The clinical efficacy of inverted internal limiting membrane flap technique with autologous blood for myopic macular hole_Chinese Journal of Ocular Fundus Diseases

Authors：

Tao Jiwei , Xu Yijun ,  Shen Lijun , Yu Jiafeng , Chen Yiqi , Mao Jianbo , Lin Li

Eye Hospital of Wenzhou Medical University, Hangzhou 310020, China;

Corresponding author：

Shen Lijun, Email: slj@mail.eye.ac.cn

Keywords：

Myopia, degenerative/complications; Retinal perforations/surgery; Vitreoretinal surgery

DOI：

10.3760/cma.j.issn.1005-1015.2019.06.006

Video：

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Objective To observe the clinical efficacy of inverted internal limiting membrane (ILM) flap technique with autologous blood for myopic macular hole.Methods A retrospective, case-controlled study. Twenty-nine eyes of 29 patients with myopic macular hole who received treatment in Eye Hospital of Wenzhou Medical University from January 2017 to May 2019 were enrolled in this study. There were 5 males (5 eyes) and 24 females (24 eyes), with an average age of 55.28±11.40 years. According to the surgical method, the patients were divided into inverted ILM flap group (12 eyes) and ILM peeling group (17 eyes). All patients underwent BCVA, spectral domain OCT and axial length measurement before surgery. There was no significant difference between the two groups in age, gender, course of disease, hole diameter, BCVA and other baseline data. Follow-up was over 4 months after surgery. The BCVA, macular hole closure and continuity of outer retina after surgery were observed.Results In ILM peeling group, 11 eyes were closed (64.7%) and 6 eyes were not closed at 3 months after surgery. In ILM flap group, 12 eyes were closed (100.0%). The difference of closure rate between two groups was statistically significant (χ²=5.34, P=0.028). The BCVA of inverted ILM flap group was significantly improved at 1, 3 months after surgery compared with preoperative measurements, and the difference was statistically significant (F=3.813, 4.667; P=0.003, 0.001). The BCVA of ILM peeling group was improved at 1 month after surgery, but the difference was not statistically significant (F=1.556, P=0.139). And the BCVA was significantly improved at 3 month after surgery compared with preoperative measurements, and the difference was statistically significant (F=2.453, P=0.026). But there was no significant difference in BCVA between the two groups at 1 and 3 months after surgery (F=0.647, 0.535; P=0.551, 0.612). There was no significant difference in the recovery of outer structure (ELM and EZ continuity) between the two groups at 3 month after surgery (F=0.008, P=0.631).Conclusions Inverted ILM flap technique with autologous blood is a safe and effective method to treat myopic macular hole. The closure rate of the hole can be improved significantly.

Citation： Tao Jiwei, Xu Yijun, Shen Lijun, Yu Jiafeng, Chen Yiqi, Mao Jianbo, Lin Li. The clinical efficacy of inverted internal limiting membrane flap technique with autologous blood for myopic macular hole. Chinese Journal of Ocular Fundus Diseases, 2019, 35(6): 549-553. doi: 10.3760/cma.j.issn.1005-1015.2019.06.006 Copy

