Vitrectomy in Small idiopathic MAcuLar hoLe (SMALL) study: conventional internal limiting membrane peeling versus inverted flap.
Journal
Eye (London, England)
ISSN: 1476-5454
Titre abrégé: Eye (Lond)
Pays: England
ID NLM: 8703986
Informations de publication
Date de publication:
24 Aug 2024
24 Aug 2024
Historique:
received:
26
02
2024
accepted:
08
08
2024
revised:
12
07
2024
medline:
26
8
2024
pubmed:
26
8
2024
entrez:
24
8
2024
Statut:
aheadofprint
Résumé
To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small idiopathic macular hole. Retrospective, multicentre cohort study including consecutive eyes with a ≤250 μm idiopathic macular hole treated with primary vitrectomy. The primary outcome was best-corrected visual acuity (BCVA) change and macular hole closure rate. Closure patterns on optical coherence tomography (OCT) and rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery were considered as secondary outcomes. A total of 389 and 250 eyes were included in the conventional ILM peeling group and in the inverted flap group, respectively. Hole closure rate was comparable between the two groups (98.5% in the ILM peeling group and 97.6% in the inverted flap group). Mean BCVA was comparable between the two groups at baseline (p = 0.331). At 12 months, mean BCVA was 0.14 ± 0.19 logMAR in the conventional ILM peeling group and 0.17 ± 0.18 logMAR in the inverted flap group (p = 0.08). At 12 months, 73% of eyes had a U-shape closure morphology in the conventional ILM peeling group versus 55% in the inverted flap group. At 12 months, ELM recovery rate was 96% and 86% in the conventional ILM peeling group and in the inverted flap group, respectively (p < 0.001); EZ recovery rate was 78% and 69%, respectively (p = 0.04). The inverted flap technique provides no advantages in terms of visual outcome and closure rate in small idiopathic macular hole surgery. Additionally, this technique seems to impair postoperative restoration of external retinal layers compared with conventional peeling.
Sections du résumé
BACKGROUND
BACKGROUND
To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small idiopathic macular hole.
METHODS
METHODS
Retrospective, multicentre cohort study including consecutive eyes with a ≤250 μm idiopathic macular hole treated with primary vitrectomy. The primary outcome was best-corrected visual acuity (BCVA) change and macular hole closure rate. Closure patterns on optical coherence tomography (OCT) and rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery were considered as secondary outcomes.
RESULTS
RESULTS
A total of 389 and 250 eyes were included in the conventional ILM peeling group and in the inverted flap group, respectively. Hole closure rate was comparable between the two groups (98.5% in the ILM peeling group and 97.6% in the inverted flap group). Mean BCVA was comparable between the two groups at baseline (p = 0.331). At 12 months, mean BCVA was 0.14 ± 0.19 logMAR in the conventional ILM peeling group and 0.17 ± 0.18 logMAR in the inverted flap group (p = 0.08). At 12 months, 73% of eyes had a U-shape closure morphology in the conventional ILM peeling group versus 55% in the inverted flap group. At 12 months, ELM recovery rate was 96% and 86% in the conventional ILM peeling group and in the inverted flap group, respectively (p < 0.001); EZ recovery rate was 78% and 69%, respectively (p = 0.04).
CONCLUSIONS
CONCLUSIONS
The inverted flap technique provides no advantages in terms of visual outcome and closure rate in small idiopathic macular hole surgery. Additionally, this technique seems to impair postoperative restoration of external retinal layers compared with conventional peeling.
