J Korean Ophthalmol Soc.  2021 Mar;62(3):329-336. 10.3341/jkos.2021.62.3.329.

Long-term Clinical Outcomes of Macular Hole Surgery Using Internal Limiting Membrane Flap or Insertion

• Park SM
• Kim JW
• Kim CG
• Lee DW
• Yoo SJ
• Cho HJ
• Kim JH

• KMID: 2514247
• DOI: http://doi.org/10.3341/jkos.2021.62.3.329

Abstract

Purpose
To evaluate the long-term outcomes of inverted internal limiting membrane (ILM) flap and ILM insertion in idiopathic macular hole (MH) and to compare the outcomes between the two techniques.
Methods
We retrospectively reviewed the medical records of 17 eyes that underwent an inverted ILM flap procedure (flap group, n = 9) or ILM insertion procedure (insertion group, n = 8) for idiopathic MH. Within each group, best-corrected visual acuity (BCVA) before surgery was compared with that at the final follow-up. The BCVA at the final follow-up was compared between the two groups. In addition, the incidence of restoration of the external limiting membrane (ELM) and ellipsoid zone was evaluated.
Results
The mean follow-up period was 25.1 ± 13.7 months after surgery. All MHs were closed after the surgery. In all 17 eyes, the logarithm of minimal angle of resolution BCVA had improved significantly from a mean value of 0.88 ± 0.23 before surgery to 0.42 ± 0.23 at the final follow-up (p < 0.001). The BCVA was significantly improved in both the flap group (from 0.92 ± 0.25 to 0.37 ± 0.29, p = 0.007) and the insertion group (from 0.83 ± 0.19 to 0.48 ± 0.15, p = 0.018). There was no significant difference in BCVA at the final follow-up between the two groups (p = 0.075). The incidence of restoration of the ELM and ellipsoid zone was significantly higher in the flap group (seven eyes, 77.8%) than in the insertion group (one eye, 12.5%).
Conclusions
Both inverted ILM flap and ILM insertion are effective in MH treatment. The restoration of retinal outer layers was better in the flap group. Further studies with a larger study population are needed to evaluate the long-term visual outcomes of the two methods.

Keyword

Ellipsoid zone, Flap, Insertion, Internal limiting membrane, Macular hole