J Korean Ophthalmol Soc.  2023 Apr;64(4):306-312. 10.3341/jkos.2023.64.4.306.

Perfluoro-n-octane-assisted Superior Inverted ILM Flap without Using the Peeling-off Technique for Large Macular Holes

• Kim JH
• Park BH
• Kim EA
• Kwon HJ
• Byon IS

• KMID: 2542164
• DOI: http://doi.org/10.3341/jkos.2023.64.4.306

Abstract

Purpose
To evaluate the surgical outcomes of a perfluoro-n-octane (PFO)-assisted superior inverted internal limiting membrane (ILM) flap without the peeling-off technique for the treatment of a large macular hole (MH).
Methods
This retrospective interventional case series examined 13 eyes with a MH ≥ 400 μm. All eyes underwent 25-gauge pars plana vitrectomy. An ILM flap stained with 0.025% brilliant blue G was made in the superior area of the hole. The ILM in the temporal, nasal, and inferior areas around the hole was not peeled off. The hole was gently covered using the inverted ILM flap, which was stabilized using a small amount of PFO. Fluidair exchange was performed slowly. The small amount of residual PFO was removed by evaporation. The patients were instructed to maintain a facedown position for 1 day postoperatively. Anatomical closure of the hole and visual acuity were assessed postoperatively.
Results
The average hole size was 605.08 ± 102.41 μm. Nine eyes had an idiopathic MH, two exhibited age-related macular degeneration, and one each had high myopia and a traumatic MH. All eyes achieved type I closure. The foveal contour improved gradually during follow-up: 92.3% of eyes had a U-shaped fovea, and 61.5% exhibited complete recovery of the ellipsoid zone. The visual acuity improved from 0.91 to 0.55 logarithm of the minimum angle of resolution (p = 0.003).
Conclusions
The PFO-assisted superior inverted ILM flap without peeling-off was effective for stabilizing the flap over the hole and consequently achieving good anatomical and visual outcomes in large MHs.

Keyword

Internal limiting membrane peeling, Inverted internal limiting membrane flap, Macular hole, Perfluoro-n-octane, Superior flap