Internal limiting membrane peel with or without finesse flex loop assistance

2020 ◽  
Vol 14 (2) ◽  
pp. 64-67
Author(s):  
Faisal Mehmood ◽  
Abdullah Irfan ◽  
Awais Afzal ◽  
Muhammad Moin ◽  
Muhammad Muneeb
Keyword(s):  
Retinal Detachment ◽  
Vitreous Hemorrhage ◽  
Internal Limiting Membrane ◽  
Retinal Hemorrhage ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Cross Sectional ◽  
Retinal Tear ◽  
Significant Difference ◽  
Surface Irregularities

Background: Internal Limiting Membrane (ILM) peeling, currently, due to more successful hole closure rate and prevention of postoperative reopening, has been accepted globally but it may leads to other trivial complications like subretinal and retinal hemorrhage, vitreous hemorrhage and retinal edema etc., which may be avoided by using adjuvant instruments, like Finesse flex Loop. The aim of this study was to compare complications after ILM peel, with and without finesse loop. Patients and methods: In this comparative cross-sectional study conducted in Ophthalmology Department of Lahore General Hospital, Lahore from February 2018 to January 2019, the data of thirty (30) patients was compared after taking informed consent through self-made pro-forma. Data analysis was done on SPSS-21. Frequency / percentage table of qualitative variables like retinal hemorrhage, retinal tear, retinal detachment and surface irregularities were designed by using excel-16. Fischer’s exact test was applied to compare complications after ILM peeling with and without using Finesse loop. Confidence interval of 0.95 with α of 0.05 was taken as significant. Results: This study included thirty (30) patients (female: 13; male: 17) with mean age of 56 years and 8 months. Comparison between outcomes of ILM peeling with and without using Finesse™ Flex Loop showed that there is statistically non-significant difference in occurrence of retinal hemorrhage (p=0.245), retinal tear (p=0.224), retinal detachment (p=1.00) and surface irregularities (p=0.39). However, the prevalence of complications like surface irregularities, retinal tear, retinal hemorrhage and retinal detachment with finesse loop were less as compared to without finesse loop. Conclusion: The prevalence of complications during ILM peel with finesse loop in a macular hole surgery, were less than that in ILM peel with ILM forceps alone.

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.

scholarly journals Outcomes of Idiopathic Full-Thickness Macular Hole Surgery: Comparing Two Different ILM Peeling Sizes

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Alireza Khodabande ◽  
Alireza Mahmoudi ◽  
Hooshang Faghihi ◽  
Fatemeh Bazvand ◽  
Ebrahim Ebrahimi ◽  
...  
Keyword(s):  
Macular Hole ◽  
Internal Limiting Membrane ◽  
Full Thickness ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Full Thickness Macular Hole ◽  
Significant Difference ◽  
Hole Index ◽  
The Impact ◽  
Anatomical Outcomes

Purpose. This study aimed to show the impact of different extents of internal limiting membrane (ILM) peeling on visual and anatomical outcomes following idiopathic full-thickness macular hole (FTMH) surgery. Methods. In this single-center prospective study, patients with idiopathic FTMH underwent standard pars plana vitrectomy with two different extents of ILM peeling: 2-disc diameters (DD) or 4 DD. The main outcome measures were the closure rate of the holes based on optical coherence tomography (OCT) findings at three months after surgery. Results. Forty eyes from 39 patients were enrolled in the study. After three months, anatomical closure was achieved in 78% and 76% eyes in 2 DD peel and 4 DD peel groups, respectively. From 29 eyes with macular hole index (MHI) ≤ 0.5, type 1 closure was achieved in 42% eyes receiving a 2 DD ILM peel, compared to 66% eyes receiving a 4 DD peel p=0.041. In comparison, this significant difference was not seen in the subgroup of MHI > 0.5 p=061. In the subgroup of subjects with baseline MHI ≤ 0.5, visual improvement was significantly more in eyes with 4 DD ILM peeling p=0.034, which was not seen in the MHI > 0.5 subgroup p=0.61. Conclusion. In patients with idiopathic full‐thickness macular hole (MHI ≤ 0.5), a larger ILM peel of 4 DD appears to yield better anatomical outcomes than a more limited 2 DD peel.

scholarly journals Ocular ultrasonography for detection of posterior segment pathology in adult patients presenting with blurred vision

2021 ◽  
Vol 25 (3) ◽  
pp. 610-618
Author(s):  
Suaad Musa ◽  
Medya Sedeq
Keyword(s):  
Retinal Detachment ◽  
Posterior Vitreous Detachment ◽  
Vitreous Hemorrhage ◽  
Retinal Hemorrhage ◽  
Cross Sectional Study ◽  
Posterior Segment ◽  
Radiology Department ◽  
Medical Conditions ◽  
Blurred Vision ◽  
Cross Sectional

