In patients undergoing macular hole surgery, the temporal inverted internal limiting membrane (ILM) flap technique does not significantly reduce the extent of dissociated optic nerve fiber layer (DONFL) compared with conventional ILM peeling, nor does it yield improved visual acuity and retinal sensitivity, according to a report published in Ophthalmology Retina.
Researchers conducted a single-center, prospective, open-label randomized controlled clinical trial to compare the effect of the temporal ILM flap technique and conventional ILM peeling on the extent of DONFL and retinal sensitivity in patients undergoing macular hole surgery.
Adult patients with macular holes larger than 250 μm were randomly assigned (1:1) to undergo macular hole surgery with conventional ILM peeling or temporal ILM flap technique. The primary outcome measure was the total 3-month postoperative DONFL score. Key secondary outcomes were microperimetry results, primary macular hole closure rate, rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery, and best-corrected visual acuity (BCVA).
The final analysis of the study included primary outcome results for 60 patients, 30 in each study arm. Baseline demographic and clinical characteristics were comparable between the arms.
The researchers reported a median 3-month postoperative DONFL score of 7.0 (range, 3.0-12.5) in the conventional ILM peeling arm and 5.0 (1.5-8.5) in the temporal ILM flap (P =.145). They also found that the macular hole closure rate, EZ and ELM recovery rates, BCVA, overall median retinal sensitivity (MRS), and MRS improvement were similar between the groups.
“These findings suggest that contrary to large or myopic [macular holes], this technique has little advantage over conventional ILM peeling in classic [macular holes],” the researchers report.
Limitations of the study included the monocentric design, subjective nature of microperimetry, and short follow-up period.
Ehrhardt A, Delpuech M, Luc A, et al. Dissociated optic nerve fiber layer appearance after macular hole surgery: a randomized controlled trial comparing the temporal inverted internal limiting membrane flap technique versus conventional peeling. Ophthalmol Retina. Published online September 12, 2022. doi:10.1016/j.oret.2022.09.002