Ophthalmology University Clinic, Faculdade de Medicina Lisboa, Universidade de Lisboa, Lisbon, Portugal.
Ophthalmology Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; and.
Retina. 2020 Jul;40(7):1299-1305. doi: 10.1097/IAE.0000000000002607.
To examine the influence of the inverted flap (IF) internal limiting membrane (ILM) technique in macular hole (MH) closure on outer retinal layers after MH surgery.
Retrospective study. Postoperative position of ILM, recovery rate of external limiting membrane and ellipsoid zone, and best-corrected visual acuity were evaluated. The Inserted group, where the IF is placed inside the hole, was compared with the Cover group, where the IF completely covers the hole.
Sixty-two eyes of 58 patients who underwent vitrectomy and ILM peeling with the IF technique for large MHs (>400 µm) with successful MH closure and a follow-up of 12 months were evaluated. In the 24 eyes of the Inserted group, there was no regeneration of external limiting membrane or ellipsoid zone after 12 months. In the 38 eyes of Cover group, external limiting membrane recovered in 55.3% of patients 1 month after surgery, and in 86.1% after 12 months. The elipsoid zone layer was present in 58% of the patients.
Poorer anatomical and visual results were associated with the IF technique where ILM insertion occurs compared with ILM placed over the hole. These findings suggest that insertion of the ILM in the hole might prevent outer retinal layers realignment and visual recovery in MH surgery.
研究黄斑裂孔（MH）手术后内界膜（ILM）翻转瓣（IF）技术对 MH 闭合中外层视网膜的影响。
回顾性研究。评估术后 ILM 位置、外节膜和椭圆体带的恢复率以及最佳矫正视力。将 IF 置于孔内的插入组与完全覆盖孔的盖组进行比较。
对 58 例 62 只接受玻璃体切割和 ILM 剥除联合 IF 技术治疗的大 MH（>400 µm）患者进行评估，这些患者的 MH 闭合成功且随访时间为 12 个月。在插入组的 24 只眼中，12 个月后没有外节膜或椭圆体带的再生。在盖组的 38 只眼中，术后 1 个月有 55.3%的患者外节膜恢复，12 个月后有 86.1%的患者外节膜恢复。有 58%的患者存在椭圆体带层。
与 ILM 覆盖孔相比，ILM 插入孔内的 IF 技术与较差的解剖和视觉结果相关。这些发现表明，MH 手术中 ILM 插入孔内可能会阻止外视网膜层的重新排列和视觉恢复。
