INVERTED INTERNAL LIMITING MEMBRANE FLAP FOR SMALL-SIZED (<250 μm) FULL-THICKNESS MACULAR HOLE Anatomical and Functional Outcome

Purpose:To compare the anatomical and functional outcome of small (mu m) and medium (250-400 mu m) full-thickness macular holes (FTMHs) treated with internal limiting membrane (ILM) inverted flap (IF) or with the standard technique.Methods:Retrospective longitudinal analysis of successfully operated eyes with small or intermediate FTMH. Outcome measures were best-corrected visual acuity (BCVA), microperimetric sensitivity (with fixation stability), and restoration of the external limiting membrane (ELM) and ellipsoid zone (EZ) at 6 months.Results:Fifty small and 50 intermediate eyes with FTMH were included, half of each group (25) treated with the standard technique, half with IF. BCVA increased in every subgroup, similarly within the same stage regardless the technique. Small FTMH treated with IF disclosed inferior foveal sensitivity at 6 months (20.79 +/- 0.48 dB) compared with the standard technique (21.51 +/- 0.79 dB; P = 0.0035). At 1 month, inferior rates of ELM (24%) and EZ (24%) restoration were also found, compared with the standard technique (56% ELM P = 0.0420; 64% EZ P = 0.0095). At 6 months, ELM and EZ were similarly restored.Conclusion:The surgical repair of small FMTH with ILM IF seem to delay the foveal structural repair and to gain an inferior foveal sensitivity compared to the standard technique.

Automated summary

This study compared the anatomical and functional outcomes of small and medium full-thickness macular holes (FTMHs) treated with internal limiting membrane (ILM) inverted flap (IF) or with the standard technique. The results showed that small FTMHs treated with IF had inferior foveal sensitivity and restoration of the external limiting membrane (ELM) and ellipsoid zone (EZ) compared to the standard technique at 6 months. However, there was no significant difference in best-corrected visual acuity (BCVA) improvement between the two techniques. Therefore, the surgical repair of small FTMHs with ILM IF may delay foveal structural repair and result in poorer visual sensitivity.