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Single-Layer Inverted Internal Limiting Membrane Flap Versus Conventional Peel for Small- or Medium-Sized Full-Thickness Macular Holes

  • Hung-Da Chou
    Affiliations
    From the Department of Ophthalmology (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., E.Y.-C.K.,Y.-H.C., C.-C.L.), Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan

    College of Medicine (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., Y.-P.C., E.Y.-C.K.,Y.-H.C., L.Y., C.-C.L.), Chang Gung University
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  • Laura Liu
    Affiliations
    From the Department of Ophthalmology (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., E.Y.-C.K.,Y.-H.C., C.-C.L.), Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan

    College of Medicine (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., Y.-P.C., E.Y.-C.K.,Y.-H.C., L.Y., C.-C.L.), Chang Gung University
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  • Chung-Ting Wang
    Affiliations
    Department of Medical Education (C.-T.W.), Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
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  • Kuan-Jen Chen
    Affiliations
    From the Department of Ophthalmology (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., E.Y.-C.K.,Y.-H.C., C.-C.L.), Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan

    College of Medicine (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., Y.-P.C., E.Y.-C.K.,Y.-H.C., L.Y., C.-C.L.), Chang Gung University
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  • Wei-Chi Wu
    Affiliations
    From the Department of Ophthalmology (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., E.Y.-C.K.,Y.-H.C., C.-C.L.), Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan

    College of Medicine (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., Y.-P.C., E.Y.-C.K.,Y.-H.C., L.Y., C.-C.L.), Chang Gung University
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  • Yih-Shiou Hwang
    Affiliations
    From the Department of Ophthalmology (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., E.Y.-C.K.,Y.-H.C., C.-C.L.), Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan

    College of Medicine (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., Y.-P.C., E.Y.-C.K.,Y.-H.C., L.Y., C.-C.L.), Chang Gung University
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  • Yen-Po Chen
    Affiliations
    College of Medicine (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., Y.-P.C., E.Y.-C.K.,Y.-H.C., L.Y., C.-C.L.), Chang Gung University

    Department of Ophthalmology (Y.-P.C.), New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
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  • Eugene Yu-Chuan Kang
    Affiliations
    From the Department of Ophthalmology (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., E.Y.-C.K.,Y.-H.C., C.-C.L.), Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan

    College of Medicine (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., Y.-P.C., E.Y.-C.K.,Y.-H.C., L.Y., C.-C.L.), Chang Gung University
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  • Yi-Hsing Chen
    Affiliations
    From the Department of Ophthalmology (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., E.Y.-C.K.,Y.-H.C., C.-C.L.), Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan

    College of Medicine (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., Y.-P.C., E.Y.-C.K.,Y.-H.C., L.Y., C.-C.L.), Chang Gung University
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  • Ling Yeung
    Affiliations
    College of Medicine (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., Y.-P.C., E.Y.-C.K.,Y.-H.C., L.Y., C.-C.L.), Chang Gung University

    Department of Ophthalmology (L.Y., C.-C.L.), Chang Gung Memorial Hospital, Keelung, Taiwan.Chi-Chun Lai is currently practicing at the Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.
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  • Chi-Chun Lai
    Correspondence
    Inquiries to Chi-Chun Lai, Department of Ophthalmology, Chang Gung Memorial Hospital, No. 222, Maijin Rd, Keelung City 20401, Taiwan
    Affiliations
    From the Department of Ophthalmology (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., E.Y.-C.K.,Y.-H.C., C.-C.L.), Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan

    College of Medicine (H.-D.C., L.L., K.-J.C., W.-C.W., Y.-S.H., Y.-P.C., E.Y.-C.K.,Y.-H.C., L.Y., C.-C.L.), Chang Gung University

    Department of Ophthalmology (L.Y., C.-C.L.), Chang Gung Memorial Hospital, Keelung, Taiwan.Chi-Chun Lai is currently practicing at the Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.
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Published:September 09, 2021DOI:https://doi.org/10.1016/j.ajo.2021.08.016

      HIGHLIGHTS

      • Vision improved significantly faster in the flap group in the first 6 months.
      • Less foveal gliosis was noted in the flap group at month 1.
      • More external limiting membrane was restored in the flap group at month 3.
      • More interdigitation zone was restored in the flap group at months 3, 6, and 12.
      • A single-layer inverted flap should be considered in macular holes ≤400 µm.

      PURPOSE

      To analyze the outcomes of using an internal limiting membrane (ILM) flap and the conventional ILM peel technique for small- or medium-sized full-thickness macular hole (FTMH) repair.

      DESIGN

      Retrospective, interventional case series.

      METHODS

      Eyes with an FTMH ≤400 µm that underwent vitrectomy with a single-layer inverted ILM flap (flap group, 55 eyes) or an ILM peel (peel group, 62 eyes) were enrolled. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) measurements were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively.

      RESULTS

      Primary hole closure was achieved in 54 (98%) and 60 (97%) eyes in the flap and peel groups, respectively. The preoperative and postoperative 12-month BCVA values were comparable between the groups but were significantly better in the flap than in the peel group at 1 month (mean ± SD logMAR: 0.83 ± 0.43 vs 1.14 ± 0.50; P = .001), 3 months (0.58 ± 0.33 vs 0.82 ± 0.43; P = .002), and 6 months (0.56 ± 0.32 vs. 0.72 ± 0.48; P = .028). In the flap group, foveal gliosis was less common than in the peel group at 1 month (P = .030), and restored external limiting membrane and interdigitation zone was more common at 3 months (P = .046 and P < .001, respectively).

      CONCLUSIONS

      The single-layer ILM flap and conventional ILM peel techniques both closed FTMHs and improved vision. ILM flaps were associated with better visual outcomes up to 6 months postoperatively and should be considered in FTMHs ≤400 µm.
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