J Korean Ophthalmol Soc > Volume 59(5); 2018 > Article
Journal of the Korean Ophthalmological Society 2018;59(5):428-436.
DOI: https://doi.org/10.3341/jkos.2018.59.5.428    Published online May 15, 2018.
The Treatment of Large Macular Holes Using a Multi-layered Inverted Internal Limiting Membrane Flap Technique.
Dong Hun Song, Myeong In Yeom, Jung Min Park
Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea. Pjm1438@hanmail.net
다층 속말림 내경계막 절편술을 이용한 크기가 큰 황반원공의 치료
송동훈⋅염명인⋅박정민
메리놀병원 안과
Correspondence:  Jung Min Park,
Email: Pjm1438@hanmail.net
Received: 30 November 2017   • Revised: 7 March 2018   • Accepted: 24 April 2018
Abstract
PURPOSE
To describe a multi-layered inverted internal limiting membrane (ILM) flap technique and to evaluate the surgical outcomes of this surgery in patients with macular holes > 800 µm in base diameter. METHODS: The medical records of patients who received a multi-layered ILM flap technique were retrospectively studied and patients with macular holes > 800 µm were included in the analyses. Best-corrected visual acuity (BCVA) before and after surgery, preoperative hole size, hole base size, vertical size, and hole closure after surgery were checked using spectral domain optical coherence tomography. Pars plana vitrectomy was performed and the ILM was stained using indocyanine green and peeled with the base attached at the hole margin. The ILM flap was inverted over the macular hole with 2~3 layers, and gas injection was performed. RESULTS: The mean age of 12 patients was 65.2 ± 12.3 years. The mean BCVA (logMAR) was 1.27 ± 0.61. The mean hole size was 563.6 ± 221.9 µm, the mean vertical size was 418.8 ± 80.9 µm, and the mean hole base size was 1,182.8 ± 298.5 µm. The mean follow-up period was 174.4 ± 143.3 days. Nine macular holes were closed after surgery but three macular holes were not closed. The postoperative mean BCVA (logMAR) was 0.21 ± 0.51. Eight eyes showed visual improvement while three eyes did not show visual improvement after macular hole surgery. CONCLUSIONS: The macular hole was closed successfully and the visual acuity improved after the multi-layered, inverted ILM flap technique. The multi-layered, inverted ILM flap technique is therefore considered the treatment of choice for large macular holes.
Key Words: Inverted internal limiting membrane (ILM) flap technique;Large macular hole;Macular hole;Macular hole surgery;Multi-layered


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