Advantages:

To evaluate anatomical foveal microstructure and functional visual recovery associated with closure of idiopathic macular holes in the inverted internal limiting membrane (ILM) flap technique, and standard internal limiting membrane peeling technique.

Methods:

We describe the spectral domain OCT findings of 30 eyes that underwent surgery for macular hole closure (vitrectomy, ILM peeling with staining, air or gas tamponade, and face-down positioning). We discuss OCT findings in cases that underwent inverted ILM flap technique (where a remnant of ILM was left at the edges of the macular hole and gently massaged until the ILM flap became inverted over the macular hole), and compare to OCT findings in eyes that underwent standard ILM peeling for macular hole closure. Functional visual recovery in relation to anatomical findings will be discussed.

Effectiveness / Safety:

It has been postulated that the pattern of foveal reconstruction depends on the balance between centripetal bridging of the ELM (external limiting membrane) with reapproximation of photoreceptors, and glial cell proliferation of Muller cells filling the defect. ELM status may play a role in explaining visual outcomes. In eyes that underwent inverted ILM flap technique, there was intact ELM in 83%, IS/OS (inner segment/outer segment) defect was present in 50%, and 16% had both disrupted ELM and IS/OS defect. Mean visual acuity was 0.7 in eyes with intact ELM, and 0.1 in eyes with disrupted ELM.

Take home message:

Inverted ILM flap technique may promote hole closure by providing a scaffold for proliferation, as well as provoking gliosis on the surface of the attached flap of ILM at the edge of the macular hole, and inside the retina. ELM integrity was associated with better visual recovery.