weeks

期刊介绍： International Journal of Retina and Vitreous focuses on the ophthalmic subspecialty of vitreoretinal disorders. The journal presents original articles on new approaches to diagnosis, outcomes of clinical trials, innovations in pharmacological therapy and surgical techniques, as well as basic science advances that impact clinical practice. Topical areas include, but are not limited to: -Imaging of the retina, choroid and vitreous -Innovations in optical coherence tomography (OCT) -Small-gauge vitrectomy, retinal detachment, chromovitrectomy -Electroretinography (ERG), microperimetry, other functional tests -Intraocular tumors -Retinal pharmacotherapy & drug delivery -Diabetic retinopathy & other vascular diseases -Age-related macular degeneration (AMD) & other macular entities