Identifiants
pubmed: 39181967
doi: 10.1038/s41433-024-03301-z
pii: 10.1038/s41433-024-03301-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Investigateurs
Tommaso Micelli Ferrari
(T)
Massimo Lorusso
(M)
Vito Primavera
(V)
Gianluigi Giuliani
(G)
Cesare Mariotti
(C)
Marco Lupidi
(M)
Luca Ventre
(L)
Antonio Valastro
(A)
Lorenzo Motta
(L)
Mikes Nomikarios
(M)
Francesco Boscia
(F)
Giacomo Boscia
(G)
Mario R Romano
(MR)
Mariantonia Ferrara
(M)
Miroslav Kacerik
(M)
Daniele Marchina
(D)
Barbara Parolini
(B)
Enrico Peiretti
(E)
Valentina Carta
(V)
Roberto dell'Omo
(R)
Marzia Affatato
(M)
Teresio Avitabile
(T)
Andrea Russo
(A)
Antonio Longo
(A)
Vincenzo Scorcia
(V)
Adriano Carnevali
(A)
Rodolfo Mastropasqua
(R)
Matteo Gironi
(M)
Agostino Salvatore Vaiano
(AS)
Riccardo Merli
(R)
Marco Mura
(M)
Marco Pellegrini
(M)
Fabrizio Giansanti
(F)
Cristina Nicolosi
(C)
Matteo Badino
(M)
Nicola Pallozzi Lavorante
(NP)
Maria T Sandinha
(MT)
Francesco Maria D'Alterio
(FM)
Mario Damiano Toro
(MD)
Robert Rejdak
(R)
Paolo Chelazzi
(P)
Claudia Azzolini
(C)
Francesco Viola
(F)
Caterina Donà
(C)
Matteo Giuseppe Cereda
(MG)
Salvatore Parrulli
(S)
Marco Codenotti
(M)
Lorenzo Iuliano
(L)
Grazia Pertile
(G)
Daniele Sindaco
(D)
Stefano De Cillà
(S)
Micol Ester Alkabes
(ME)
Vincenza Bonfiglio
(V)
Maria Vadalà
(M)
Alberto La Mantia
(A)
Viviana Randazzo
(V)
Tito Fiore
(T)
Gianluigi Tosi
(G)
Rino Frisina
(R)
Chiara Angeli
(C)
Marco Coassin
(M)
Mariateresa Laborante
(M)
Tommaso Rossi
(T)
Luca Placentino
(L)
Stanislao Rizzo
(S)
Matteo Mario Carlà
(MM)
Magda Gharbiya
(M)
Giuseppe Maria Albanese
(GM)
Luigi Caretti
(L)
Martina Formisano
(M)
Gian Marco Tosi
(GM)
Tommaso Bacci
(T)
David H Steel
(DH)
Nikolaos Dervenis
(N)
Iordanis Vagiakis
(I)
Daniele Tognetto
(D)
Marco Rocco Pastore
(MR)
Francesco Faraldi
(F)
Carlo Alessandro Lavia
(CA)
Paolo Lanzetta
(P)
Leopoldo Rubinato
(L)
Daniele Veritti
(D)
Paolo Radice
(P)
Andrea Govetto
(A)
Informations de copyright
© 2024. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.
Références
Park DW, Sipperley JO, Sneed SR, Dugel PU, Jacobsen J. Macular hole surgery with internal-limiting membrane peeling and intravitreous air. Ophthalmology. 1999;106:1392–8.
doi: 10.1016/S0161-6420(99)00730-7
pubmed: 10406628
Michalewska Z, Michalewski J, Adelman RA, Nawrocki J. Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology. 2010;117:2018–25.
doi: 10.1016/j.ophtha.2010.02.011
pubmed: 20541263
Shen Y, Lin X, Zhang L, Wu M. Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis. BMC Ophthalmol. 2020;20:14.
