Does Inverted Internal Limiting Membrane Flap Technique for Stage 4 Macular Holes Result in Reconstitution of Outer Retinal Layers?

Vitreo-Retina

Abstract

Introduction: Unsatisfactory anatomical  outcomes have been reported following conventional internal limiting membrane (ILM) peel technique for large macular holes (MHs); therefore, the inverted ILM flap technique was invented.1,2 This involves the inversion of  peeled ILM around the MH into it. This technique provides better anatomical hole closure rates for the repair of difficult, large macular  holes > 400microns.3,4 There is a question regarding the degree of outer retina reconstruction occurring after this  technique. The aim  of this study was to determine the degree of outer retina reconstruction (EZ - Ellipsoid Zone and ELM - External Limiting  Membrane) in  eyes, which have undergone the inverted ILM flap technique for the repair of large MHs, >400microns as determined by Spectral  Domain Optical Coherence Tomography (SD OCT) imaging.  

Methods: A retrospective non-comparative single surgeon review of preoperative and postoperative SD OCT images using n=14  consecutive eyes of 14 patients who had surgery between April 2015 and Jan 2017. Standard surgery was a 23G pars plana vitrectomy  (PPV) and dye assisted ILM peel with duoblue. Tamponade used was sulfur hexafloride (SF6), perfluoropropane(C3F8) gases  and air.  All 14 eyes had serial SD OCT & 2 cases OCT Angiography.