Reoperation with inverted ILM flap technique can lead to success after primary failure
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FORT LAUDERDALE, Fla. — Reoperation with inverted internal limiting membrane flap technique after primary failure leads to successful macular hole closure and visual acuity improvement in most cases, according to one specialist.
The technique entails the creation of an internal limiting membrane (ILM) flap, obtained by peeling the membrane from the temporal side and reversing it to cover the macular hole (MH).
“During this surgery, we may encounter situations in which, during fluid-air exchange, the flap moves to its original place away from the fovea,” Zofia Nawrocka, MD, PhD, said at the Retina World Congress. “We just have to proceed with fluid-air exchange, and the flap naturally covers the hole again.”
If the flap becomes displaced after surgery, an additional flap can be created, and silicone oil may be used for better stabilization of the flap, especially in patients who cannot maintain facedown positioning, she said.
In a study conducted some years ago, failure occurred in 32 of 830 eyes operated with this technique over 10 years.
“After the secondary procedure, we had a success rate of 90%, and after the third procedure, all 32 eyes achieved complete MH closure. Final mean VA was 20/80,” Nawrocka said.
She said that, after reintervention, the anatomy of the fovea differed slightly from the eyes in which primary success was achieved, with fewer U-shaped closures in 30% of the cases and photoreceptor defects in 80% of the cases, which might be responsible for lower visual acuity when compared with primary success.
Silicone oil and air tamponade during the secondary procedure were found to be similarly effective, she said, although flap manipulations might be easier with silicone oil.
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Nawrocka S. Reoperations for refractory macular hole after ILM flap technique. Presented at: Retina World Congress; May 12-15, 2022; Fort Lauderdale, Fla.
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