1.	Sayanagi K, Ikuno Y, Gomi F, et al. Retinal vascular microfolds in highly myopic eyes[J]. Am J Ophthalmol, 2005, 139(4): 658-663. DOI: 10.1016/j.ajo.2004.11.025.
2.	Mateo C, Dutra Medeiros M, Alkabes M, et al. Illuminated ando plombe for optimal positioning in highly myopic eyes with vitreoretinal diseases secondary to posterior staphyloma[J]. JAMA Ophthalmol, 2013, 131(10): 1359-1362. DOI: 10.1001/jamaophthalmol.2013.4558.
3.	Ohno-Matsui K, Lai TY, Lai CC, et al. Updates of pathologic myopia[J]. Prog Retin Eye Res, 2016, 52(5): 156-187. DOI: 10.1016/j.preteyeres.2015.12.001.
4.	Michalcwska Z, Michalewski J, Adelman RA, et al. Inverted intemaI limiting membrane nap technique for large macular holes[J]. Ophthalmology, 2010, 117(10): 2018-2025. DOI: 10.1016/J.ophtha.2010.02.011.
5.	Hu XT, Pan QT, Zhang ZD, et al. Foveal microstructure and visual outcomes of myopic macular hole surgery with or without the inverted internal limiting membrane flap technique[J]. Br J Ophthalmol, 2019, 103(10): 1495-1502. DOI: 10.1136/bjophthalmol-2018-313311.
6.	徐昶中, 吴建华, 何俊文, 等. 单层内界膜翻转治疗高度近视眼黄斑裂孔视网膜脱离的临床观察[J]. 中华眼科杂志, 2017, 53(5): 338-343. DOI: 10.3760/cma.j.issn.0412-4081.2017.05.005.Xu CZ, Wu JH, He JW, et al. Observation of single-layered inverted internal limiting membrane flap technique for macular hole with retinal detachment in high myopia[J]. Chin J Ophthalmol, 2017, 53(5): 338-343. DOI: 10.3760/cma.j.issn.0412-4081.2017.05.005.
7.	Ho R, Ki LW. Efficacy of the inverted internal limiting membrane flap technique with perfluorocarbon liquid-mediated selective staining for large macular hole repair[J]. Curr Eye Res, 2019, 44(1): 53-59. DOI: 10.1080/02713683.2018.1524014.
8.	Baba R, Wakabayashi Y, Umazume K, et al. Efficacy of the inverted internal limiting membrane flap technique with vitrectomy for retinal detachment associated with myopic macular holes[J]. Retina, 2017, 37(3): 466-471. DOI: 10.1097/IAE.0000000000001211.
9.	Takahashi H, Inoue M, Koto T, et al. Inverted internal limiting membrane flap technique for treatment of macular hole retinal detachment in highly myopic eyes[J]. Retina, 2018, 38(12): 2317-2326. DOI: 10.1097/IAE.0000000000001898.
10.	Lai CC, Chen YP, Wang NK, et al. Vitrectomy with internal limiting membrane repositioning and autologous blood for macular hole retinal detachment in highly myopic eyes[J]. Ophthalmology, 2015, 122(9): 1889-1898. DOI: 10.1016/j.ophtha.2015.05.040.
11.	Chen SN, Yang CM. Inverted internal limiting membrane insertion for macular hole-associated retinal detachment in high myopia[J]. Am J Ophthalmol, 2016, 166(6): 210-211. DOI: 10.1016/j.ajo.2016.04.006.
12.	Masanori I, Takamasa K, Hirotomo M, et al. Influence of inverted internal limiting membrane flap technique on the outer retinal layer structures after a large macular hole surgery[J]. Retina, 2019, 39(8): 1470-1477. DOI: 10.1097/IAE.0000000000002209.
13.	Bové Álvarez M, Sabaté S, Gómez-Resa M, et al. Anatomical and visual outcomes of inverted internal limiting membrane flap technique versus internal limiting membrane peeling in myopic macular hole without retinal detachment[J]. Retina, 2018, 2018: E1[2018-10-29]. http://dx.doi.org/10.1097/IAE.0000000000002368. DOI: 10.1097/IAE.0000000000002368. [published online ahead of print].
14.	Ho TC, Ho A, Chen MS. Vitrectomy with a modified temporal inverted limiting membrane flap to reconstruct the foveolar architecture for macular hole retinal detachment in highly myopic eyes[J]. Acta Ophthalmol, 2018, 96(1): 46-53. DOI: 10.1111/aos.13514.