Background and objective: Ocular posterior segment lesions can affect individuals of both sexes at all ages. Such lesions can lead to serious manifestations such as retinal detachment and retinal hemorrhage, leading to permanent loss of eyesight. This study aimed to determine the association between age and gender and changes in ocular posterior segment based on ultrasonography findings. Methods: This prospective cross-sectional study included 50 patients with blurry vision who had been referred from ophthalmology outpatient clinics to the radiology department of Rizgary Teaching Hospital in Erbil, Kurdistan region in Iraq. Required data were collected using a researcher-designed questionnaire, and the patients were examined using a high resolution 7.5-10 MHz linear array ultrasound transducer. Results: The most frequent complications associated with ocular posterior segment pathologies were old vitreous hemorrhage (72%), posterior vitreous detachment (36%), and retinal detachment (34%). Diabetes and hypertension were the most frequent diseases associated with ocular posterior segment pathology. A significant association was seen between the patients' age with old vitreous hemorrhage (P = 0.003). A significant association was seen between the patients’ medical conditions with old vitreous hemorrhage and retinal detachment. There was no significant correlation between the patients’ gender and the studied ocular posterior segment pathologies. Conclusion: Age has a strong correlation with old vitreous hemorrhage, chronic medical conditions such as diabetes, and hypertension correlated with old vitreous hemorrhage and retinal detachment. Keywords: Ocular ultrasonography; Posterior segment pathology; Blurred vision; Age; Gender.

scholarly journals Displacement of the retina after idiopathic macular hole surgery with different internal limiting membrane peeling patterns

2021 ◽  
Vol 14 (9) ◽  
pp. 1408-1412
Author(s):  
Jin Liu ◽  
◽  
Xin-Hua Zheng ◽  
Yuan-Long Li ◽  
Jun-Long Huang ◽  
...  
Keyword(s):  
Macular Hole ◽  
Influencing Factor ◽  
Visual Outcome ◽  
Internal Limiting Membrane ◽  
Idiopathic Macular Hole ◽  
Ilm Peeling ◽  
Macular Hole Surgery ◽  
Closure Rate ◽  
Internal Limiting Membrane Peeling ◽  
Significant Difference

AIM: To explore retinal displacement after surgical treatment for idiopathic macular hole (IMH) with different internal limiting membrane (ILM) peeling patterns. METHODS: Totally 22 eyes from 20 patients with IMH were randomly allocated into two groups, N-T group (11 eyes) and T-N group (11 eyes). For patients in N-T group, ILM was peeled off from nasal to temporal retina. For patients in T-N group, ILM was peeled off from temporal to nasal retina. Preoperative, postoperative 1, 3, and 6mo, autofluorescence fundus images were collected for manual measurement of distances of fixed nasal (N), temporal (T), superior (S), and inferior (I) retinal points (bifurcation or crossing of retinal vessels) around the macula to the optic disc (OD). These were respectively defined as N-OD, T-OD, S-OD, and I-OD. The retinal displacement, macular hole closure rate, and best corrected visual acuity (BCVA) were compared between the two groups after surgery. RESULTS: At postoperative 1, 3, and 6mo, the macula slipped toward the OD, manifested by the decreased T-OD, N-OD, S-OD, and I-OD (P<0.05). No significant difference was found in the T-OD, N-OD, S-OD, and I-OD between N-T group and T-N group. IMH closure rate was 100% both in N-T group and T-N group. There was no significant difference in BCVA between two groups (P<0.05). CONCLUSION: The macula slips toward the OD after successful macular hole surgery. The two different ILM peeling pattern show similar visual outcome and retinal displacement, which means ILM peeling directions are not the influencing factor of postoperative retinal displacement.

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.

