Foveal Displacement following Temporal Inverted Internal Limiting Membrane Technique for Full Thickness Macular Holes: 12 Months Results

ABSTRACT

Purpose: To compare conventional 360° internal limiting membrane (ILM) peeling and temporal inverted ILM flap technique with regard to postoperative foveal displacement.

Methods: Patients who underwent 23 G vitrectomy with either 360° ILM peeling (Group 1) or temporal inverted ILM technique (Group 2) for idiopathic macular hole with a minimum follow up of 12 months were included. The metamorphopsia rates and distances between fovea and 3 retinal landmarks: the first retinal vascular bifurcation or crossover located superonasal and inferonasal to the fovea and ciliary vessel at the temporal margin of the disc, were compared on MultiColor SLO and near-infrared reflectance images. In addition, papillofoveal distance was measured on B-scan optical coherence tomography (OCT).

Results: A total of 57 eyes were recruited (Group 1, n = 25; Group 2, n = 32). The visual acuity at month-1 was significantly higher in Group 2 than Group 1 (p = .007). A significant postoperative foveal displacement towards the disc was observed in Group 1 and Group 2 (p < .001 and p = .002 respectively). Shortening of the papillofoveal distance was greater in Group 1 than Group 2 at all postoperative visits (p < .05 for all). Furthermore, significant changes in papillofoveal distance continued until 6 months in Group 1 (p < .05 for all), whereas no significant changes occurred in Group 2 after month-1 (p > .05 for all). The complaints of metamorphopsia was significantly higher in Group 1 (n = 18/25) compared with Group 2 (n = 10/32) (p = .002).

Conclusion: Temporal inverted ILM flap appear to be superior to 360° ILM peeling with regard to faster visual rehabilitation, lower rates of subjective metamorphopsia and less foveal displacement.

KEYWORDS:

• Foveal displacement
• internal limiting membrane peeling
• metamorphopsia
• papillofoveal distance
• temporal inverted internal limiting membrane flap

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