CONVENTIONAL INTERNAL LIMITING MEMBRANE PEELING VERSUS INVERTED FLAP FOR SMALL-TO-MEDIUM IDIOPATHIC MACULAR HOLE A Randomized Trial

Purpose:To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small-to-medium idiopathic macular hole.Methods:Eyes with <= 400 mu m idiopathic macular holes were randomized into the conventional ILM peeling group (25 eyes) and inverted flap group (25 eyes). A 12-month follow-up was considered. Macular sensitivity (MS) change detected with MP-1 microperimetry was the primary outcome. Secondary outcomes included best-corrected visual acuity change, closure rate, anatomical findings on optical coherence tomography such as U-shape foveal contour, restoration of external limiting membrane, and ellipsoid zone.Results:In both groups, MS improved throughout the follow-up. Final MS was greater in the conventional ILM peeling group compared with the inverted flap group, being 16.6 +/- 2.3 dB versus 14.9 +/- 2.9 dB, respectively (P = 0.026). In both groups best-corrected visual acuity improved throughout the follow-up, with a final best-corrected visual acuity of 0.19 +/- 0.14 logMar (20/31 Snellen) in the conventional ILM group and 0.22 +/- 0.11 logMar (20/33 Snellen) in the inverted flap group (P = 0.398). Anatomical hole closure was achieved in all cases. No difference in optical coherence tomography findings was shown between the two groups.Conclusion:A better final MS was found in eyes undergoing conventional ILM peeling. Inverted flap technique has disadvantages compared with conventional peeling for the treatment of small-to-medium idiopathic macular holes.

Automated summary

This study compared the efficacy of conventional internal limiting membrane peeling with inverted flap technique in treating small-to-medium idiopathic macular hole. The results showed that conventional ILM peeling group had better final macular sensitivity, but there were no significant differences between the two groups in terms of visual acuity improvement, hole closure, and optical coherence tomography findings.