MANAGEMENT OF LARGE FULL-THICKNESS MACULAR HOLES: Long-Term Outcomes of Internal Limiting Membrane Flaps and Internal Limiting Membrane Peels

Kaitlyn Richards, Ankit Kadakia, Charles C. Wykoff, James C. Major, Tien P. Wong, Eric Chen, Amy C. Schefler, Sagar B. Patel, Rosa Y. Kim, Christopher R. Henry, Richard H. Fish, David M. Brown, Matthew S. Benz, William Pearce, Ankoor R. Shah

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND/PURPOSE: To determine and compare the efficacy of a surgical internal limiting membrane (ILM) flap technique with the traditional ILM peel on long-term visual and anatomical outcomes for large (>400 µm) full-thickness macular holes.

METHODS: From October 2016 to July 2022, patients undergoing initial full-thickness macular hole repair with the ILM flap or ILM peel technique were reviewed. Final outcomes were recorded and based on size in microns: 401 to 800, 801 to 1,200, and >1,200.

RESULTS: Patients treated with ILM flap (n = 52, 94.2% closure rate) or ILM peel (n = 407, 93.6% closure rate) were followed with a mean follow-up time of 15.0 ± 10.2 and 20.0 ± 13.4 months, respectively. Success rates for ILM flaps and ILM peels were compared for full-thickness macular holes of 401 to 800 (100%, 95.8%, P = 0.39), 801 to 1,200 (95%, 93%, P = 0.74), and >1,200 (86.7%, 86.7%, P = 1.0) µm. Mean best-recorded logarithm of the minimal angle of resolution visual acuity for ILM flaps and ILM peels, respectively, was 1.02 ± 0.46 and 0.87 ± 0.47 preoperatively, with follow-up acuity of 0.48 ± 0.32 (P < 0.03) and 0.39 ± 0.42 (P < 0.01) at Year 3.

CONCLUSION: Both techniques provide a similar anatomical closure rate and functional improvement in vision. Comparisons should be cautiously made based on difference in preoperative hole size.

Original languageEnglish (US)
Pages (from-to)1165-1170
Number of pages6
JournalRetina
Volume44
Issue number7
DOIs
StatePublished - Jul 1 2024

Keywords

  • ILM flap
  • chronic
  • full-thickness macular hole
  • internal limiting membrane
  • large
  • membrane peel
  • Vitrectomy/methods
  • Surgical Flaps
  • Retinal Perforations/surgery
  • Follow-Up Studies
  • Tomography, Optical Coherence
  • Humans
  • Middle Aged
  • Male
  • Treatment Outcome
  • Visual Acuity/physiology
  • Endotamponade/methods
  • Time Factors
  • Epiretinal Membrane/surgery
  • Female
  • Retrospective Studies
  • Aged
  • Basement Membrane/surgery

ASJC Scopus subject areas

  • Ophthalmology

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