Paired Study On The Treatment Of Macular Hole By Inverted Internal Limiting Membrane Flap Technique

Objective To evaluate the clinical effect of inverted internal limiting membrane(ILM) flap technique and internal limiting membrane peeling technique in the treatment of macular hole(MH).To find the advantages of inverted internal limiting membrane flap technique.Methods Collected 34 patients with MH who underwent vitrectomy in Tianjin Ophthalmological Hospital from October 2014 to June 2015. Paired the patients with similar age, the size of the hole, the axis of the eye, the duration of the disease, the visual acuity and the condition of the retinal detachment. All patients were divided into 17 pairs and belonged to 2 groups(group A and group B). Preoperative examination including best corrected visual acuity(BCVA), intraocular pressure(I0P),slit lamp microscope, binocular indirect ophthalmoscope and spectral-domain optical coherence tomography(SD-0CT). All patients underwent standard 3-port pars plana vitrectomy and indocyanine green staining.At the same time group A underwent inverted ILM flap technique and group B underwent ILM peeling technique. After fluid–air exchange, the vitreous cavity was filled with 100% C3F8 gas.Patients were advised to maintain a prone position postoperatively for at least three weeks. A total of 31 cases of cataract patients, simultaneously underwent phacoemulsification,posterior chamber intraocular lens implantation and posterior capsulotomy. Posterior capsulotomy were given for the other three patients who previously had phacoemulsification and posterior chamber intraocular lens implantation.Followed up for 6 months. When patients reviewed, we checked the best-corrected visual acuity, under slit lamp fundus examination, intraocular pressure and macular OCT examination,observed whether patients with anterior segment inflammation,and recorded the best-corrected visual acuity, intraocular pressure, and the situations of the hole, the retinal and the ellipsoid zone. After 6 months of follow-up,recorded the best corrected visual acuity(BCVA),the postoperative macular hole closure rate,the condition of retinal reattachment, the postoperative macular hole closure type and ellipsoid zone closure rate. Statistical Analysis was carried out.Results The BCVA(Log MAR) was 0.50 ± 0.07 in group A, which was much better than that in group B(0.91 ± 0.12), showing statistically significant difierences between them(t =-3.786, P =0.002). The time of closure in group A was less than that in group B,showing statistically significant difierences(Z =-2.149,P =0.032). The BCVA time was similar in group A and group B, showing no statistically significant difierences( t = 1.286,P =0.287). The closure rate was 94.1%(16/17) in group A, and that was 70.6%(12/17) in group B, showing no statistically significant difierences(P=0.175). In group A,U-type closure was 8 cases(4 cases with idiopathic macular hole,4 cases with macular hole in high myopia),V-type closure was 7 cases, W-type closure was 1 case and 1 case was unclosed. In group B,U-type closure was 4 cases(2 cases with idiopathic macular hole,2 cases with macular hole in high myopia),V-type closure was 8 cases, W-type closure was 0 case and 5 cases was unclosed. Ellipsoid zone closure rate was 41.7% in group A,which was much higher than that in group B(0%), showing statistically significant difierences between them(P=0.044,P?0.05). Postoperatively 1 case was intraocular hyperpressure in group A and 2 cases in group B. There was no other serious complications occurred in all cases.Conclusion Vitrectomy combined with inverted ILM flap technique can improve the BCVA for patients with MH, and be good for U-type closure and ellipsoid zone closure. It is a safe and effective method in the treatment of MH.