J Friedrich1, N Bleidißel2, J Klaas2, N Feucht3, A Nasseri2, C P Lohmann2, M Maier2. 1. Klinikum rechts der Isar, Augenklinik, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland. julia.friedrich@mri.tum.de. 2. Klinikum rechts der Isar, Augenklinik, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland. 3. Smile Eyes Augenklinik Munich Airport, Terminalstraße Mitte 18, 85356, München, Deutschland.
Abstract
BACKGROUND: Age, preoperative visual acuity and macular hole size have been reported to be prognostic markers for the postoperative outcome in patients with full thickness macular holes (FTMH). OBJECTIVE: A retrospective observational clinical study was performed in order to compare the postoperative course after conventional internal limiting membrane peeling (c-ILM) and inverted flap ILM peeling (i-ILM). Patients with i‑ILM peeling had preoperatively a significantly larger macular hole MATERIAL AND METHODS: In this study 45 consecutive patients with a full thickness macular hole (FTMH) were divided into two groups (c-ILM vs. i ILM) and evaluated with respect to the postoperative best corrected visual acuity (BCVA) and retinal morphology. Using spectral domain optical coherence tomography (SD-OCT) the integrity of the outer retinal layers, external limiting membrane (ELM), ellipsoid zone (EZ) and outer photoreceptor outer segments (OS) were analyzed postoperatively for at least 6 months. RESULTS: The preoperative aperture in the i‑ILM group was significantly larger (i-ILM = 408.4 µm, SD = 157.5 µm; c‑ILM = 287.4 µm, SD = 104.9 µm; p = 0.01). The preoperative BCVA and postoperative BCVA after 1 month were significantly better in the group with c‑ILM peeling (p = 0.03 and p = 0.001). The postoperative BCVA after at least 6 months showed no significant difference between the two groups (p = 0.24). The ELM was the first of the outer retinal layers to show postoperative recovery in both groups. CONCLUSION: Using the i‑ILM peeling technique in this consecutive series it seemed to be possible to achieve a similar postoperative visual outcome in patients with a large FTMH as for patients with a smaller FTMH operated on with the c‑ILM peeling technique.
BACKGROUND: Age, preoperative visual acuity and macular hole size have been reported to be prognostic markers for the postoperative outcome in patients with full thickness macular holes (FTMH). OBJECTIVE: A retrospective observational clinical study was performed in order to compare the postoperative course after conventional internal limiting membrane peeling (c-ILM) and inverted flap ILM peeling (i-ILM). Patients with i‑ILM peeling had preoperatively a significantly larger macular hole MATERIAL AND METHODS: In this study 45 consecutive patients with a full thickness macular hole (FTMH) were divided into two groups (c-ILM vs. i ILM) and evaluated with respect to the postoperative best corrected visual acuity (BCVA) and retinal morphology. Using spectral domain optical coherence tomography (SD-OCT) the integrity of the outer retinal layers, external limiting membrane (ELM), ellipsoid zone (EZ) and outer photoreceptor outer segments (OS) were analyzed postoperatively for at least 6 months. RESULTS: The preoperative aperture in the i‑ILM group was significantly larger (i-ILM = 408.4 µm, SD = 157.5 µm; c‑ILM = 287.4 µm, SD = 104.9 µm; p = 0.01). The preoperative BCVA and postoperative BCVA after 1 month were significantly better in the group with c‑ILM peeling (p = 0.03 and p = 0.001). The postoperative BCVA after at least 6 months showed no significant difference between the two groups (p = 0.24). The ELM was the first of the outer retinal layers to show postoperative recovery in both groups. CONCLUSION: Using the i‑ILM peeling technique in this consecutive series it seemed to be possible to achieve a similar postoperative visual outcome in patients with a large FTMH as for patients with a smaller FTMH operated on with the c‑ILM peeling technique.
Authors: Gábor G Deák; Wolfgang M Schmidt; Reginald E Bittner; Georgios Mylonas; Philipp K Roberts; Stefan Zotter; Bernhard Baumann; Michael Pircher; Christoph K Hitzenberger; Ursula M Schmidt-Erfurth; Markus Ritter Journal: Retina Date: 2019-03 Impact factor: 4.256