scholarly journals Inverted Internal Limiting Membrane Flap Technique versus Internal Limiting Membrane Peeling for Vitrectomy in Highly Myopic Eyes with Macular Hole-Induced Retinal Detachment: An Updated Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Ling Ling ◽  
Yao Liu ◽  
Baixing Zhou ◽  
Feifei Gao ◽  
Zhe Hu ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Macular Hole ◽  
Meta Analysis ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Internal Limiting Membrane Peeling ◽  
Flap Technique ◽  
Initial Surgery ◽  
Retinal Reattachment

Background. The aim of this meta-analysis was to compare morphological and functional outcomes between vitrectomy with the inverted internal limiting membrane (ILM) flap technique and vitrectomy with internal limiting membrane peeling in highly myopic eyes with macular hole- (MH-) induced retinal detachment (MHRD). Methods. The PubMed, Web of Science, Embase, and Cochrane Library databases were comprehensively searched from inception to November 10, 2019, for published studies comparing the two techniques for the treatment of MHRD. The outcomes in the collected articles included the postoperative MH closure rate, retinal reattachment rate, and best-corrected visual acuity (BCVA). Review Manager (version 5.3) was used for analyses. Results. In total, seven retrospective studies comparing the inverted ILM flap technique with ILM peeling for the treatment of MHRD were included. The MH closure rate was significantly higher in the inverted ILM flap group than in the ILM peeling group at 6 and 12 months after initial surgery (OR = 15.39; 95% CI: 6.68 to 35.43;P<0.00001 and OR = 12.58, 95% CI: 3.51 to 45.08; P=0.0001), while the retinal reattachment rate was similar in both groups at 6 months after initial surgery (OR = 2.40; 95% CI: 0.89 to 6.50; P=0.08). Besides, the postoperative BCVA was significantly better in the inverted ILM flap group than in the ILM peeling group at 12 months after initial surgery (MD = −0.35; 95% CI: −0.52 to −0.18; P<0.0001). Conclusions. Thus, the MH closure rate and postoperative BCVA may be better with the inverted ILM flap technique than with ILM peeling for myopic MHRD, while the postoperative retinal reattachment rate appears to be similar with both techniques. Therefore, in the future, vitrectomy with the inverted ILM flap technique should be preferred over standard ILM peeling technique for the treatment of MHRD in highly myopic eyes.

Foveal microstructure and visual outcomes of myopic macular hole surgery with or without the inverted internal limiting membrane flap technique

2018 ◽  
Vol 103 (10) ◽  
pp. 1495-1502 ◽  
Author(s):  
Xu-Ting Hu ◽  
Qin-Tuo Pan ◽  
Jing-Wei Zheng ◽  
Zong-Duan Zhang
Keyword(s):  
Retinal Detachment ◽  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Flap Technique ◽  
Hyperreflective Foci ◽  
Retinal Reattachment ◽  
Pars Plana ◽  
Myopic Macular Hole

PurposeThe aim of this study was to determine the effect of the inverted internal limiting membrane (ILM) flap technique on the macular hole (MH) closure and foveal microstructure recovery of patients with highly myopic MH.MethodsPars plana vitrectomy and gas tamponade with the inverted ILM flap technique (19 eyes) or with the ILM peeling technique (21 eyes) were performed in patients with highly myopic MH with or without retinal detachment. The rate of MH closure and retinal reattachment, the reconstructive anatomical change of the foveal microstructure and the best-corrected visual acuities (BCVA) of the two groups were compared.ResultsThe anatomic closure rate was statistically significantly higher in the inverted group (100%) than in the peeling group (66.7%; p=0.009). All eyes with MH retinal detachment had successful retinal reattachment in these two groups. However, the rate of the external limiting membrane (ELM) and ellipsoid zone (EZ) (p=0.020), as well as gliosis (p=0.049) in macular area, detected by OCT, was significantly greater in the inverted group than in the peeling group. The postoperative BCVA was significantly better in the eyes with ELM, EZ (p=0.031) and gliosis (p=0.008), but without hyperreflective foci (p=0.001).ConclusionsThese findings demonstrate that the inverted ILM flap technique has better efficacy than the ILM peeling technique for patients with myopic MH in closure rate, foveal microstructure and postoperative BCVA.

Modified Superior Inverted Internal Limiting Membrane Flap Technique With Vitrectomy Versus Vitrectomy With Internal Limiting Membrane Peeling For Retinal Detachment With Myopic Macular Hole

2021 ◽  
Author(s):  
María José Crespo Carballés ◽  
Marina Sastre-Ibáñez ◽  
Mar Prieto del Cura ◽  
Laura Jimeno Anaya ◽  
Natalia Pastora Salvador ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Macular Hole ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Retinal Layer ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Flap Technique ◽  
Before And After ◽  
Hole Closure

