Inverted internal limiting membrane-flap technique for large macular hole: a microperimetric study

Giancarlo Sborgia; Alfredo Niro; Alessandra Sborgia; Valeria Albano; Tiziana Tritto; Luigi Sborgia; Valentina Pastore; Rossella Donghia; Ermete Giancipoli; Nicola Recchimurzo; Francesco Boscia; Giovanni Alessio

doi:10.1186/s40942-019-0195-6

Inverted internal limiting membrane-flap technique for large macular hole: a microperimetric study

Int J Retina Vitreous. 2019 Oct 18:5:44. doi: 10.1186/s40942-019-0195-6. eCollection 2019.

Affiliations

¹ 1Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, Bari, Italy.
² Eye Clinic, Hospital "S. G. MOSCATI", ASL TA, Via Per Martina Franca, 74010 Statte, Taranto Italy.
³ National Institute of Gastroenterology "S. de Bellis" Research Hospital, Castellana Grotte, Bari, Italy.
⁴ 4Department of Surgical, Microsurgical and Medical Sciences, Eye Clinic, University of Sassari, Sassari, Italy.

Abstract

Background: Inverted Internal Limiting Membrane (ILM)-flap technique would seem to lead to higher closure rate and better visual acuity than traditional procedure with ILM peeling for the treatment of large macular hole (LMH). Visual acuity recovery does not reveal many other functional changes related to surgical approach. Our purpose was to evaluate macular function and morphology over a 1-year follow-up after inverted ILM-flap technique for LMH by using microperimetry in order to predict visual prognosis.

Methods: This study was a prospective unrandomized single-center study. 23 eyes of 22 patients with idiopathic LMH, with a minimum diameter ranging from 400 to 1000 μm, were included. All patients underwent vitrectomy with inverted ILM-flap technique and gas tamponade. We analyzed macular hole closure rate and functional outcomes including best-corrected visual acuity (BCVA), macular sensitivity (MS) at central 12° and central macular sensitivity (CMS) at central 4°, and fixation behavior as bivariate contour ellipse area (BCEA, degrees²) at 68%, 95%, and 99% of fixation points measured by microperimeter, over a follow-up of 12 months.

Results: The macular hole closure rate was 98%. The BCVA improved from 20/230 (Logmar, 1.06 ± 0.34) to 20/59 (logMar, 0.47 ± 0.45) at last follow-up (p < 0.001). Retinal sensitivity and BCEA significantly improved (MS, p = 0.001; CMS, p < 0.0001; BCEA: 68%, p < 0.01; 95%, p < 0.01; 99%, p = 0.001). Multiple stepwise regression analysis showed the final BCVA was significantly associated with macular hole size (β = 0.002, p = 0.03), preoperative MS (β = - 0.06, p = 0.001) and BCEA at 95% and 99% of fixation points (β = - 0.12, p = 0.01; β = 0.06, p = 0.01).

Conclusions: Inverted ILM-flap technique for LMH results in good morphologic and functional outcomes. Macular hole size and microperimetric parameters as preoperative MS and BCEA have a predictive role on post-surgical visual acuity.

Keywords: Fixation behaviour; Inverted ILM-flap; Large macular hole; Microperimetry; Retinal sensitivity.