Department of Ophthalmology, University of Catania, Catania, Italy.
Department of Surgical Sciences, Section of Ophthalmology, University of Turin, Turin, Italy.
Eye (Lond). 2024 Dec;38(17):3334-3340. doi: 10.1038/s41433-024-03301-z. Epub 2024 Aug 24.
To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small idiopathic macular hole.
Retrospective, multicentre cohort study including consecutive eyes with a ≤250 μm idiopathic macular hole treated with primary vitrectomy. The primary outcome was best-corrected visual acuity (BCVA) change and macular hole closure rate. Closure patterns on optical coherence tomography (OCT) and rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery were considered as secondary outcomes.
A total of 389 and 250 eyes were included in the conventional ILM peeling group and in the inverted flap group, respectively. Hole closure rate was comparable between the two groups (98.5% in the ILM peeling group and 97.6% in the inverted flap group). Mean BCVA was comparable between the two groups at baseline (p = 0.331). At 12 months, mean BCVA was 0.14 ± 0.19 logMAR in the conventional ILM peeling group and 0.17 ± 0.18 logMAR in the inverted flap group (p = 0.08). At 12 months, 73% of eyes had a U-shape closure morphology in the conventional ILM peeling group versus 55% in the inverted flap group. At 12 months, ELM recovery rate was 96% and 86% in the conventional ILM peeling group and in the inverted flap group, respectively (p < 0.001); EZ recovery rate was 78% and 69%, respectively (p = 0.04).
The inverted flap technique provides no advantages in terms of visual outcome and closure rate in small idiopathic macular hole surgery. Additionally, this technique seems to impair postoperative restoration of external retinal layers compared with conventional peeling.
比较特发性小黄斑裂孔中传统内界膜（ILM）剥离与翻转瓣技术。
回顾性多中心队列研究，纳入了接受初次玻璃体切除术治疗的特发性小黄斑裂孔患者的连续眼。主要结局是最佳矫正视力（BCVA）变化和黄斑裂孔闭合率。将光学相干断层扫描（OCT）上的闭合模式和外节带（ELM）和椭圆体带（EZ）恢复率作为次要结局。
传统 ILM 剥离组和翻转瓣组分别纳入 389 只眼和 250 只眼。两组裂孔闭合率相当（ILM 剥离组为 98.5%，翻转瓣组为 97.6%）。两组基线时平均 BCVA相当（p=0.331）。12 个月时，传统 ILM 剥离组平均 BCVA 为 0.14±0.19 logMAR，翻转瓣组为 0.17±0.18 logMAR（p=0.08）。12 个月时，传统 ILM 剥离组中有 73%的眼呈 U 形闭合形态，翻转瓣组为 55%。12 个月时，传统 ILM 剥离组和翻转瓣组的 ELM 恢复率分别为 96%和 86%（p<0.001）；EZ 恢复率分别为 78%和 69%（p=0.04）。
在特发性小黄斑裂孔手术中，翻转瓣技术在视力结果和闭合率方面没有优势。此外，与传统剥离相比，该技术似乎损害了术后外视网膜层的恢复。
