Download PDF
Klin Monbl Augenheilkd 2023; 240(12): 1413-1420
DOI: 10.1055/a-1946-5448
Klinische Studie

Repeat Surgery following Temporal Inverted ILM Flap Technique: Next Step after Primary Failure

Reoperation bei Makulalöchern, die sich trotz Anwendung der temporalen invertierten Lappentechnik (I – ILM) in der Primärchirurgie nicht schließen
Cengiz Alagoz
1   Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
,
Damla Bektasoglu
2   Department of Ophthalmology, Igdir State Hospital, Igdir, Turkey
,
Nese Alagoz
1   Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
,
Erdem Erdogdu
1   Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
,
Özgür Artunay
1   Ophthalmology, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Purpose We aimed to report our surgical experience with repeat surgery as the next step after an unsuccessful hole closure with the primary single-layered temporal inverted flap technique (IFT).

Methods We identified cases with persistent macular holes by reviewing the records of eyes that underwent IFT between October 2018 and October 2021. These cases were evaluated for hole features, anatomical closure, and visual improvement before and after the first and second surgeries. In addition, the technique applied in repeat surgery was recorded. Optical coherence tomography (OCT) images at follow-up were used to evaluate the flap position.

Results A persistent hole was identified in 11 (6.4%) of 172 patients who underwent IFT. An inferotemporal displacement was observed in seven eyes, while no flap could be identified in the OCT images of the other four eyes. In the second surgery, the old flap was reinverted in one eye, and a new flap was created from the superior region in five eyes and the nasal region in the other five eyes and was stabilized under perfluorocarbon liquid. A gas tamponade (C3F8/SF6) was used in all patients at the end of surgery. The minimum hole diameter was > 400 µm in all eyes and 100% closure was achieved after the second surgery. Visual acuity gain of ≥ 3 lines was observed in 9 of the 11 eyes (81.8%). The mean visual acuity increase at the last follow-up was significant (p = 0.008).

Conclusion With single-layer temporal IFT in the primary surgery of macular holes, unsuccessful results may be observed due to the flap displacement in the early period. In our series, IFT was applied again with the use of the old flap or the creation of a new flap in the second surgery of the persistent holes, and successful results were obtained.

Zusammenfassung

Hintergrund Bewertung des erneuten chirurgischen Vorgehens und der klinischen Ergebnisse von Makulalöchern, die sich nicht schlossen und bei denen die Technik der einschichtigen temporal invertierten inneren Begrenzungsmembranklappe (I – ILM) in der Primärchirurgie verwendet wurde.

Patienten und Methoden Alle konsekutiven Fälle, die zwischen Oktober 2018 und Oktober 2021 in unserer Klinik einer primären Operation (I – ILM) unterzogen wurden, wurden gescreent und Fälle von nicht verschlossenen Makulalöchern bestimmt. Diese Fälle wurden retrospektiv in Bezug auf Merkmale des Makulalochs, anatomischen Verschluss und visuelle Verbesserung vor und nach der 1. und 2. Operation bewertet. Außerdem wurde die bei der erneuten Operation angewandte Technik notiert. OCT-Bilder aller Fälle bei der Nachuntersuchung wurden verwendet, um die Lappenposition zu bewerten.

Ergebnisse In 11 (6,4%) von 172 Fällen, die in unserer Klinik durchgeführt wurden (I – ILM), wurde ein Makulaforamen ohne Verschluss festgestellt. OCT-Bilder dieser Fälle zeigten, dass der Lappen bei 7 Augen nach inferior temporal verlagert war. In den OCT-Bildern der anderen 4 Fälle wurde kein Flap beobachtet. In der 2. Operation wurde der alte Lappen invertiert und in 1 Auge wiederverwendet, ein neuer Lappen wurde in 5 Augen aus dem oberen und in den anderen 5 Augen aus der nasalen Region hergestellt und unter Perfluorkohlenstoff stabilisiert. Am Ende der Operation wurde bei allen Patienten eine Gastamponade (C3F8/SF6) verwendet. Der minimale Lochdurchmesser betrug in allen Augen > 400 µm und ein 100%iger Verschluss wurde nach der 2. Operation erreicht. Bei 9 von 11 Augen (81,8%) wurde eine visuelle Zunahme von 3 Linien oder mehr beobachtet. Der mittlere Anstieg der Sehschärfe bei der letzten Nachuntersuchung war signifikant (p = 0,008).

