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      Internal limiting membrane transplantation for unclosed and large macular holes

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          Inverted internal limiting membrane flap technique for large macular holes.

          Large macular holes usually have an increased risk of surgical failure. Up to 44% of large macular holes remain open after 1 surgery. Another 19% to 39% of macular holes are flat-open after surgery. Flat-open macular holes are associated with limited visual acuity. This article presents a modification of the standard macular hole surgery to improve functional and anatomic outcomes in patients with large macular holes. A prospective, randomized clinical trial. Patients with macular holes larger than 400 μm were included. In group 1, 51 eyes of 40 patients underwent standard 3-port pars plana vitrectomy with air. In group 2, 50 eyes of 46 patients underwent a modification of the standard technique, called the inverted internal limiting membrane (ILM) flap technique. In the inverted ILM flap technique, instead of completely removing the ILM after trypan blue staining, a remnant attached to the margins of the macular hole was left in place. This ILM remnant was then inverted upside-down to cover the macular hole. Fluid-air exchange was then performed. Spectral optical coherence tomography and clinical examination were performed before surgery and postoperatively at 1 week and 1, 3, 6, and 12 months. Visual acuity and postoperative macular hole closure. Preoperative mean visual acuity was 0.12 in group 1 and 0.078 in group 2. Macular hole closure was observed in 88% of patients in group 1 and in 98% of patients in group 2. A flat-hole roof with bare retinal pigment epithelium (flat-open) was observed in 19% of patients in group 1 and 2% of patients in group 2. Mean (or median) postoperative visual acuity 12 months after surgery was 0.17 (range, 0.1-0.6) in group 1 and 0.28 (range, 0.02-0.8) in group 2 (P = 0.001). The inverted ILM flap technique prevents the postoperative flat-open appearance of a macular hole and improves both the functional and anatomic outcomes of vitrectomy for macular holes with a diameter greater than 400 μm. Spectral optical coherence tomography after vitrectomy with the inverted ILM flap technique suggests improved foveal anatomy compared with the standard surgery. Copyright © 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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            Vitreous Surgery for Idiopathic Macular Holes

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              Autologous transplantation of the internal limiting membrane for refractory macular holes.

              To determine the effectiveness of autologous transplantation of the internal limiting membrane (ILM) for refractory macular holes.
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                Author and article information

                Journal
                Graefe's Archive for Clinical and Experimental Ophthalmology
                Graefes Arch Clin Exp Ophthalmol
                Springer Science and Business Media LLC
                0721-832X
                1435-702X
                November 2016
                August 12 2016
                November 2016
                : 254
                : 11
                : 2095-2099
                Article
                10.1007/s00417-016-3461-4
                27520464
                695a5d16-c3c3-44f0-bdf7-a53a2c9faf08
                © 2016

                http://www.springer.com/tdm

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