Simple Superior Inverted Flap Technique with Extended Internal Limiting Membrane Peeling for the Treatment of Large Macular Holes
Abstract
Purpose: To evaluate the anatomical and functional outcomes of a simplified superior inverted internal limiting membrane (ILM) flap technique with extended ILM peeling for the surgical treatment of large idiopathic macular holes (iMH).
Patients and methods: This retrospective, non-randomized, interventional consecutive case series included 42 eyes of 40 patients with iMH. Patients were grouped according to the CLOSE study classification: Group 1: large holes (n=19, minimum linear diameter [MLD] >400 to ≤550 µm), Group 2: extra-large holes (n=18, MLD >550 to ≤800 µm), and Group 3: XXL holes (n=5, MLD >800 to ≤1000 µm). The mean follow-up time was 20.63 ± 18.32 months. The primary endpoint was MH closure rate. Secondary outcomes included closure type, changes in best-corrected visual acuity (BCVA), ellipsoid zone (EZ) defect, flap position, and surgical complications.
Results: Anatomical type 1 closure was achieved in all 42 eyes (100%). The proportion of favorable U-shaped closure decreased significantly with increasing hole size (χ2 = 9.26, df = 2, p = 0.010), with rates of 84.2%, 81.3%, and 20.0% in Groups 1, 2, and 3, respectively. BCVA and EZ defect improved significantly over time in all groups. Final BCVA gain was 4.4 ± 3.3, 6.2 ± 2.7, and 7.3 ± 4.7 ETDRS lines in Groups 1, 2, and 3, respectively, without significant inter-group differences (p > 0.05). Final BCVA correlated with preoperative BCVA (r = 0.51, p 0.05). No major complications were observed.
Conclusion: The…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 40 participants or records.
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