Macular hole surgery - Inverted ILM flap technique скачать в хорошем качестве

Macular hole surgery - Inverted ILM flap technique

The inverted ILM flap technique was described a decade back by Michalewska et al and has become a useful technique for managing large (greater than400 micron diameter as per IVTS study group) and myopic full thickness macular holes. It improves the closure rate (type 1 closure) and may allow better functional results in these challenging macular holes. Expanding indications of this technique include MH associated with RD, traumatic MH and patients with positioning issues. While the exact mechanism is still debatable, the ILM, containing Muller cells, might help in inducing gliosis and provide a scaffold for glial cell proliferation, facilitating hole closure (in addition to removal of the anteroposterior and tangential traction). In 2015 Michalewska described an equally effective yet safer modification where the ILM is peeled temporally and inverted to cover the MH. Learning points: ILM peeling of 2 disc diameters around the MH is sufficient. A wide ILM peel (arcade to arcade) is also thought to assist in closure of large MH. However, this may have physiological repercussions like asymmetrical macular displacement, temporal macular thinning, decreased distance between the fovea and disc and increased DONFL. Trimming of the flap using cutter requires high cut rate and very low suction (around 10) to prevent inadvertent loss of the flap. Tucking the flap into the MH must be done with utmost care to prevent risk of iatrogenic damage to the RPE. The ILM flap might detach during fluid air exchange, hence this step must be performed carefully as depicted. For more details please visit my Facebook page   / drngvr