Title

PEDICLE INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE FOR A LARGE MACULAR HOLE: A 4-CASE SERIES

Introduction

A macular hole is defined as a full thickness retinal break caused in most cases by vitreoretinal traction. After primary repair by the standard technique, large macular holes remain open in up to 44% of all cases. Thus, surgical alternatives are being developed for holes >400 µm, such as ILM peeling with an inverted flap in order to improve the anatomical and functional results

Methods

This is a retrospective series of four patients with large macular hole who were treated with pedicle ILM flap technique , between May 2018 and May 2019. The particular detail of this technique is related to ILM flap creation. During the peeling, the ILM was not removed completely from the retina but was left attached to the edges of the macular hole, and subsequently trimmed with the vitrectomy probe using the scissors mode.

Results

We reported here patients operated with the inverted ILM pedicle flap technique for large MH (>400 m). Of the 4 cases reported, 3 obtained anatomical closure (75%).

Discussion

Michawleska et al, in a comparative study of two groups – one of 51 eyes submitted to standard pars plana vitrectomy and the other of 50 eyes submitted to the pedicle inverted ILM flap - obtained closure of the MH in 88% of the patients in the conventional group and in 98% of the patients in the other group. Studies by Michalewska et al and Imai et al have shown that the form with the best and more prevalent functional result (45%) is U-shaped closure, followed by V-shaped closure and W closure (irregular,19-39%). In the present study, we performed 2 V-shaped closures and 1 U-shaped closure. Another important factor for final BCVA, i.e, preserved functionality after closure of the MH, is to observe the continuity of the outer retina (photoreceptor layer). The present study describes the first brazilian case series of large MH treated by the inverted pedicle IML flap technique. In large holes (>700 µm), this technique showed prelimiary promising results and further studies are warranted.

Keywords

macular hole; pedicle ILM flap technique

Area

SURGICAL CASE

Authors

IGOR NEVES COELHO, RODRIGO JORGE, MARCOS ÁVILA, JOSÉ EDÍSIO SILVA TAVARES NETO, David Leonardo Cruvinel Isaac