Schlussfolgerung Bei der Behandlung des Makulaforamens können aufgrund der in der Frühphase zu beobachtenden Verschiebung der Lappenposition erfolglose Ergebnisse in Fällen beobachtet werden, in denen ein einschichtiges Temporal (I – ILM) in der Primäroperation angewendet wurde. In unserer Studie wurde bei der 2. Operation der Löcher, die sich nicht schlossen, erneut der alte Lappen verwendet oder ein neuer Lappen (I – ILM) erstellt und es wurden erfolgreiche Ergebnisse erzielt.

Key words

inverted flap technique - persistent macular hole - repeat surgery

Schlüsselwörter

Makulaloch - invertierte ILM-Lappen - ILM-Lappen


Publication History

Received: 26 June 2022

Accepted: 01 September 2022

Article published online:
24 February 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References/Literatur

  • 1 Ezra E. Idiopathic full thickness macular hole: natural history and pathogenesis. Br J Ophthalmol 2001; 85: 102-108
    CrossrefPubMedGoogle Scholar
  • 2 Gass JD. Idiopathic senile macular hole. Its early stages and pathogenesis. Arch Ophthalmol 1988; 106: 629-639
    CrossrefPubMedGoogle Scholar
  • 3 Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes. Results of a pilot study. Arch Ophthalmol 1991; 109: 654-659
    CrossrefPubMedGoogle Scholar
  • 4 Park DW, Sipperley JO, Sneed SR. et al. Macular hole surgery with internal-limiting membrane peeling and intravitreous air. Ophthalmology 1999; 106: 1392-1398
    CrossrefPubMedGoogle Scholar
  • 5 Michalewska Z, Michalewski J, Adelman RA. et al. Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology 2010; 117: 2018-2025
    CrossrefPubMedGoogle Scholar
  • 6 Guber J, Lang C, Valmaggia C. Internal limiting membrane flap techniques for the repair of large macular holes: a short-term follow-up of anatomical and functional outcomes. Klin Monbl Augenheilkd 2017; 234: 493-496
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Rizzo S, Tartaro R, Barca F. et al. Internal limiting membrane peeling versus inverted flap technique for treatment of full-thickness macular holes: a comparative study in a large series of patients. Retina 2018; 38: 73-78
    CrossrefPubMedGoogle Scholar
  • 8 Avci R, Mavi Yildiz A, Yilmaz S. Conventional internal limiting membrane peeling versus temporal inverted internal limiting membrane flap for large macular holes. Eur J Ophthalmol 2021; 31: 679-687
    CrossrefPubMedGoogle Scholar
  • 9 Romano MR, Rossi T, Borgia A. et al. Management of refractory and recurrent macular holes: A comprehensive review. Surv Ophthalmol 2022; 67: 908-931
    CrossrefPubMedGoogle Scholar
  • 10 Maguire MJ, Steel DH, Yorston D. et al. Outcome of revision procedures for failed primary macular hole surgery. Retina 2021; 41: 1389-1395
    CrossrefPubMedGoogle Scholar
  • 11 Yek JTO, Hunyor AP, Campbell WG. et al. Australian and New Zealand Society of Retinal Specialists Macular Hole Study Group. Outcomes of Eyes with Failed Primary Surgery for Idiopathic Macular Hole. Ophthalmol Retina 2018; 2: 757-764
    CrossrefPubMedGoogle Scholar
  • 12 Cao JL, Kaiser PK. Surgical Management of Recurrent and Persistent Macular Holes: A Practical Approach. Ophthalmol Ther 2021; 10: 1137-1153
    CrossrefPubMedGoogle Scholar
  • 13 Szurman P, Wakili P, Stanzel BV. et al. Persistent macular holes – what is the best strategy for revision?. Graefes Arch Clin Exp Ophthalmol 2021; 259: 1781-1790
    CrossrefPubMedGoogle Scholar
  • 14 Michalewska Z, Nawrocki J. Repeat surgery in failed primary vitrectomy for macular holes operated with the inverted ILM flap technique. Ophthalmic Surg Lasers Imaging Retina 2018; 49: 611-618