Rizzo S, Tartaro R, Barca F, Caporossi T, Bacherini D, Giansanti F. Internal limiting membrane peeling versus inverted flap technique for treatment of full-thickness macular holes: a comparative study in a large series of patients. Retina. 2018;38:S73–S78.
doi: 10.1097/IAE.0000000000001985
pubmed: 29232338
Ch’ng SW, Patton N, Ahmed M, Ivanova T, Baumann C, Charles S, et al. The Manchester large macular hole study: is it time to reclassify large macular holes? Am J Ophthalmol. 2018;195:36–42.
doi: 10.1016/j.ajo.2018.07.027
pubmed: 30071212
Yamashita T, Sakamoto T, Terasaki H, Iwasaki M, Ogushi Y, Okamoto F, et al. Best surgical technique and outcomes for large macular holes: retrospective multicentre study in Japan. Acta Ophthalmol. 2018;96:e904–e910.
doi: 10.1111/aos.13795
pubmed: 29671948
Li P, Li L, Wu J. Inverted internal limiting membrane flap versus internal limiting membrane peeling for <400 μm macular hole: a meta-analysis and systematic review. Ophthalmic Res. 2023; 66. https://pubmed.ncbi.nlm.nih.gov/37931613/ .
Baumann C, Dervenis N, Kirchmair K, Lohmann CP, Kaye SB, Sandinha MT. Functional and morphological outcomes of the inverted internal limiting membrane flap technique in small-sized and medium-sized macular holes. Retina. 2021;41:2073–8. https://pubmed.ncbi.nlm.nih.gov/33758135/ .
doi: 10.1097/IAE.0000000000003160
pubmed: 33758135
Chou H-D, Liu L, Wang C-T, Chen K-J, Wu W-C, Hwang Y-S, et al. Single-layer inverted internal limiting membrane flap versus conventional peel for small- or medium-sized full-thickness macular holes. Am J Ophthalmol. 2022;235:111–9. https://doi.org/10.1016/j.ajo.2021.08.016 .
doi: 10.1016/j.ajo.2021.08.016
pubmed: 34509434
Ventre L, Fallico M, Longo A, Parisi G, Russo A, Bonfiglio V, et al. Conventional internal limiting membrane peeling versus inverted flap for small-to-medium idiopathic macular hole: a randomized trial. Retina. 2022;42. https://pubmed.ncbi.nlm.nih.gov/36084331/ .
Fallico M, Jackson TL, Chronopoulos A, Hattenbach LO, Longo A, Bonfiglio V, et al. Factors predicting normal visual acuity following anatomically successful macular hole surgery. Acta Ophthalmol. 2021;99:e324–e329.
doi: 10.1111/aos.14575
pubmed: 32833307
Iuliano L, Corbelli E, Bandello F, Codenotti M. Inverted internal limiting membrane flap for small-sized (<250 µm) full-thickness macular hole: anatomical and functional outcome. Retina. 2023;43:547–54. https://pubmed.ncbi.nlm.nih.gov/36728896/ .
doi: 10.1097/IAE.0000000000003728
pubmed: 36728896
Duker JS, Kaiser PK, Binder S, De Smet MD, Gaudric A, Reichel E, et al. The International Vitreomacular Traction Study Group classification of vitreomacular adhesion, traction, and macular hole. Ophthalmology. 2013;120:2611–9. https://pubmed.ncbi.nlm.nih.gov/24053995/ .
doi: 10.1016/j.ophtha.2013.07.042
pubmed: 24053995
Parisi G, Fallico M, Maugeri A, Barchitta M, Agodi A, Russo A, et al. Primary vitrectomy for degenerative and tractional lamellar macular holes: a systematic review and meta-analysis. PLoS ONE. 2021;16. https://pubmed.ncbi.nlm.nih.gov/33667237/ .
