Retinal Structure And Visual Outcome Of Inverted Internal Limiting Membrane Flap Technique For The Treatment Of Idiopathic Macular Hole

Purpose:To evaluate the retinal structure and visual outcome after macular hole surgery with inverted internal limiting membrane flap technique for idiopathic macular holes with minimum diameter more than 500μm and maximum base diameter more than1000μm.Methods:Prospective case study. 13 eyes of 13 patients were included in the study. All patients underwent pars plana vitrectomy with ICG staining and inverted internal limiting membrane flap technique. Patients were evaluated by SD-OCT, BCVA and488 nm AF.Results:The minimum diameter of macular hole scaned by SD-OCT preoperatively was653.07 1±72.31 μm and the maximum diameter of the bottom of macular hole was1273.46±311.841μm; 1 month after surgery, the macular hole closure rate was100%with the "U" or "V" shape recovery and maintain stable in the follow-up period. Preoperative mean logMAR BCVA was 1.207± 0.193; postoperative 1month BCVA were increased and the average logMAR BCVA was 0.876 ±0.130,the preoperative difference was statistically significant(t =8.301, p < 0.001). The follow-up period stable visual acuity and postoperative 3 months average logMAR BCVA was 0.792 ± 0.132;the difference between postoperative 1 month and 3 month was statistically significant(t =5.500, P< 0.001); after 6 month, the average logMAR BCVA was 0.707± 0.175; compared with postoperative 3 months the difference was statistical significance(t=3.091, P= 0.009). During follow-up, the EZ of the postoperative 1 month,,3 months and 6 months were(1377.46 ±272.10) μm,964.61±403.61 μm and 817.07±502.01 μm; in the various period EZ defect value compared with the previous time, there is statistical significance, t3vs1 =4.538, p3vs1 =0.001; t6vs3 =3.301, p6vs3= 0.006. In postoperative 1 month, 3 months and 6 months,the ELM defect diameter were respectively 969.61±289.31 μm, 649.92 ±471.86 μm and 557.61±472.72μm; each time the ELM defect value compared with the previous time were statistically significant,t3vs1=3.145, p3vs1 = 008; t6vs3=3.930, p6vs3= 0.002.Conclusion:The Inverted Internal limiting membrane flap thechnique can be an effective and safe method for the reconstruction of macular hole with minimum diameter more than 500μm and maximum base diameter more than 1000μm.