    CrossrefPubMedGoogle Scholar
  • 15 Manasa S, Kakkar P, Kumar A. et al. Comparative evaluation of standard ILM peel with inverted ILM flap technique in large macular holes: a prospective, randomized study. Ophthalmic Surg Lasers Imaging Retina 2018; 49: 236-240
    CrossrefPubMedGoogle Scholar
  • 16 Ghoraba HH, Leila M, Ghoraba H. et al. Comparative study between pars plana vitrectomy with internal limiting membrane peel and pars plana vitrectomy with internal limiting membrane flap technique for management of traumatic full thickness macular holes. J Ophthalmol 2019; 2019: 1959082
    CrossrefPubMedGoogle Scholar
  • 17 Oleñik A, Rios J, Mateo C. Inverted internal limiting membrane flap technique for macular holes in high myopia with axial length ≥ 30 mm. Retina 2016; 36: 1688-1693
    CrossrefPubMedGoogle Scholar
  • 18 Chou HD, Liu L, Wang CT. et al. Single-layer inverted internal limiting membrane flap versus conventional peel for small- or medium-sized full-thickness macular holes. Am J Ophthalmol 2021; 235: 111-119
    CrossrefPubMedGoogle Scholar
  • 19 Tam ALC, Yan P, Gan NY. et al. The current surgical management of large, recurrent, or persistent macular holes. Retina 2018; 38: 1263-1275
    CrossrefPubMedGoogle Scholar
  • 20 Meyer CH, Szurman P, Haritoglou C. et al. Application of subretinal fluid to close refractory full thickness macular holes: treatment strategies and primary outcome: APOSTEL study. Graefes Arch Clin Exp Ophthalmol 2020; 258: 2151-2161
    CrossrefPubMedGoogle Scholar
  • 21 Figueroa MS, Mora Cantallops A, Virgili G. et al. Long-term results of autologous plasma as adjuvant to pars plana vitrectomy in the treatment of high myopic full-thickness macular holes. Eur J Ophthalmol 2021; 31: 2612-2620
    CrossrefPubMedGoogle Scholar
  • 22 Rizzo S, Caporossi T, Tartaro R. et al. A human amniotic membrane plug to promote retinal breaks repair and recurrent macular hole closure. Retina 2019; 39: 95-103
    CrossrefPubMedGoogle Scholar
  • 23 Chen SN, Yang CM. Lens capsular flap transplantation in the management of refractory macular hole from multiple etiologies. Retina 2016; 36: 163-170
    CrossrefPubMedGoogle Scholar
  • 24 Grewal DS, Mahmoud TH. Autologous neurosensory retinal free flap for closure of refractory myopic macular holes. JAMA Ophthalmol 2016; 134: 229-230
    CrossrefPubMedGoogle Scholar
  • 25 Wolfensberger TJ. Autologous internal limiting membrane (ILM) recycling to close very large refractory macular holes. Klin Monbl Augenheilkd 2015; 232: 585-586
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Reid GA, McDonagh N, Wright DM. et al. First Failed Macular Hole Surgery or Reopening of a Previously Closed Hole: Do We Gain By Reoperating? – A Systematic Review and Meta-Analysis. Retina 2020; 40: 1-15
    CrossrefPubMedGoogle Scholar
  • 27 Bando H, Ikuno Y, Choi JS. et al. Ultrastructure of internal limiting membrane in myopic foveoschisis. Am J Ophthalmol 2005; 139: 197-199
    CrossrefPubMedGoogle Scholar
  • 28 Morawski K, Kocemba-Pilarczyk K, Zarzycka M. et al. In vitro culture Muller cell model to study the role of inverted internal limiting membrane flap technique in macular hole closure. J Physiol Pharmacol 2021; 72: 391-398
    PubMedGoogle Scholar
  • 29 Shiode Y, Morizane Y, Matoba R. et al. The role of inverted internal limiting membrane flap in macular hole closure. Invest Ophthalmol Vis Sci 2017; 58: 4847-4855
    CrossrefPubMedGoogle Scholar