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 Effect of inverted internal limiting membrane flap technique on small-medium size macular holes

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Kanako Yamada ◽  
Akio Oishi ◽  
Mao Kusano ◽  
Hirofumi Kinoshita ◽  
Eiko Tsuiki ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Internal Limiting Membrane ◽  
Medium Size ◽  
External Limiting Membrane ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Postoperative Visual Acuity ◽  
Flap Technique ◽  
Macular Holes ◽  
Significant Difference

AbstractInverted internal limiting membrane (ILM) flap technique was developed to achieve macular hole (MH) closure in large MH and refractory cases. In this study, we evaluate the effect of the technique for small-medium size MH. We recruited patients who underwent vitrectomy for small-medium size (< 400 μm) MH with either inverted ILM flap technique (flap group) or with conventional ILM peeling (peeling group). Using propensity score, 21 eyes of 21 patients in the peeling group were matched against 21 eyes of 21 patients in the flap group. We compared MH closure rate, postoperative visual acuity, and recovery of the external limiting membrane (ELM) and ellipsoid zone (EZ). The MH closure rate was not different between the two groups (flap vs peeling: 90% vs 100%, P = 0.49). Whereas there was no significant difference in visual acuity improvement between the two groups, the flap group showed more disruption of the ELM 3 months after surgery and of the EZ at 3 and 6 months after surgery (P = 0.02, P = 0.03, and P = 0.04, respectively). The result suggested that inverted ILM flap technique does not have additional benefits for small-medium size MHs and may delay recovery of retinal integrity.

scholarly journals The Role of Internal Limiting Membrane Flap for Highly Myopic Macular Hole Retinal Detachment: Improving the Closure Rate but Leading to Excessive Gliosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Yiqi Chen ◽  
Jun Wang ◽  
Xin Ye ◽  
Jiafeng Yu ◽  
Jiwei Tao ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Macular Hole ◽  
Autologous Blood ◽  
Internal Limiting Membrane ◽  
Closure Rate ◽  
Flap Technique ◽  
Significant Difference ◽  
Macular Hole Retinal Detachment ◽  
Myopic Macular Hole

Purpose: To investigate the surgical outcomes of the inverted internal limiting membrane (ILM) flap technique for macular hole retinal detachment (MHRD) in high myopia.Methods: This was a retrospective interventional study on 45 highly myopic eyes with MHRD after ILM peeling (n = 24, peeling group) or the inverted ILM flap technique (n = 21, inverted group). The inverted group was consisted of autologous blood (AB) subgroup (n = 10) and perfluorocarbon liquid (PFCL) subgroup (n = 11). MH closure, best-corrected visual acuity (BCVA), foveal microstructures, and excessive gliosis were analyzed during a follow-up of over 12 months.Results: The inverted group achieved a higher MH closure rate (95.24%) than the peeling group (41.67%; p &lt; 0.001). No significant difference was found in postoperative BCVA between the two groups (p = 0.98) or between the closed MH with or without excessive gliosis (p = 0.60). Excessive gliosis was identified in 9 eyes in the inverted group, and there was no difference in the incidence of excessive gliosis between the AB subgroup (4 in 10 eyes, 40%) and the PFCL subgroup (5 in 11 eyes, 45.45%) (p &gt; 0.999).Conclusion: The inverted ILM flap technique was effective in MH closure but had no advantage in postoperative BCVA and microstructural restoration. Excessive gliosis was only detected in the inverted group but did not affect the postoperative BCVA. Additionally, the incidence of excessive gliosis was not affected by adjuvants.

scholarly journals Effect of Inverted Internal Limiting Membrane Flap Technique on Normal Size Macular Holes

2021 ◽  
Author(s):  
Kanako Yamada ◽  
Akio Oishi ◽  
Mao Kusano ◽  
Hirofumi Kinoshita ◽  
Eiko Tsuiki ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Propensity Score ◽  
Internal Limiting Membrane ◽  
External Limiting Membrane ◽  
Ilm Peeling ◽  
Closure Rate ◽  
Postoperative Visual Acuity ◽  
Flap Technique ◽  
Macular Holes ◽  
Significant Difference

Abstract Inverted internal limiting membrane (ILM) flap technique was developed to achieve macular hole (MH) closure in large MH and refractory cases. In this study, we evaluate the effect of the technique for normal size MH. We recruited patients who underwent vitrectomy for normal size (< 400 µm) MH with either inverted ILM flap technique (flap group) or with conventional ILM peeling (peeling group). Using propensity score,21 eyes of 21 patients in the peeling group were matched against 21 eyes of 21 patients in the flap group. we compared MH closure rate, postoperative visual acuity, and recovery of the external limiting membrane (ELM) and ellipsoid zone (EZ). The MH closure rate was not different between the two groups (flap vs peeling: 90% vs 100%, P = 0.49). Whereas there was no significant difference in visual acuity improvement between the two groups, the flap group showed more disruption of the ELM 3 months after surgery and of the EZ at 3 and 6 months after surgery (P = 0.02, P = 0.03, and P = 0.04, respectively). The result suggested that inverted ILM flap technique does not have additional benefits for normal size MHs and may delay recovery of retinal integrity.

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.

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