Comparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole

Fariba Ghassemi,1 Hassan Khojasteh,1 Alireza Khodabande,1 Lauren A Dalvin,2 Mehdi Mazloumi,1,3 Hamid Riazi-Esfahani,1 Masoud Mirghorbani1 1Eye Research Center (ERC), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; 2Department of Ophthalmology, Mayo Clinic, Rochester, MN, US...

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Autores principales:	Ghassemi F, Khojasteh H, Khodabande A, Dalvin LA, Mazloumi M, Riazi-Esfahani H, Mirghorbani M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	internal limiting membrane peel inverted flap macular hole pars plana vitrectomy Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/c1f20d08437b45c89e198e191612a008
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spelling	oai:doaj.org-article:c1f20d08437b45c89e198e191612a0082021-12-02T06:43:12ZComparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole1177-5483https://doaj.org/article/c1f20d08437b45c89e198e191612a0082019-12-01T00:00:00Zhttps://www.dovepress.com/comparison-of-three-different-techniques-of-inverted-internal-limiting-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Fariba Ghassemi,1 Hassan Khojasteh,1 Alireza Khodabande,1 Lauren A Dalvin,2 Mehdi Mazloumi,1,3 Hamid Riazi-Esfahani,1 Masoud Mirghorbani1 1Eye Research Center (ERC), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; 2Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA; 3Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USACorrespondence: Hassan KhojastehEye Research Center (ERC), Farabi Eye Hospital, Qazvin Square, PO Box: 14155-7146, Tehran, IranTel +982155421113Fax +982155419095Email khojaste_hasan@yahoo.comPurpose: To evaluate and compare three different techniques of inverted internal limiting membrane (ILM) flap in the treatment of large idiopathic full-thickness macular hole.Methods: In a comparative interventional case series, 72 eyes from 72 patients with large (> 400 μm) full-thickness macular hole were randomly enrolled into three different groups: group A – hemicircular ILM peel with temporally hinged inverted flap; group B – circular ILM peel with temporally hinged inverted flap; and group C – circular ILM peel with superior inverted flap. Best-corrected visual acuity (BCVA), anatomical closure rate, and ellipsoid zone (EZ) or external limiting membrane (ELM) defects were evaluated preoperatively, at week 1, and months 1, 3 and 6 after surgery.Results: There were 24 eyes in group A, 23 in group B, and 25 in group C. In all three groups, larger diameter macular hole was associated with worse preoperative visual acuity (r=0.625, P<0.001). Mean BCVA improved significantly in all three groups 6 months after surgery (0.91vs 0.55, p<0.001). 6 months after surgery, mean BCVA improved from 0.91 logMAR to 0.52±0.06 in group A, 0.90 to 0.53±0.06 in group B, and 0.91 to 0.55±0.11 in group C. In group A vs. B vs. C, improvement of BCVA was 0.380±0.04 vs. 0.383±0.04 vs. 0.368±0.11 logMAR, with no statistically significant difference between groups (P=0.660). The rate of successful hole closure was 87.5% vs. 91.3% vs. 100%. Although the closure rate was 100% in Group C (circular ILM peel with superiorly hinged inverted flap), this difference was not statistically significant (P=0.115).Conclusion: ILM peel with an inverted flap is a highly effective procedure for the treatment of large, full-thickness macular hole. Different flap techniques have comparable results, indicating that the technique can be chosen based on surgeon preference.Keywords: internal limiting membrane peel, inverted flap, macular hole, pars plana vitrectomyGhassemi FKhojasteh HKhodabande ADalvin LAMazloumi MRiazi-Esfahani HMirghorbani MDove Medical Pressarticleinternal limiting membrane peelinverted flapmacular holepars plana vitrectomyOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 13, Pp 2599-2606 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	internal limiting membrane peel inverted flap macular hole pars plana vitrectomy Ophthalmology RE1-994
spellingShingle	internal limiting membrane peel inverted flap macular hole pars plana vitrectomy Ophthalmology RE1-994 Ghassemi F Khojasteh H Khodabande A Dalvin LA Mazloumi M Riazi-Esfahani H Mirghorbani M Comparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole
description	Fariba Ghassemi,1 Hassan Khojasteh,1 Alireza Khodabande,1 Lauren A Dalvin,2 Mehdi Mazloumi,1,3 Hamid Riazi-Esfahani,1 Masoud Mirghorbani1 1Eye Research Center (ERC), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; 2Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA; 3Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USACorrespondence: Hassan KhojastehEye Research Center (ERC), Farabi Eye Hospital, Qazvin Square, PO Box: 14155-7146, Tehran, IranTel +982155421113Fax +982155419095Email khojaste_hasan@yahoo.comPurpose: To evaluate and compare three different techniques of inverted internal limiting membrane (ILM) flap in the treatment of large idiopathic full-thickness macular hole.Methods: In a comparative interventional case series, 72 eyes from 72 patients with large (> 400 μm) full-thickness macular hole were randomly enrolled into three different groups: group A – hemicircular ILM peel with temporally hinged inverted flap; group B – circular ILM peel with temporally hinged inverted flap; and group C – circular ILM peel with superior inverted flap. Best-corrected visual acuity (BCVA), anatomical closure rate, and ellipsoid zone (EZ) or external limiting membrane (ELM) defects were evaluated preoperatively, at week 1, and months 1, 3 and 6 after surgery.Results: There were 24 eyes in group A, 23 in group B, and 25 in group C. In all three groups, larger diameter macular hole was associated with worse preoperative visual acuity (r=0.625, P<0.001). Mean BCVA improved significantly in all three groups 6 months after surgery (0.91vs 0.55, p<0.001). 6 months after surgery, mean BCVA improved from 0.91 logMAR to 0.52±0.06 in group A, 0.90 to 0.53±0.06 in group B, and 0.91 to 0.55±0.11 in group C. In group A vs. B vs. C, improvement of BCVA was 0.380±0.04 vs. 0.383±0.04 vs. 0.368±0.11 logMAR, with no statistically significant difference between groups (P=0.660). The rate of successful hole closure was 87.5% vs. 91.3% vs. 100%. Although the closure rate was 100% in Group C (circular ILM peel with superiorly hinged inverted flap), this difference was not statistically significant (P=0.115).Conclusion: ILM peel with an inverted flap is a highly effective procedure for the treatment of large, full-thickness macular hole. Different flap techniques have comparable results, indicating that the technique can be chosen based on surgeon preference.Keywords: internal limiting membrane peel, inverted flap, macular hole, pars plana vitrectomy
format	article
author	Ghassemi F Khojasteh H Khodabande A Dalvin LA Mazloumi M Riazi-Esfahani H Mirghorbani M
author_facet	Ghassemi F Khojasteh H Khodabande A Dalvin LA Mazloumi M Riazi-Esfahani H Mirghorbani M
author_sort	Ghassemi F
title	Comparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole
title_short	Comparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole
title_full	Comparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole
title_fullStr	Comparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole
title_full_unstemmed	Comparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole
title_sort	comparison of three different techniques of inverted internal limiting membrane flap in treatment of large idiopathic full-thickness macular hole
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/c1f20d08437b45c89e198e191612a008
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Comparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole

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