Michalewska Z, Michalewski J, Cisiecki S, Adelman R, Nawrocki J. Correlation between foveal structure and visual outcome following macular hole surgery: a spectral optical coherence tomography study. Graefe’s Arch Clin Exp Ophthalmol. 2008;246:823–30.
doi: 10.1007/s00417-007-0764-5
Haller JA, Stalmans P, Benz MS, Gandorfer A, Pakola SJ, Girach A, et al. Efficacy of intravitreal ocriplasmin for treatment of vitreomacular adhesion: subgroup analyses from two randomized trials. Ophthalmology. 2015;122:117–22. https://pubmed.ncbi.nlm.nih.gov/25240630/ .
doi: 10.1016/j.ophtha.2014.07.045
pubmed: 25240630
Chan CK, Mein CE, Glassman AR, Beaulieu WT, Calhoun CT, Jaffe GJ, et al. Pneumatic vitreolysis with perfluoropropane for vitreomacular traction with and without macular hole: DRCR retina network protocols AG and AH. Ophthalmology. 2021;128:1592–603. https://pubmed.ncbi.nlm.nih.gov/33989683/
doi: 10.1016/j.ophtha.2021.05.005
pubmed: 33989683
Chan CK, Crosson JN, Mein CE, Daher N. Pneumatic vitreolysis for relief of vitreomacular traction. Retina. 2017;37:1820–31. https://pubmed.ncbi.nlm.nih.gov/28099316/ .
doi: 10.1097/IAE.0000000000001448
pubmed: 28099316
pmcid: 5642323
Morescalchi F, Costagliola C, Gambicorti E, Duse S, Romano MR, Semeraro F. Controversies over the role of internal limiting membrane peeling during vitrectomy in macular hole surgery. Surv Ophthalmol. 2017;62:58–69. https://pubmed.ncbi.nlm.nih.gov/27491476/ .
doi: 10.1016/j.survophthal.2016.07.003
pubmed: 27491476
Tadayoni R, Gaudric A, Haouchine B, Massin P. Relationship between macular hole size and the potential benefit of internal limiting membrane peeling. Br J Ophthalmol. 2006;90:1239–41. https://pubmed.ncbi.nlm.nih.gov/16809385/ .
doi: 10.1136/bjo.2006.091777
pubmed: 16809385
pmcid: 1857449
Lois N, Burr J, Norrie J, Vale L, Cook J, McDonald A, et al. Internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole: a pragmatic randomized controlled trial. Investig Ophthalmol Vis Sci. 2011;52:1586–92. https://pubmed.ncbi.nlm.nih.gov/21051731/ .
doi: 10.1167/iovs.10-6287
Neubauer J, Gelisken F, Ozturk T, Bartz-Schmidt KU, Dimopoulos S. The time course of spontaneous closure of idiopathic full-thickness macular holes. Graefe’s Arch Clin Exp Ophthalmol. 2024. https://pubmed.ncbi.nlm.nih.gov/38587655/ .
Gu C, Qiu Q. Inverted internal limiting membrane flap technique for large macular holes: a systematic review and single-arm meta-analysis. Graefe’s Arch Clin Exp Ophthalmol. 2018;256:1041–9.
doi: 10.1007/s00417-018-3956-2
Yamada K, Oishi A, Kusano M, Kinoshita H, Tsuiki E, Kitaoka T. Effect of inverted internal limiting membrane flap technique on small-medium size macular holes. Sci Rep. 2022;12. https://pubmed.ncbi.nlm.nih.gov/35031664/ .
Park JH, Lee SM, Park SW, Lee JE, Byon IS. Comparative analysis of large macular hole surgery using an internal limiting membrane insertion versus inverted flap technique. Br J Ophthalmol. 2019;103:245–50.
doi: 10.1136/bjophthalmol-2017-311770
pubmed: 29610221
Iwasaki M, Miyamoto H, Imaizumi H. Effects of inverted internal limiting membrane technique and insertion technique on outer retinal restoration associated with glial proliferation in large macular holes. Graefe’s Arch Clin Exp Ophthalmol. 2020;258:1841–9.
doi: 10.1007/s00417-020-04655-2
Ventre L, Fallico M, Longo A, Parisi G, Russo A, Bonfiglio V, et al. Reply. Retina 2023;43:E27. https://pubmed.ncbi.nlm.nih.gov/36796036/ .
doi: 10.1097/IAE.0000000000003752
pubmed: 36796036