A new technique of inverted internal limiting membrane flap formation in a surgical treatment for large idiopathic macular holes

Purpose. To develop a surgical treatment for large idiopathic macular holes using a new technique of internal limiting membrane fragment formation to close the macular hole.

Material and methods. We observed 19 patients, from 56 to 71 years old (average age was 63,8±5,3 years old) with idiopathic macular holes (IMH) stage III according to J. Gass classification. Standard ophthalmologic examination and spectral optical coherence tomography and microperimetry were performed in all cases. The follow-up was before treatment and 2 weeks, 1 and 3 months after surgery. A new technique of internal limiting membrane (ILM) fragment formation reminds the process of removal petals from a flower and is performed in several steps, including step-by-step separation of local areas ILM around MH preserving foveolar fragments and one ILM fragment, which is then partially separated towards MH, stopping at a distance of 0,1‑0,2 mm from the edge of the MH, inverted and covered on MH, closing it.

Results. Surgical interventions were made in full volume without complications in all cases. During follow-up visual acuity increased from 0.1‑0.4 to 0.3‑0.7 (mean 0,39±0,15). An improvement of the retina anatomical condition in foveal zone was observed in all cases: complete closure of MH was achieved in 8 patients, and partial closure of MH was achieved in 11 patient. Fixation point offset on 153‑369 mm toward the center of the fovea and fixation stabilization, and disappearance of absolute scotoma in the fovea center was observed in all patients.

Conclusion. The developed technique is perspective in the treatment of large idiopathic macular holes. Further investigations are necessary.

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