Macular hole closure patterns associated with different internal limiting membrane flap techniques.
OBJECTIVE
To compare the anatomic and functional outcome of two variants of the inverted internal limiting membrane (I-ILM) flap technique for idiopathic macular holes (IMH) larger than 400 µm.


METHODS
Twenty-seven consecutive patients undergoing PPV for IMH were randomly assigned to different variants of I-ILM technique: the Cover group included 14 patients in which the I-ILM was folded upside-down over the MH as a single layer while the Fill group enrolled 13 patients in which the I-ILM was folded within the MH in multiple layers.


RESULTS
MH closed in 12/14 Cover and in 13/13 Fill eyes (84.6 vs. 100%, p = 0.14; n.s.). Vision at 1 month was Snellen 0.44 ± 0.17 vs. 0.28 ± 0.21 (p = 0.05) and 0.48 ± 0.20 vs. 0.37 ± 0.25 (n.s.) at 3 months. IS/OS line interruption width was 463 ± 385 vs. 602 ± 210 µm, respectively, at 1 month (n.s.) and 602 ± 210 vs. 563 ± 209 µm at 3 months (n.s.). The Cover group showed outer retina cystic changes more often (p < 0.01). MH over 700 µm closed in 0/2 and in 2/2 cases, respectively, in the Cover and Fill groups (0.045).


CONCLUSIONS
Cover and Fill I-ILM techniques allowed similar closure rates and post-operative vision at 3 months. The Cover group showed better anatomical restoration and vision at 1 month while the Fill technique might be more efficient in closing larger MHs.
IRCCS Azienda Ospedaliera Universitaria San Martino, IST, Genoa, Italy. tommaso.rossi@usa.net.|, Via Tina Modotti 93, 00142, Rome, Italy. tommaso.rossi@usa.net.
Tommaso
T
Rossi
UO oculistica Clinica Villa dei Fiori, Acerra, Napoli, Italy.
Aldo
A
Gelso
Cattedra di Oftalmologia, Università degli Studi del Molise, Campobasso, Italy.
Ciro
C
Costagliola
IRCCS Azienda Ospedaliera Universitaria San Martino, IST, Genoa, Italy.
Carlandrea
C
Trillo
IRCCS Azienda Ospedaliera Universitaria San Martino, IST, Genoa, Italy.
Annalisa
A
Costa
UO oculistica Clinica Villa dei Fiori, Acerra, Napoli, Italy.
Carlo
C
Gesualdo
G.B. Bietti Foundation ONLUS - IRCCS, Rome, Italy.
Guido
G
Ripandelli
D000368:Aged; D001485:Basement Membrane / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012160:Retina / Q000473:pathology*; D012167:Retinal Perforations / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013524:Surgical Flaps; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
Inverted internal limiting membrane flap; Macular holes; Pars plana vitrectomy