Purpose: To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small-to-medium idiopathic macular hole.
Methods: Eyes with ≤400 microns Idiopathic macular holes were randomized into the conventional ILM peeling group (25 eyes) and inverted flap group (25 eyes). A 12-month follow-up was considered. Macular sensitivity (MS) change detected with MP-1 microperimetry was the primary outcome. Secondary outcomes included best corrected visual acuity (BCVA) change, closure rate, anatomical findings on optical coherence tomography (OCT) such as U-shape foveal contour, restoration of external limiting membrane and ellipsoid zone.
Results: In both groups MS improved throughout the follow-up. Final MS was greater in the conventional ILM peeling group compared with the inverted flap group, being 16.6±2.3dB versus 14.9±2.9dB, respectively (P=0.026). In both groups BCVA improved throughout the follow-up, with a final BCVA of 0.19±0.14 logMar (20/31 Snellen) in the conventional ILM group and 0.22±0.11 logMar (20/33 Snellen) in the inverted flap group (P=0.398). Anatomical hole closure was achieved in all cases. No difference in OCT findings was shown between the two groups.
Conclusions: A better final MS was found in eyes undergoing conventional ILM peeling.Inverted flap technique has disadvantages compared with conventional peeling for the treatment of small-to-medium idiopathic macular holes.
Ventre L, Fallico M, Longo A, et al. Conventional internal limiting membrane peeling versus inverted flap for small-to-medium idiopathic macular hole: a randomized trial. Retina 2022. https://pubmed.ncbi.nlm.nih.gov/36084331/