1. Sayanagi K, Ikuno Y, Gomi F, et al. Retinal vascular microfolds in highly myopic eyes[J]. Am J Ophthalmol, 2005, 139(4): 658-663. DOI: 10.1016/j.ajo.2004.11.025.
2. Mateo C, Dutra Medeiros M, Alkabes M, et al. Illuminated ando plombe for optimal positioning in highly myopic eyes with vitreoretinal diseases secondary to posterior staphyloma[J]. JAMA Ophthalmol, 2013, 131(10): 1359-1362. DOI: 10.1001/jamaophthalmol.2013.4558.
3. Ohno-Matsui K, Lai TY, Lai CC, et al. Updates of pathologic myopia[J]. Prog Retin Eye Res, 2016, 52(5): 156-187. DOI: 10.1016/j.preteyeres.2015.12.001.
4. Michalcwska Z, Michalewski J, Adelman RA, et al. Inverted intemaI limiting membrane nap technique for large macular holes[J]. Ophthalmology, 2010, 117(10): 2018-2025. DOI: 10.1016/J.ophtha.2010.02.011.
5. Hu XT, Pan QT, Zhang ZD, et al. Foveal microstructure and visual outcomes of myopic macular hole surgery with or without the inverted internal limiting membrane flap technique[J]. Br J Ophthalmol, 2019, 103(10): 1495-1502. DOI: 10.1136/bjophthalmol-2018-313311.
6. 徐昶中, 吴建华, 何俊文, 等. 单层内界膜翻转治疗高度近视眼黄斑裂孔视网膜脱离的临床观察[J]. 中华眼科杂志, 2017, 53(5): 338-343. DOI: 10.3760/cma.j.issn.0412-4081.2017.05.005.Xu CZ, Wu JH, He JW, et al. Observation of single-layered inverted internal limiting membrane flap technique for macular hole with retinal detachment in high myopia[J]. Chin J Ophthalmol, 2017, 53(5): 338-343. DOI: 10.3760/cma.j.issn.0412-4081.2017.05.005.
7. Ho R, Ki LW. Efficacy of the inverted internal limiting membrane flap technique with perfluorocarbon liquid-mediated selective staining for large macular hole repair[J]. Curr Eye Res, 2019, 44(1): 53-59. DOI: 10.1080/02713683.2018.1524014.
8. Baba R, Wakabayashi Y, Umazume K, et al. Efficacy of the inverted internal limiting membrane flap technique with vitrectomy for retinal detachment associated with myopic macular holes[J]. Retina, 2017, 37(3): 466-471. DOI: 10.1097/IAE.0000000000001211.
9. Takahashi H, Inoue M, Koto T, et al. Inverted internal limiting membrane flap technique for treatment of macular hole retinal detachment in highly myopic eyes[J]. Retina, 2018, 38(12): 2317-2326. DOI: 10.1097/IAE.0000000000001898.
10. Lai CC, Chen YP, Wang NK, et al. Vitrectomy with internal limiting membrane repositioning and autologous blood for macular hole retinal detachment in highly myopic eyes[J]. Ophthalmology, 2015, 122(9): 1889-1898. DOI: 10.1016/j.ophtha.2015.05.040.
11. Chen SN, Yang CM. Inverted internal limiting membrane insertion for macular hole-associated retinal detachment in high myopia[J]. Am J Ophthalmol, 2016, 166(6): 210-211. DOI: 10.1016/j.ajo.2016.04.006.
12. Masanori I, Takamasa K, Hirotomo M, et al. Influence of inverted internal limiting membrane flap technique on the outer retinal layer structures after a large macular hole surgery[J]. Retina, 2019, 39(8): 1470-1477. DOI: 10.1097/IAE.0000000000002209.
13. Bové Álvarez M, Sabaté S, Gómez-Resa M, et al. Anatomical and visual outcomes of inverted internal limiting membrane flap technique versus internal limiting membrane peeling in myopic macular hole without retinal detachment[J]. Retina, 2018, 2018: E1[2018-10-29]. http://dx.doi.org/10.1097/IAE.0000000000002368. DOI: 10.1097/IAE.0000000000002368. [published online ahead of print].
14. Ho TC, Ho A, Chen MS. Vitrectomy with a modified temporal inverted limiting membrane flap to reconstruct the foveolar architecture for macular hole retinal detachment in highly myopic eyes[J]. Acta Ophthalmol, 2018, 96(1): 46-53. DOI: 10.1111/aos.13514.

Chinese Journal of Ocular Fundus Diseases

The clinical efficacy of inverted internal limiting membrane flap technique with autologous blood for myopic macular hole

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