Abstract Purpose: To evaluate the efficacy of the modified superior inverted internal limiting (ILM) membrane flap technique in retinal reattachment, macular hole closure and external retinal layers restoration in macular hole associated retinal detachment compared to ILM peeling. Methods: Retrospective case series of 10 patients that required pars plana vitrectomy for retinal detachment with macular hole followed for more than 12 months. Data from medical records were retrospectively collected and patients were divided into the superior inverted flap (5 patients) and ILM peeling group (5 patients). We compared best corrected visual acuity (BCVA) before and after surgery, retinal attachment, macular hole closure rate and external retinal layer restoration between groups. Results: There were significant improvements in BCVA in both groups before and after surgery, with no differences between the two groups at 12 months after surgery (p = 0.9). The macular hole closed in 100% of cases in the inverted flap group and 80% of the ILM peeling group with no significant differences between groups. The retina was reattached in 100% of cases in both groups. Only 2 patients in the inverted flap group (40%) had external retinal layer restoration and none in ILM peeling group (p=0,62). Conclusions: ILM peeling and superior inverted flap techniques are useful for treating retinal detachment with macular hole in myopic eyes.

scholarly journals Inverted internal limiting membrane flap technique versus internal limiting membrane peeling for large macular holes: A meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Ji-Guo Yu ◽  
Jing Wang ◽  
Yi Xiang
Keyword(s):  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Internal Limiting Membrane ◽  
Controlled Trials ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Flap Technique ◽  
Randomized Controlled ◽  
Macular Holes

Background: Vitrectomy with internal limiting membrane (ILM) peeling is an effective surgical procedure for the treatment of macular holes (MHs). However, there is a possibility of poor postoperative anatomical closure with conventional ILM peeling for MHs larger than 400 μm. Therefore, a novel inverted ILM flap technique was developed for such cases. Objectives: This meta-analysis study was performed to evaluate and compare the anatomical and visual outcomes of the inverted ILM flap technique and ILM peeling in large MHs. Methods: The Cochrane Library, PubMed, and Embase databases were searched to identify randomized controlled trials (RCTs). The trial eligibility and risk of bias were assessed according to Cochrane review methods. The primary outcome measures included MH closure rate and postoperative visual acuity (VA). Subgroup analysis of postoperative VA based on follow-up time was also conducted. Pooled odds ratios (ORs), weighted mean difference (WMD), and 95% confidence intervals (CIs) were calculated. Statistical analysis was performed using RevMan 5.3 software. Results: Five RCTs with a total of 155 eyes in the inverted ILM flap group and 161 eyes in the ILM peeling group were included in this meta-analysis. Statistical meta-analysis revealed that the overall MH closure rate in the inverted ILM flap group was significantly higher than that in the ILM peeling group (OR, 3.10; 95% CI, 1.25 to 7.66; P = 0.01). The postoperative VA was significantly better in the inverted ILM flap group than ILM peeling group (WMD, -0.14; 95% CI, -0.21 to -0.07; P = 0.0002). The subgroup meta-analysis indicated that the postoperative VA was significantly better in the inverted ILM flap group than ILM peeling group (WMD, -0.17; 95% CI, -0.26 to -0.08; P = 0.0004) at the 3-month follow-up. However, no significant difference was observed between the two groups at the 6-month follow-up (WMD, -0.09; 95% CI, -0.20 to 0.02; P = 0.10). Conclusions: Vitrectomy with inverted ILM flap technique showed a higher anatomical closure rate as well as visual gain—although only in the short-term as no difference in visual recovery was found at the 6-month follow-up—than did ILM peeling in large MHs. The inverted ILM flap technique should be considered as a preferred and routine procedure for the treatment of patients with MHs larger than 400 µm.

scholarly journals Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yu Shen ◽  
Xiaoqin Lin ◽  
Luyi Zhang ◽  
Miaoqin Wu
Keyword(s):  
Sensitivity Analysis ◽  
Meta Analysis ◽  
Internal Limiting Membrane ◽  
Ilm Peeling ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
Visual Outcomes ◽  
Flap Technique ◽  
Macular Holes

Abstract Background The purpose of this study was to compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique and internal limiting membrane peeling in large macular holes (MH). Methods Related studies were reviewed by searching electronic databases of Pubmed, Embase, Cochrane Library. We searched for articles that compared inverted ILM flap technique with ILM peeling for large MH (> 400 μm). Double-arm meta-analysis was performed for the primary end point that was the rate of MH closure, and the secondary end point was postoperative visual acuity (VA). Heterogeneity, publication bias, sensitivity analysis and subgroup analysis were conducted to guarantee the statistical power. Results This review included eight studies involving 593 eyes, 4 randomized control trials and 4 retrospective studies. After sensitivity analysis for eliminating the heterogeneity of primary outcome, the pooled data showed the rate of MH closure with inverted ILM flap technique group was statistically significantly higher than ILM peeling group (odds ratio (OR) = 3.95, 95% confidence interval (CI) = 1.89 to 8.27; P = 0.0003). At the follow-up duration of 3 months, postoperative VA was significantly better in the group of inverted ILM flap than ILM peeling (mean difference (MD) = − 0.16, 95% CI = − 0.23 to 0.09; P < 0.00001). However, there was no difference in visual outcomes between the two groups of different surgical treatments at relatively long-term follow-up over 6 months (MD = 0.01, 95% CI = − 0.12 to 0.15; P = 0.86). Conclusion Vitrectomy with inverted ILM flap technique had a better anatomical outcome than ILM peeling. Flap technique also had a signifcant visual gain in the short term, but the limitations in visual recovery at a longer follow-up was found.

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